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AbledALERT Outbreak post banner shows a close-up of a young girl's face with her left eye swollen shut. This is called Romaña's sign and is a marker of acute Chagas disease. The swelling is due to bug feces being accidentally rubbed into the eye and eyelids. The headline reads: AbledALERT: Outbreak: Tracking the spread of a debilitating disease that packs a delayed punch. The main headline reads: Chagas Disease-Special Ongoing Coverage.

What Is CHAGAS?

Chagas (CHAH-gus) disease is an inflammatory, infectious disease caused by a parasite found in the feces of the blood-sucking triatomine (reduviid) bug, also called the ‘Kissing bug’ because of it’s tendency to bite on the face.

Chagas disease is named after the Brazilian physician Carlos Chagas, who discovered the disease in 1909.

Chagas disease is common in South America, Central America and Mexico, the primary home of the triatomine bug. More cases of Chagas disease are being diagnosed in the southern United States because of migration and shipping.

Also called American trypanosomiasis, Chagas disease can infect anyone, but is diagnosed most often in children. Left untreated, Chagas disease later can cause serious heart and digestive problems.

In the United States, Chagas disease is considered one of the neglected parasitic infections (NPI), a group of five parasitic diseases that have been targeted by the U.S. Centers For Disease Control And Prevention (CDC) for public health action.

Treatment of Chagas disease focuses on killing the parasite in the acute infection stage and managing signs and symptoms in later stages. You can take steps to prevent the infection.

(Sources: CDC | Mayo Clinic)

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How Does It Spread?

Chagas disease, or American trypanosomiasis, is caused by the parasite Trypanosoma cruzi. Infection is most commonly acquired through contact with the feces of an infected triatomine bug (or “kissing bug”), a blood-sucking insect that feeds on humans and animals.

These insects can become infected by T. cruzi when they ingest blood from an animal already infected with the parasite.

Triatomine bugs live primarily in mud, thatch or adobe huts in Mexico, South America and Central America. They hide in crevices in the walls or roof during the day, then come out at night — often feeding on sleeping humans.

Infected bugs defecate after feeding, leaving behind T. cruzi parasites on the skin. The parasites can then enter your body through your eyes, mouth, a cut or scratch, or the wound from the bug’s bite.

Scratching or rubbing the bite site helps the parasites enter your body.

Once in your body, the parasites multiply and spread.

Infection can also occur from:

>> Mother-to-baby (congenital)

>> Contaminated blood products (transfusions)

>> An organ transplanted from an infected donor

>> Laboratory accident

>>  Contaminated food or drink (rare)

>> Spending time in a forest that contains infected wild animals, such as raccoons and opossums

>> Being around an infected pet

Chagas disease is endemic throughout much of Mexico, Central America, and South America where an estimated 8 million people are infected. The triatomine bug thrives under poor housing conditions (for example, mud walls, thatched roofs), so in endemic countries, people living in rural areas are at greatest risk for acquiring infection.

Public health efforts aimed at preventing transmission have decreased the number of newly infected people and completely halted vectorborne transmission in some areas. Infection acquired from blood products, organ transplantation, or congenital transmission continues to pose a threat.

By applying published seroprevalence figures to immigrant populations, CDC estimates that more than 300,000 persons with Trypanosoma cruzi infection live in the United States. Most people with Chagas disease in the United States acquired their infections in endemic countries. Although there are triatomine bugs in the U.S. , only rare vectorborne cases of Chagas disease have been documented.

(Sources: CDC | Mayo Clinic)

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What Are The Symptoms?

Chagas disease can cause a sudden, brief illness (acute), or it may be a long-lasting (chronic) condition. Symptoms range from mild to severe, although many people don’t experience symptoms until the chronic stage.

ACUTE PHASE

The acute phase of Chagas disease, which lasts for weeks or months, is often symptom-free. When signs and symptoms do occur, they are usually mild and may include:

>> Swelling at the infection site

>> Fever

>> Fatigue

>> Rash

>> Body aches

>> Eyelid swelling, also called Romaña’s Sign

>> Headache

>> Loss of appetite

>> Nausea, diarrhea or vomiting

>> Swollen glands

>> Enlargement of your liver or spleen

Signs and symptoms that develop during the acute phase usually go away on their own. If left untreated, the infection persists and, in some cases, advances to the chronic phase.

