Introduction:
Chagas cardiomyopathy is also called American trypanosomiasis. The parasite Trypanosoma cruzi is responsible for this infection and is widely seen in populations residing in Central America, South America, and Mexico. It causes serious heart issues like dilated cardiomyopathy with heart failure, ventricular arrhythmias, stroke, etc. And it is diagnosed by performing ECG (electrocardiogram), chest X-ray, echocardiogram, etc. They are then treated with antiparasitic medications like Benznidazole and antiprotozoals like Nifurtimox.
What Is Chagas Cardiomyopathy?
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Chagas cardiomyopathy is a severe, life-threatening condition caused by an infection from the parasite Trypanosoma cruzi. It causes neurogenic and autoimmune responses leading to cardiac problems.
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It is endemic and prevalent in the Latin American region. But, now it has become a global issue since the infected persons migrate to different regions, spreading the disease. The disease is not confined to Latin America now but has spread to developing countries like Europe and North America.
What Causes Chagas Cardiomyopathy?
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Endemic Infection: The protozoan parasite Trypanosoma cruzi exists in two forms, namely, trypomastigotes and amastigotes. These parasites are transferred through blood-sucking triatomine bugs. When biting the human skin, these bugs pass feces infected with the trypomastigote parasite. And thus, the human gets the infection.
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Host Infection: Another way the infection spreads is when these bugs bite humans, penetrate deep into the mucous membrane, and invade the cellular function in the penetration site. It transforms into amastigotes and multiplies and transforms into trypomastigotes passing the infection into the blood circulation.
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Global Infection: The infection is spread from the infected person while migrating to other regions. They spread the infection through blood transfusion, organ transplantation, or pregnancy.
What Are the Symptoms of Chagas Cardiomyopathy?
Chagas cardiomyopathy presents in two phases:
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Acute Phase: The acute phase starts one to two weeks after the infection and resolves in four to eight weeks. In cases of infection through blood transfusion or organ transplant, the infection can last for four months, also leading to immunosuppression and aggravating the acute symptoms.
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Symptoms are usually mild, and sometimes no symptoms occur in the acute phase.
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The symptomatic phase exhibits the following symptoms:
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Inoculation Chagoma: Inoculation chagoma is a subcutaneous nodule on the insect bite site.
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Ramona Sign: It is a painless, unilateral swelling in the periorbital area (areas surrounding the eyes), one of the unique features of inoculation chagoma.
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Fever: Elevated body temperature.
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Generalized Adenopathy: Generalized lymph node enlargement.
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Edema: Swelling.
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Hepatosplenomegaly: Enlargement of the liver and the spleen.
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Myocarditis: Inflammation or swelling of the heart muscle.
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They also co-exhibit a few gastrointestinal like
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Mild Achalasia: In achalasia, the esophagus loses its ability to move food downward due to paralysis of the esophageal muscles. Mild achalasia occurs in a mild form.
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Dysphagia: Difficulty swallowing.
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Odynophagia: Pain during swallowing.
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Esophageal Reflux: It is the upward movement of gastric contents into the esophagus.
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Cough: A way of body response when something irritates the airway or the throat.
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Regurgitation: It is the movement of swallowed food back to the mouth.
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Constipation: It happens when there are fewer bowel movements, less than three in a week. Also, the stools are hard, dry, and difficult to pass stools.
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Esophageal Carcinoma: Cancerous growth in the esophagus (a tubular structure that passes food from the mouth to the stomach)
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Chronic Phase: This phase is uncommon. However, the acute phase can progress to the chronic phase, or the symptoms may appear after decades of infection.
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It generally appears in three syndromes. And can lead to sudden death.
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Heart Failure: Failure of the heart to function properly leading to various com[locations.
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Cardiac Arrhythmia: It occurs when there is a disturbance in the electrical coordination in the heart leading to an irregular heartbeat.
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Thromboembolism: It is the obstruction or block in a blood vessel caused by a dislodged clot.
