Abstract
Chagas disease, caused by the infection with the protozoan parasite Trypanosoma cruzi, is clinically manifested in approximately one-third of infected people by inflammatory heart disease (cardiomyopathy) and, to a minor degree, gastrointestinal tract disorders (megaesophagus or megacolon). Chagas disease is a zoonosis transmitted among animals and people through the contact with triatomine bugs, which are found in much of the western hemisphere, including most countries of North, Central and South America, between parallels 45° north (Minneapolis, USA) and south (Chubut Province, Argentina). Despite much research on drug discovery for T. cruzi, there remain only two related agents in widespread use. Likewise, treatment is not always indicated due to the serious side effects of these drugs. On the other hand, the epidemiology and pathogenesis of Chagas disease are both highly complex, and much is known about both. However, it is still impossible to predict what will happen in an individual person infected with T. cruzi, because of the highly variability of parasite virulence and human susceptibility to infection, with no definitive molecular predictors of outcome from either side of the host-parasite equation. In this Minireview we briefly discuss the current state of T. cruzi infection and prognosis and look forward to the day when it will be possible to employ precision health to predict disease outcome and determine whether and when treatment of infection may be necessary.
Highlights
Reviewed by: John Kelly, University of London, United Kingdom Michael Alexander Miles, University of London, United Kingdom
Chagas disease is a zoonosis transmitted among animals and people through the contact with triatomine bugs, which are found in much of the western hemisphere, including most countries of North, Central and South America, between parallels 45◦ north (Minneapolis, USA) and south (Chubut Province, Argentina)
The route of infection was originally felt to be restricted to contamination of the wound or mucous membrane with T. cruzi-contaminated excreta of hematophagous insects, other forms of transmission are important, including oral infection through consumption of food and drink contaminated with the parasite, blood transfusion, organ transplantation, and congenital infection (Moncayo, 2003; Coura, 2014; Dolhun and Antes, 2016; Alarcón de Noya et al, 2017)
Summary
American trypanosomiasis, is caused by infection with the protozoan parasite Trypanosoma cruzi which displays a complex life cycle involving human and animal hosts as reservoirs of disease and triatomine insects of the Reduviidae family as vectors. The lack of an effective vaccine against T. cruzi, and the moderate effectiveness and toxicity of first-line drugs aggravate the situation (Schaub et al, 2011; Nunes et al, 2013; Rodríguez-Morales et al, 2015) Considering these aspects of epidemiology, continued surveillance of insects and wild animals, continued screening of the blood supply, and perhaps implementing screening of women of childbearing age will help to reduce transmission of T. cruzi through various routes. We have recently reviewed pathogenesis (Bonney et al, 2019) and will not discuss this further in this review
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