American trypanosomiasis etiology

Two distinct forms of the genus Trypanosoma occur in humans. One is associated with African trypanosomiasis (sleeping sickness) and the other with American trypanosomiasis (Chagas' disease). T. brucei gambiense and T. brucei rhodesiense are the causative organisms for the East African and West African trypanosomiasis, respectively. T. brucei rhodesiense causes the acute disease and is the more virulent of the two spe cies. Both East and West African trypanosomiasis are transmitted by various species of tsetse fly belonging to the genus Glossina. Further discussion of this subject will focus on American trypanosomiasis.

T. cruzi is the agent that causes American trypanosomiasis. American trypanosomiasis is transmitted by a number of species of reduviid bugs (Triatoma infestans and Rhodrium prolixus) that live in wall cracks of houses in rural areas of North, Central, and South America.75-79 The reduviid bug is infected by sucking blood from animals (e.g., opossums, dogs, and cats) or humans infected with circulating trypomastig-otes. American trypanosomiasis is endemic in all Latin American countries and can be transmitted congenitally, by blood transfusion, and by organ transplantation.

Clinical Presentation and Diagnosis of Trypanosomiasis Acute

• Unilateral orbital edema (Romana's sign)

• Fever, hepatosplenomegaly, and lymphadenopathy Chronic

• Cardiac: cardiomyopathy and heart failure

• ECG: first-degree heart block, right bundle-branch block, and arrhythmias

• GI: enlargement of the esophagus and colon ("mega" syndrome)

• CNS: meningoencephalitis, strokes, seizures, and focal paralysis Diagnosis

Positive history of exposure and use of serology: indirect hemagglutination test, ELISA (Chagas EIA, Abbott Labs, Abbott Park, IL), and complement fixation (CF) test. (Note: CF may produce false-positive reactions in those exposed to leishmaniasis, syphilis, and malaria. PCR may be more definitive for diagnosis.)

Patient Care and Monitoring

• It is essential to identify T. cruzi-infected patients by serology and to monitor the cardiovascular status of these patients by ECG periodically.

• Some patients will benefit from implantation of pacemakers.

• All transplant candidates from areas endemic for Chagas' disease need to be screened for T. cruzi. Immunosuppression in these patients can lead to overwhelming infections.

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