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What Are the Tests Used to Detect Chagas Cardiomyopathy?
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ELISA (Enzyme-Linked Immunoassay) Test: It is a common laboratory test to check antibodies in the blood. This test helps detect specific antibodies against Trypanosoma cruzi.
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Serologic Test: Serologic test is a scientific way to study the serum and other fluids in the body to check for antibodies. It happens in an antigen-antibody reaction during an infection.
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CRP (C-Reactive Protein): A c-reactive protein is produced in the liver and released into the bloodstream when inflammation occurs. This test measures the c-reactive protein in the blood.
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ECG (Electrocardiogram): An electrocardiogram is used to check the heart's rhythmic cation and electric conduction activity.
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Echocardiogram: An echocardiogram is a type of scanning method to check the heart’s function and its neighboring blood vessels.
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Chest X-Ray: In a chest X-ray, radiofrequency waves are projected at the chest to obtain images of the chest cavity and the organs surrounding it. Clear images of the heart, lungs, and chest wall are obtained to check for abnormalities.
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Cardiac MRI (Magnetic Resonance Imaging): In a cardiac MRI, high-frequency radio waves in a magnetic field are used to capture pictures of the heart and its surrounding structures.
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Biomarkers: Biomarkers are biological molecules present in the blood, body fluids, and tissues that indicate the occurrence of a normal or abnormal condition. BNP (brain natriuretic peptide) is commonly used as a biomarker for conditions like heart failure.
How Is Chagas Cardiomyopathy Treated?
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Antiparasitic Drugs: Antiparasitic medications like Benznidazole and Nifurtimox are recommended for parasitic infections. It reduces the activity of the parasites causing infection and reduces the symptoms.
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Anti-heart Failure Medications: Medications like renin-angiotensin-aldosterone blockers, beta-blockers diuretics, and Hydralazine and nitrate are very effective in controlling the severity of heart dysfunction. Renin-angiotensin-aldosterone blockers and beta-blockers reduce the severity of the symptoms (reduce morbidity), and diuretics (reduce mortality) reduce fatality risk.
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Antiarrhythmic Drugs: Amiodarone is an antiarrhythmic medication that treats and prevents arrhythmia.
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Pacemaker: A pacemaker is a tiny device implanted in the heart to artificially conduct electrical impulses that make the heart function so that the heart's beats must be slow.
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Heart Transplantation: Sometimes, when other means of treatment modality have not been effective, a heart transplant is done. A healthy heart from a healthy, dying donor due to a road traffic accident is replaced with a diseased heart.
What Are the Complications of Chagas Cardiomyopathy?
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Myocarditis: Inflammation of the heart muscle due to infection,
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Meningoencephalitis: Inflammation of the brain due to infection crossing the blood-brain barrier.
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Cardiomegaly: Enlargement of the heart.
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Megacolon: Enlargement or dilatation of the colon (part of the large intestine).
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Esophagitis: Enlargement or widening of the esophagus.
What Is the Prognosis of Chagas Cardiomyopathy?
The prognosis of Chagas cardiomyopathy is highly variable as it affects multiple systems. In cardiomyopathy cases, its pathological feature is complex. There is an increase of around 55 to 60 percent mortality rate in chronic Chagas cardiomyopathy.
Conclusion:
Chagas cardiomyopathy is a protozoan parasitic infection leading to inflammation of the heart and heart dysfunction. It was seen only in the Latin American population in the past, but now it has spread globally. The infection spreads from the bite of a triatomine bug that bites the human skin for blood feeding. During this process, it spreads the parasite through the bite site deep into the cells leading to infection transfer to the blood. These infections circulate through the body, leading to complications like heart failure, arrhythmias, and sudden death. Therefore, it is advisable to visit the doctor if one hails from Latin American countries and anyone in contact with them. Doing this allows the disease to be detected early, and treatment can be planned accordingly. And also, preventing the disease from spreading to other regions can be done successfully.