CHRONIC PHASE

Signs and symptoms of the chronic phase of Chagas disease may occur 10 to 20 years after initial infection, or they may never occur. In severe cases, however, Chagas disease signs and symptoms may include:

>> Irregular heartbeat

>> Congestive heart failure

>> Sudden cardiac arrest

>> Difficulty swallowing due to enlarged esophagus

>> Abdominal pain or constipation due to enlarged colon

WHEN TO SEE A DOCTOR

See your doctor if you live in or have traveled to an area at risk of Chagas disease and you have signs and symptoms of the condition, such as swelling at the infection site, fever, fatigue, body aches, rash and nausea.

(Sources: CDC | Mayo Clinic)

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Treatment | Prevention

TREATMENT

Treatment for Chagas disease focuses on killing the parasite and managing signs and symptoms.

During the acute phase of Chagas disease, the prescription medications benznidazole and nifurtimox may be of benefit. Both drugs are available in the regions most affected by Chagas disease. In the United States, however, the drugs can be obtained only through the Centers for Disease Control and Prevention.

Once Chagas disease reaches the chronic phase, medications won’t cure the disease. But, the drugs may be offered to people under 50 because they may help slow the progression of the disease and its most serious complications.

Additional treatment depends on the specific signs and symptoms:

>> Heart: Treatment may include medications, a pacemaker or other devices to regulate your heart rhythm, surgery, or even a heart transplant.

>> Digestive: Treatment may include diet modification, medications, corticosteroids or, in severe cases, surgery.

 

If you live in a high-risk area for Chagas disease, these steps can help you prevent infection:

>> Avoid sleeping in a mud, thatch or adobe house. These types of residences are more likely to harbor triatomine bugs.

>> Use insecticide-soaked netting over your bed when sleeping in thatch, mud or adobe houses.

>> Use insecticides to remove insects from your residence.

>> Use insect repellent on exposed skin.

(Sources: CDC | Mayo Clinic)

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This is an Abled Alternative Text English translation transcript for blind and low-vision visitors who are using screenreader applications of the Spanish language video that follows below titled: ‘What Is Chagas Disease?’ produced for I S Global - The Barcelona Institute for Global Health by quepo. The video contains English sub-titles for sighted visitors. The sub-titled text is as follows: Usually considered an affliction of the poor, Chagas disease has long been a neglected and hidden disease, ignored even by the governments of the countries affected. Today Chagas disease affects an estimated 8 to 10 million people worldwide. The problem is no longer confined to Latin America since the disease has spread to the USA, Canada, Europe, and even Australia and Japan. Chagas disease is caused by a parasite which is transmitted to humans through the bite of the triatomine bug, known popularly as the kissing bug. The infection can also be passed from a mother to her baby. The parasite can also be transferred to a patient who receives an infusion of contaminated blood from an infected donor. Most people with Chagas disease never develop any symptoms. Those who do have clinical manifestations typically develop cardiac disorders or digestive complications. Chagas disease can be diagnosed through a simple blood test. There are currently two treatments for Chagas disease and we are searching for new tools to control the disease. Fortunately, Chagas disease can be treated. For more information you can go to infochagas.org. Click here to go to their website.
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AbledALERT-OUTBREAK-Chagas Photo shows a mother and her daughter and other patients at a health clinic in Bolivia. There is a handmade banner on the wall that says CHAGAS in capital letters and there is a poster showing more information about the disease. The caption reads: Drug shelved in 1980 is now testing in Bolivia/Africa for parasitic diseases like Chagas.

New Drug Candidate For Chagas Now Testing In Patients

Fexinidazole, a drug that was previously ‘shelved’ in the 1980s and ‘rediscovered’ by the Drugs For Neglected Diseases Initiative (DNDi), is now undergoing a Phase II trial in Bolivia as a treatment for Chagas disease, and is also being tested in patients in Africa for two other parasitic diseases – sleeping sickness and visceral leishmaniasis.

