Chagas Disease

Chagas disease is a parasitic disease also known as American trypanosomiasis, caused by Trypanosoma cruzi, often occurs in southern parts of the Americas (Mexico). This flagellate is transmitted by a bug coming from the family Triatominae; this infects humans through a bite (these insects are of blood-sucking specie) and may also be handed on through blood transfusions and organ transplants; can also be transferred thru placental transmission; or simply by consumption of food infected by this parasite.

Symptoms

Acute Stage

  • May be asymptomatic
  • Romaña’s  sign (swelling of the eyelids on the side from which the bite wound is located)
  • Fever
  • Body fatigue
  • Body malaise
  • Rash
  • Diarrhea
  • Vomiting
  • Headache
  • Local swelling (chagoma-appears along the entry site of the parasite)
  • Spleen enlargement
  • Liver enlargement
  • Swollen glands

Chronic Stage

  • Cardiac injury (rhythm abnormalities)
  • Neuritis
  • Sensory impairment
  • Neurological symptoms (confusion, dementia, motor deficits)
  • Digestive symptoms (GI tract dilatation, weight loss, difficulty swallowing)

Transmission

These blood-sucking triatomine bugs are known to attack the face. Once they bit and feed onto the host, they defecate and leave their feces alongside the bite site. As a natural reaction to an insect bite, the host scratches the wound bite, letting the parasite enter the host via the wound site and the proximal mucus membranes. Once it enters the system, they attack the body cells and transform into intracellular amastigotes. These amastigotes then transform into trypomastigotes, a state where they can readily be transported into the bloodstream.

Diagnosis

  • Microscopic examinations (Giemsa- stained smears for direct parasite visualization)
  • Immunoassays (differentiate varied Trypanosoma cruzi strains)
    • ELISA
    • Indirect hemagglutination
    • Indirect fluorescence assays
    • Polymerase Chain Reaction

Management

  1. Even though reports have been documented regarding incidence of resistance to medication, the most effective treatment yet is still antiparasitic drugs, specifically benznidazole and nifurtimox. This is useful especially during the acute stages of the disease. In chronic stages, management of manifestations and complications may be the only option. Therefore, available regimens for treatment of Chagas disease may only be antiparasitic therapy or symptom-focused treatment. Until recently, researches have been conducted to finally generate a drug that would target and eliminate Trypanosoma cruzi.
  2. Nursing management involves adequate care plan since most of the medical regimen is of symptomatic treatment. Proper assessment of disease prognosis is helpful to visualize the possible damage and complications that might happen, so as that medical intervention could be done immediately.
  3. Health education regarding disease prevention is vital since no vaccine is yet available in the market (on-going research is conducted).
  4. Sanitation and cleanliness (body, environment, food ingested) plays a big role in averting the presence of these bugs.
  5. Insecticide sprays are used to eliminate these bugs.
  6. People should be assertive in getting blood from the blood banks; these blood institutions should have a strict and stringent screening test specifically monitoring possible exposure to Chagas.

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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