Abstract
Chagas disease is caused by infection with the protozoan Trypanosoma cruzi, and although over 100 years have passed since the discovery of Chagas disease, it still presents an increasing problem for global public health. A plethora of information concerning the chronic phase of human Chagas disease, particularly the severe cardiac form, is available in the literature. However, information concerning events during the acute phase of the disease is scarce. In this review, we will discuss (1) the current status of acute Chagas disease cases globally, (2) the immunological findings related to the acute phase and their possible influence in disease outcome, and (3) reactivation of Chagas disease in immunocompromised individuals, a key point for transplantation and HIV infection management.
Highlights
In 2010, the 63rd World Health Assembly passed resolution WHA63.20, highlighting the seriousness of Chagas disease in both endemic and non-endemic countries, which called for measures to address Chagas disease transmission, diagnostics, and treatment at all levels
The acute phase of Chagas disease is a critical period for this debilitating infection for many reasons: (1) it represents the first overt disease phase as a result of the host–pathogen interaction, often accompanied by serious symptoms, especially in patients infected by the oral route; (2) early detection in this phase allows for the introduction of effective and appropriate therapeutics; and (3) the immunological events that take place during the acute phase will likely influence disease outcome during the chronic phase, helping determine whether the patient will remain in the asymptomatic form, or progress to the deadly, cardiac, clinical form of the disease
The epidemiological data reviewed in this article demonstrate that despite the successful initiatives to eliminate T. cruzi transmission by Triatoma infestans in certain endemic countries of Latin America, the coexistence of T. cruzi, their reservoirs, and vectors persists as a health problem, leading to outbreaks caused by oral and vectorial transmission
Summary
It is challenging to determine with complete certainty if the human infections observed in these areas occur by the oral route, given that the presence of the vector may lead to conventional transmission, but recent studies have implicated contaminated acaı consumption as one of the main causes for acute Chagas outbreaks in the Amazon region [3]. The acute phase of Chagas disease represents the first contact between the parasite and the host, and the moment in which the immunological response will be triggered. It is possible (and likely) that the immunological events that take place during the acute phase will greatly influence the outcome of the disease towards the development of protective or pathogenic response in the chronic phase.
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