Existing as an acute or chronic disease American Trypanosomiasis or Chagas’ disease is caused by the hemoflagellate protozoa, Trypanosoma cruzi. The disease occurs in Central and South America. Chagas’ disease cause cardiac and gastrointestinal tract autonomic de-efferentation years after primary infection. CNS involvement, though rare, should suggest concurrent HIV infection.
Chagas’ disease is a zoonotic disease, transmitted by reduvid bug of the genus Triatoma. The trypanosome inhabits the gut of the bug. The bug bites at night and defecates at the time of biting. The infection is transmitted by rubbing the fecal matter containing the metacyclic stage of the parasite into the tiny skin puncture, other abrasions of the skin, or by rubbing the eyes or other mucosal surface with infected fingers. The infection can also be transmitted trans-place tally, by blood transfusions, or from organ transplant.
Pathology of Chagas’ disease
Pseudo cysts of intracellular aggregates of multiplying parasites are seen in infected tissue. Chagomas, seen mainly on the face, demonstrate intracellular parasites with lymphocyte infection and reactive hyperplasia in regional lymph nodes.
The heart is dilated, walls are thin with aneurismal dilation at the apex and there is formation of mural thrombi. Histologically, fibrosis, atrophy of myocardial fibres and lymphocytic and lymphocytic infiltration is seen. Myocardial damage and left ventricular dilatation precede cardiac parasympathetic nerve changes with an apparent correlation between the degree of left ventricular parasympathetic never changes. T. cruzi probably selectively destroys the postganglionic parasympathetic vagal nerve.
The esophagus and colon are grossly dilated and hypertrophied. Microscopically, there is lymphocytic infiltration and reduction in the number of neurons in the myenteric plexus.
Clinical Features of Chagas’ disease
Acute Chagas’ disease, mostly in children, is a flulike illness occurring about 1 week after inoculation with fever, lymphadenitis, malaise, hepatosplenomegaly, facial edema, tachycardia, and, rarely, meningoencephalitis.
The portal of entry may shoe nodular or ulcerative swelling (chagoma) in about 25% of cases. In 50% of cases the primary site is the outer canthus of the eye, with unilateral palpebral edema and periauricular lymph node enlargement (Romana’s sign). Early myocarditis, meningoencephalitis or reactivated Chagas’ disease suggests concurrent HIV infection. CNS involvement manifests as seizures, tremors, rigidity, paralysis, and altered mentation. Death in the acute stage is caused by acute myocarditis, congestive cardiac failure, or meningoencephalitis.
Chronic Chagas’ disease develops years or decades after initial infection with clinical features suggesting involvement of heart, gastrointestinal tract, and nervous systems. Cardiac involvement is commonest in chronic disease with congestive cardimyopathy, syncopal attacks, and systemic and CNS embolization from mural thrombi of a left ventricular apical aneurysm.
Destruction of autonomic ganglion in the heart results in postural hypotension, dizziness, and rhythm disturbance, whereas similar involvement of the gastrointestinal tract results in mega colon and mega esophagus. CNS involvement in chronic Chagas’ disease is due to embolization of cerebral vessels from intramural cardiac thrombi or from formation of mass lesions with seizures, hemi paresis, cerebellar ataxia, or other focal deficit.
Transplacental transmission of T. cruzi results in congenital Chagas’ diseases with premature birth and developmental delay in the survivors.
- A. Chest X-ray
The chest x-ray shows a dilated heart that increase to severe proportions as the disease progresses. The lungs may show evidence of fluid accumulation with pleural effusions, but eh lung field may be relatively clear if mainly right heart failure occurs.
- B. Blood Tests
In Chagas disease the serum aldolase is usually elevated. A complement fixation test (machado Guerreiro test) that has high specificity and sensitivity is used to identify chronic Chagas disease. Xeno-diagnosis is the preferred test in endemic areas. With this test reduvid bugs bred in the laboratory are allowed to bite the patient. The parasites are then found in the intestine of the insect proving infection in the patient.
- C. Echocardiography
Echocardiography shows enlargement of all four heart chambers in Chagas patients. There is also a reduction in the injection fraction. On echo, the appearance of Chagas is distinctive: there is hypo kinesis, poor contractility of the left ventricular posterior wall, relatively preserved intraventricular septal wall motion, and poor movement of the apical segment of the heart with dilatation and aneurismal formation.
- A. Prevention
Vector control and interruption of transmission of the parasites to humans remain crucial. In endemic areas individuals should avoid having dogs or cats in the home. Improved housing conditions, repair of walls and ceilings, and added fresh paint should deter bugs from these areas. The use of the nets for sleeping should prevent bugs from falling from ceilings onto the exposed face at night.
- B. Medications
Anti-parasitic agents reduce parasitemia in the acute phase, but they do not have any effect on the auto-immune mediated chronic form of the disease. Anti-coagulants are necessary in patients with left ventricular aneurysms or thrombi detected in the ventricle and those who have sustained embolism. Arrhythmias often require treatment with antiarrhythmics. These drugs are used for symptomatic relief and does not appear to prolong life.
Homeopathic treatment of chaga’s disease symptoms – Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat Chagas’ disease symptoms but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to cure Chagas ‘ disease symptoms that can be selected on the basis of cause, sensations and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of chaga’s’ disease symptoms:
China, Lycopodium, Natrum Sulph, Nux vomica, Arsenic Album, Bryonia, Calcaria Carb, Cocculus Indicum, Belladonna, Apis Mel, Rhus Tox, Iodum, Ceonathus and many other medicines.
M.I. Gabriel Khan: Encyclopedia of heart diseases; 2005; 225
Walter George Bradley: Neurology in Clinical Practice: the Neurological disorders; 2044; 1564
Ranjan L. Femando, Sujatha S. E. Femando , Anthony sie; Tropical infectious diseases: epidemiology, investigation, diagnosis and…..;2001; 63