Chagas disease, with up to 8 million cases and 100 million at risk of infection in Latin America and increasingly elsewhere, is the number one cause of infectious heart muscle disease worldwide, and is responsible for about 12,500 deaths each year as of 2006.

Endemic in 21 countries across Latin America, Chagas disease kills more people in the region each year than any other parasite-born disease, including Malaria.

Despite what health officials call the ‘vast disease burden’ only two treatments exist at the present time – nifurtimox and benznidazole – as the best available treatment options, yet both are associated with side effects such as brain toxicity, irritation of the digestive system and skin disorders.

Alarmingly, these less than optimal current treatments for Chagas disease reach only 1% of the estimated 8 million people affected, highlighting what DNDi calls ‘the immediate need to scale-up treatment today and accelerate development of entirely new drugs’.

The Phase II trial will try to see whether fexinidazole can work best on its own or in combination with benznidazole for the treatment of adult patients with chronic indeterminate Chagas disease to reduce side-effects and improve effectiveness.

 

(Sources: DNDi | infectionresearch | Wikipedia

AbledLERT info graphic from the CDC shows the life cycle of the parasite that causes Chagas disease and how it spreads to humans.

On The Frontlines: Diagnosis And Treatment Of Chagas in Mexico

Doctors Without Borders / Médecins Sans Frontières (MSF) is an international medical humanitarian organization. They have provided medical services and treatment in war zones, viral outbreak zones, areas of healthcare exclusion and natural or man-made disasters.

They work on the front lines, dangerous or not, wherever they go.

Just this week, an MSF staff member from Norway has been placed in isolation after being diagnosed with Ebola hemorrhagic fever in the city of Bo in Sierra Leone and will soon be transferred to a specialized treatment center in Europe. Close to 3,000 MSF staff  have been responding to the Ebola outbreak in West Africa since March, 2014, including some 250 international staff.

They are also busy on the front lines of the Chagas epidemic.  In Mexico, where an estimated 1.1 million people are infected with the disease, MSF has collaborated with the Health Secretariat in Oaxaca State to initiate diagnosis and treatment activities in the region where the prevalence of Chagas is estimated to be between 4 and 12 percent.

Every year there are 7,700 new cases in Mexico, and eight states, including Oaxaca state, account for more than 69 percent of reported Chagas cases nationwide.

So far, after the arrival of rapid diagnostic tests and the first batch of medicines to treat the disease, 1,512 serological tests have been performed and the first patients diagnosed with Chagas have started the corresponding treatment.

The first Chagas-positive patient, an 18 year-old from Puerto Àngel, Oaxaca was abled to begin treatment in late August and he is undergoing weekly check-ups and is not scared because he knows there is a cure and that by receiving the 60-day treatment he requires, his health will improve and he will be able to continue with his studies.

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AbledALERT-Chagas info graphic from CanadianPharmacyMeds.com contains a graphical layout of the information we have already detailed in our FAQ section and in the main post and videos sections. Click here to go to CanadianPharmacyMeds.com .
Infographic about Chagas in Spanish from El Imparcial Newspaper in Puerto Rico. Click here to go to their website.
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CHAGAS DISEASE:: ‘The New HIV/AIDS Of The Americas.

Chagas disease, a tropical illness that is transmitted by biting insects, may pose a major unseen threat to poor populations in the Americas and Europe, according to a report published in 2012 in the journal PLoS.

While this PRESSTV video compares to Chagas to HIV/AIDS, some doctors say a more accurate comparison would be something like Chronic Lyme Disease because of the delayed, yet progressive, evolution of symptoms.

CHAGAS IN BOLIVIA: En Español with English subtitles.

Chagas disease is the most common parasitic disease in Bolivia: about 1 million Bolivians have chronic Chagas disease. Chagas disease is a silent but deadly killer.

In this video, researchers, doctors and patients speak about Chagas disease. They highlight not only the urgent need to treat patients today, but also the importance of finding better treatments for the future. 

AbledALERT info graphic from NPR shows the threat of Neglected Tropical Diseases (NTDs( which include Chagas. We are working on an audio transcript of this info graphic and will update this as soon as it's ready.
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