Chagas disease

The following factors may increase your risk of getting Chagas disease:

• Living in impoverished rural areas of Central America, South America and Mexico
• Living in a residence that contains triatomine bugs
• Receiving a blood transfusion or organ transplant from a person who carries the infection

It’s rare for travelers to the at-risk areas in South America, Central America and Mexico to contract Chagas disease because travelers tend to stay in well-constructed buildings, such as hotels. Triatomine bugs are usually found in structures built with mud or adobe or thatch.

If Chagas disease progresses to the chronic phase, serious heart or digestive complications may occur. These may include:

• Heart failure. Heart failure occurs when your heart becomes so weak or stiff that it can’t pump enough blood to meet your body’s needs.
• Enlargement of the esophagus (megaesophagus). This rare condition is caused by the abnormal widening (dilation) of your esophagus, which can result in difficulty with swallowing and digestion.
• Enlargement of the colon (megacolon). Megacolon occurs when your colon becomes abnormally dilated, causing abdominal pain, distension and severe constipation.

You’re likely to start by seeing your family doctor or a general practitioner. Depending on his or her findings, your doctor may refer you to an infectious disease specialist.

It’s a good idea to be well-prepared for your appointment. Here’s some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including travel to other countries, major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements that you’re taking.
• Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For Chagas disease, some basic questions to ask your doctor include:

• What’s the most likely cause of my symptoms?
• What kinds of tests do I need?
• Is my condition likely temporary or long lasting?
• What treatments are available?
• I have these other health conditions. How can I best manage these conditions together?
• Am I contagious? Are others who traveled with me likely infected?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Does anything improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have you lived or traveled anywhere, such as Mexico, where the triatomine bug or Chagas disease is common?

Your doctor will conduct a physical exam, asking about your symptoms and any factors that put you at risk of Chagas disease.

If you have the signs and symptoms of Chagas disease, blood tests can confirm the presence of the T. cruzi parasite or the proteins that your immune system creates (antibodies) to fight the parasite in your blood.

If you’re diagnosed with Chagas disease, you’ll likely undergo additional tests to determine whether the disease has entered the chronic phase and caused heart or digestive complications. These tests may include:

• Electrocardiogram, a procedure that records the electrical activity of your heart
• Chest X-ray, which lets your doctor see if your heart is enlarged
• Echocardiogram, a test that uses sound waves to capture moving images of your heart, allowing your doctor to see any changes to the heart or its function
• Abdominal X-ray, a procedure that uses radiation to capture images of your stomach, intestines and colon
• Upper endoscopy, a procedure in which you swallow a thin, lighted tube (endoscope) that transmits images of your esophagus onto a screen

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-related complications. Treatment may include medications, a pacemaker or other devices to regulate your heart rhythm, surgery, or even a heart transplant.
• Digestive-related complications. Treatment may include diet modification, medications, corticosteroids or, in severe cases, surgery.