Maladie de Chagas : formes cliniques et prise en charge en zone non endémique

Abstract

International migration has led to the emergence of Chagas disease in industrialized countries, notably France. Clinicians should consider and test for Chagas disease in several situations: chronic cardiac and digestive manifestations in patients who lived (or whose parents lived) in an endemic area; pregnant woman who come from an endemic area and in the infant if the mother's serologic tests are positive; and more rarely, patients with a persistent fever who recently visited an endemic area. During the acute phase, diagnosis is confirmed by parasitological testing. During the chronic phrase, diagnosis remains serologic. The usefulness of PCR has not been determined. The recent recognition of the parasite's pathogenic role during the chronic phase has enlarged the indications for treatment. Today, all patients younger than 50 years with Chagas disease in the acute, chronic symptomatic or chronic asymptomatic phases should receive treatment, except for pregnant women, patients with hepatic or renal failure, or advanced cardiac or digestive manifestations. Treatment must be considered on an individual basis in patients older than 50 years. The frequency and seriousness of potential adverse events due to treatment require careful monitoring of the patient throughout treatment.