0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22
1458 Trypanosomiasis, American (Chagas’ Disease)indeterminate and chronic phases, more sensitive than xenodiag-
nosis. Commercial ELISA kits available in US, or serology can be
performed at CDC.
differential diagnosis
■Acute phase: Fever can resemble many other febrile diseases, includ-
ing typhoid, leishmaniasis, malaria, mononucleosis. Presence of
chagoma or Romana’s sign helps distinguish. In chronic stage, other
causes of myocardiopathy, rheumatic heart disease, endomyocar-
dial fibrosis. Megasyndromes are quite distinct.management
What to Do First
■Acute phase: Treat fever; attention to fluids, nutrition.
■Chronic phase: evaluate heart and GI tract.General Measures
■Same. Fumigate housing and vicinity.
specific therapy
Indications
■Any acute case. Treatment in indeterminate and chronic phase is
controversial. Recent papers suggest parasites can be eliminated in
some, but pathology not reversed.Treatment Options
■Acute stage: Nifurtimox for 30–120 days (available only through CDC)
■Benznidazole for 30–60 days, all ages (not available in US)Side Effects & Complications
■Nifurtimox: peripheral neuropathy is most serious effect. Also
tremor, excitation, anorexia, rashes, exfoliation.
■Benznidazole: rash, exfoliation, peripheral neuropathy, anorexia,
hematologic abnormalities.
■Contraindications to treatment: absolute: allergy to drug, pregnancy
(but treat newborn of infected), and indeterminate cases with no
pathology.
■Contraindications to treatment: relative: chronic cases with advan-
ced manifestations.follow-up
During Treatment
■Observe for side effects, which can be severe. Monitor CBC.