Chagas cardiomyopathy: Europe is not spared!

Abstract

Chagas’ disease was first described in 1909 by the Brazilian physician Carlos Chagas, who named the parasite Trypanosoma cruzi after his mentor, Oswaldo Cruz.1 It causes more deaths in the Americas than any other parasitic disease.1 Due to the parasite distribution throughout Central and South America, it is commonly known as the ‘American trypanosomiasis’. As such, it is considered to be an ‘exotic’ disease in Europe, where it is virtually undiagnosed. However, thanks to free circulation of individuals and employment opportunities Europe is a magnet for millions of immigrants, many of whom are from South America. We will review the compelling arguments by which chagasic cardiomyopathy should be moved upfront in the mindset of European cardiologists, actively looked for, and appropriately recognized. Vectorial transmission of the disease is the most common form in endemic countries. This occurs through haematophagous insects (Triatominae), which become vectors for Trypanosoma cruzi by biting an infected animal or person; when infected triatominae bite, they transmit the parasite by defecating on the host's skin.2 The insects vector of the disease is present throughout most of South and Central America, their zone of distribution encompassing southern USA.2 In non-endemic countries, the disease is transmitted through blood transfusions, organ donations, and from mother to child at birth. However, besides possible occurrence of new cases of infection, substantial concern exists regarding the progressive development of cardiomyopathy in many individuals who had already become infected in their native country, and then move to Europe. The disease has three phases. The initial infection is characterized by an acute phase, which in most cases goes asymptomatic. Infection is followed by a long ‘indeterminate phase’.2 The indeterminate form of chronic Chagas’ disease is defined as chronically infected patients with positive serology but no alterations of heart, oesophagus, and …