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Chagas disease, a condition caused by an insect-borne parasite, can cause major health problems, including death. Yet, many people infected and at risk, and their healthcare providers, don’t know enough about the disease.
The U.S. Centers for Disease Control and Prevention estimates that about 8 million people worldwide have Chagas disease, including about 280,000 in the U.S. Many of them are unaware they are infected. The Trypanosoma cruzi parasite is transmitted in the infected feces (poop) of insects called triatomine, which are sometimes called kissing bugs. The parasite is transmitted through scratching or rubbing the eyes.
Our research at MedStar Washington Hospital Center has confirmed that Chagas disease is behind a significant portion of heart disease among patients from rural Mexico, Central America, or South America where the condition is endemic. Of 97 patients from countries with Chagas disease and heart-disease symptoms that needed a heart ultrasound, 16 were infected with the parasite that causes the disease.
Yet, almost 92% of these patients had never heard of Chagas disease, even though they came from places where it is common. Similarly, many healthcare providers are taught that they are unlikely to see patients with Chagas—highlighting an opportunity for more research and provider-patient education.
What is Chagas disease?
Chagas disease cannot be transmitted from person to person like the flu. It can pass through organ transplants, blood transfusion, and from pregnant patients to their babies.
Chagas disease has two stages. The acute phase happens right after infection. The chronic phase can last a lifetime. In the weeks or months after infection, symptoms can be mild if there are any at all. These can include:
- Body aches
- Diarrhea
- Exhaustion
- Fever
- Headache
- Lack of appetite
- Rash
- Vomiting
If the infection is in the eye, the eyelid can swell up, causing a symptom known as Romaña's sign.
Most people with chronic Chagas disease don’t have symptoms. As many as 30% of people develop serious health conditions, such as:
- Heart problems, including heart rhythm disturbances, an enlarged heart, congestive heart failure, stroke, or sudden death.
- Digestive issues, including an enlarged esophagus or colon, which can cause problems eating or using the toilet.
Diagnosis, treatment, and screening for Chagas disease.
Chagas disease can be diagnosed with a laboratory blood test. If we detect it early, antiparasitic medication can eliminate the parasite. There is no treatment for chronic Chagas disease. But it’s
important to understand who has the condition, so they can be monitored for heart and digestive problems.
While all people born in or who have lived in endemic countries should be tested for infection, it is particularly important that women of childbearing age receive screening. for Chagas disease. If a pregnant woman tests positive, we can provide curative treatment to her newborn and subsequent children. We will also know that her other family members are much more likely to have Chagas disease and can help them get care. And treatment of mom prior to her next pregnancy markedly reduces the risk of maternal-fetal transmission.
The people most at risk often face barriers to treatment, such as:
- Awareness of the disease
- Difficulty advocating for their own care
- Language barriers
- Limited financial means
Medicaid coverage was expanded during the COVID-19 pandemic, so many women from Chagas-endemic areas have better access health care when they are pregnant.
Raising awareness of Chagas disease in the U.S.
There are signs that awareness of Chagas disease is increasing, but we have more work to do. Northern Virginia is home to the largest population of Bolivian immigrants in the U.S., many of whom know about Chagas disease because it is so common there. Some young patients originally from El Salvador tell me they have learned about Chagas in school.
Yet, very few doctors have the expertise to diagnose or treat Chagas disease.
To help more people learn about it and expand treatment opportunities, I’m proud to serve as medical director for the Latin American Society of Chagas, or LASOCHA. Our goal is to provide medical services to patients in the D.C. area and to raise awareness in both the at-risk and medical communities. Since 2013, we have been working in three major areas:
- Medical services: To provide care to patients in need
- Patient advocacy: To raise awareness of Chagas and barriers to health care
- Research: To advance knowledge of Chagas in the U.S.
