A chagas disease it is part of the neglected tropical diseases group of the World Health Organization (WHO). The disease has a high prevalence and significant mortality burden, in addition to contributing to the maintenance of a critical cycle of poverty.
The infection, caused by the protozoan Trypanosoma cruzi, affects about 6 million people in the Americas, with an annual incidence of 30,000 new cases in the region and, on average, 14,000 deaths each year. It is estimated that there are currently at least one million people infected by T. cruzi.
In recent studies, estimates have ranged from 1.9 to 4.6 million people, probably closer to the current range of 1.0 to 2.4% of the population. The Ministry of Health points to a high mortality burden from Chagas in the country, representing one of the four major causes of death from infectious and parasitic diseases. In recent years, around 4,000 deaths per year have been recorded in the country, which had the disease as the underlying cause.
O World Chagas Disease Day , celebrated this Friday (14), promotes awareness about the fight against the disease, which can be silent. At an event at the Oswaldo Cruz Institute (IOC/Fiocruz), researcher Tania Araújo Jorge highlighted the importance of advances in research in the area.
“This relationship between basic research and clinical research in Chagas disease is advancing a lot because we are talking about Chagas with people directly affected, who are interested in research generating products, innovations and results”, he said.
Why Chagas disease persists as a public health problem
Uncontrolled migration, environmental degradation, climate change and concentration of people in urban areas are some of the determining factors for the transmission of the causative agent of Chagas disease to humans.
With unequal perspectives, infected populations are more vulnerable, with greater exposure to other diseases. Lack of or difficult access to health services make diagnosis difficult, leading to failures in prevention strategies and access to adequate treatment, increasing the likelihood of developing serious forms of the disease.
Late diagnosis also happens due to the lack of knowledge of professionals and health managers about risk conditions and information about the identification of new cases. The delay favors the worsening of the clinical condition, leading to significant consequences for the organism, which are physical, cardiac, digestive and neurological.
The risk of vectorial transmission of Chagas disease persists due to different factors, such as the existence of native triatomine species with a high potential for colonizing the home or a recurrent history of invasion of the home environment.
The presence of reservoir animals T. cruzi and the increasingly frequent approach of human populations to these environments is also a relevant issue for transmission. As well as the persistence of residual foci of T. infestans in the state of Bahia.
According to the Ministry of Health, in addition to this picture are the occurrence of cases and outbreaks by oral transmission through the ingestion of contaminated food (sugar cane juice, açaí, bacaba, among others), household vector without colonization and extra-domestic vector, mainly in the Legal Amazon.
silent disease
Chagas disease, also called American trypanosomiasis, has an acute phase that can be symptomatic or not, and a chronic phase, which can manifest itself in indeterminate (asymptomatic), cardiac, digestive or cardiodigestive forms – depending on the impacts caused in the body .
It is estimated that 60% of people infected with T. cruzi remain in the indeterminate form, 30% and 10% will progress to the cardiac and digestive forms, respectively.
Despite the large reduction in the incidence of cases of acute Chagas disease, the systematic occurrence of these cases related to oral transmission, mainly in the Amazon region, as well as to vectorial transmission, has been evident in recent years.
The condition presents significant mortality, in addition to being a cause of disability for individuals. The cardiac form is responsible for most deaths, with clinical manifestations grouped into three groups: arrhythmias, heart failure and thromboembolic (associated with the formation of thrombosis).
Normally, the acute phase is asymptomatic and may go unnoticed, according to the Oswaldo Cruz Foundation (Fiocruz). When apparent, the clinical picture of the infection appears 5 to 14 days after transmission by the vector, the main symptoms being: prolonged fever, lasting more than seven days, headache, intense weakness, swelling of the face and legs.
In the chronic phase, most cases have no symptoms (60%), but the rest may have heart and digestive problems later, 20 to 40 years after the original infection. The severe picture is characterized by fever of varying intensity, malaise, inflammation of the lymph nodes and swelling of the liver and spleen.
Transmission occurs through the feces of infected parasites, after bites by the kissing bug, ingestion of food contaminated with parasites, transmission of parasites from infected women to their babies, during pregnancy or childbirth, blood transfusion or transplantation of organs from infected donors to healthy recipients and, accidentally, by contact of injured skin or mucous membranes with contaminated material.
Diagnosis and treatment
Timely diagnosis is essential for the immediate initiation of treatment and prevention of the disease worsening with cardiac and digestive impacts.
In the acute phase and in the chronic forms of Chagas disease, the diagnosis can be made by detecting the parasite causing the infection by means of laboratory methods of visualization of the parasite directly or indirectly and by the presence of antibodies in the serum, by means of specific tests.
The treatment of Chagas disease must be indicated by a doctor, after confirmation of the disease. The medicine, called benznidazole, is provided free of charge by the Unified Health System (SUS), upon request from the State Health Departments and should be used in people who have the acute disease as soon as it is diagnosed.
For people in the chronic phase, the indication of this drug depends on the clinical form and must be evaluated on a case-by-case basis. In cases of intolerance or cases that do not respond to treatment with benznidazole, the Ministry of Health offers nifurtimox as an alternative treatment.
Prevention of Chagas disease is associated with the form of transmission. One of the forms of control is to prevent the kissing bug from forming colonies inside homes, through the use of insecticides.
In areas where insects can enter houses flying through openings or crevices, mosquito nets or metal screens can be used. The Ministry of Health also recommends the use of individual protection measures, such as repellents and long-sleeved clothes, when carrying out night activities in forested areas.
Source: CNN Brasil
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