UNIVERSITY OF GUYANA

IMMUNOHAEMATOLOGY AND BLOOD BANKING I

CHAGAS DISEASE
(Trypanosomiasis )
PRESENTERS: THEONA DA
COSTA
MARLYN BOUYEA
HEERMALA KALIKA

PUJAA NARINE
 OBJECTIVES

• What is Chagas Disease

• Clinical Manifestations
• Pathology
• Epidemiology
• Transmission
• Laboratory Diagnosis
• Prophylaxis
• Treatment
 WHAT IS CHAGAS DISEASE?

• Chagas disease or American trypanosomiasis is caused by the parasite

Trypanosoma cruzi.
• The organism T. Cruzi and infection in humans were first described in 1909 by
the Brazilian physician Carlos R. J. Chagas.
• T. cruzi is flagellated obligate intracellular protozoan found mostly in blood-
sucking triatomine insects
 THE TRIATOMINE BUG

• Also known as the “kissing” bug or reduviid bug

• Thrives under poor housing conditions (for
example, mud walls, thatched roofs)
• In endemic countries people living in rural areas
are at greatest risk for acquiring the infection

Retrieved from: https://medicalxpress.com/news/2014-08-specialists-vaccine-chagas-disease-years.html

 ACUTE PHASE
• Occurs immediately after infection
• May last up to a few weeks or months
• Parasites may be found in the circulating blood
• Infection may be mild or asymptomatic
• Immune system triggers an inflammed skin (chagoma) or conjunctiva (Romana’s sign)
• Fever, headache, joint and muscle ache, lymph node enlargement, hepatosplenomegaly
and convulsion
• Rarely, acute infection may result in severe inflammation of the brain and lining around
the brain.
 TRIPOMASTIGOTE IN BLOODSTREAM

Retrieved from: https://www.aol.com/article/news/2018/08/23/chagas-disease-spreading-and-causing-heart-problems/23508010/

 ROMANA’S SIGN

Retrieved from: https://www.reddit.com/r/Pathognomonic/comments/2bwvap/roma

%C3%B1a_sign_chagas_disease_trypanosoma_cruzi/
 CHAGOMA

Retrieved from: https://slideplayer.com/slide/9302413/28/images/19/T.+cruzi+causes+cutaneous+stage+%28chagoma%29.jpg

 INTERMEDIATE PHASE

• In this phase persons serve as a reservoir for T. cruzi

• There are no signs and symptoms of Chagas disease
• Persons may have the same life expectancy as non-infected persons
• Positive serological test for IgG
 CHRONIC PHASE
• Starts 2 months after initial infection
• 20 - 30% of infected people will develop medical problems
• Heart rhythm abnormalities
• Thromboembolism
• A dilated heart
• Dilated oesophagus which alters oesophageal motility leading to difficulty in
swallowing, regurgitation of ingested food and epigastralgia
• Megacolon due to constipation which leads to dilatation and the thickening of the
sigmoid colon and rectum causing pain and discomfort.
 DILATED HEART

Retrieved from: https://www.studyblue.com/notes/note/n/cardiomyopathy-and-heart-failure/deck/3232147

 EPIDEMIOLOGY

• Rendered a rural area disease

• Deforestation, urbanization and socio-economic changes caused the disease to

spread to urbanized areas

• Spread by migration, adoption and travelers

• Found mostly in Latin America

• Approximately 8 million persons infected worldwide (10,000 deaths per year)

 TRANSMISSION

• Being bitten by the bug

• Consumption of food contaminated with infected bugs

• Blood or blood product transfusion from infected donors

• From an infected mother to her newborn during pregnancy or childbirth

• Organ transplants using organs from infected donors

• Laboratory accidents
 LABORATORY DIAGNOSIS

• Acute infection:
-Parasite detection in blood smears
-Immunofluorescence tests
• Chronic infection:
-Xenodiagnosis
-Enzyme-Linked Immunosorbent Assay (ELISA).
 LABORATORY DIAGNOSIS
PERIPHERAL BLOOD SMEAR

• Examination of a thin and thick peripheral blood smear stained

with Giemsa/Wright’s stain.
• Direct visualization of parasites under a microscope.
• Blood smears allow morphologic characterization of the parasite and
differentiation from other trypanosomes
 LABORATORY DIAGNOSIS
MICROSCOPY
The trypomastigote is the infective flagellated form of the parasite found in the
blood of its hosts.

Retrieved from: https://emedicine.medscape.com/article/214581-overview

 LABORATORY DIAGNOSIS
IMMUNOFLUORESCENCE ANTIBODY TEST

• Which is based on the use of specific antibodies which

have been chemically conjugated to fluorescent dyes.
• IgM antibodies are usually associated with the early onset
phase of an infection (acute),
• while  IgG  is generally associated with long-term
immunity or reactivity towards a pathogen (chronic).

Retrieved from: http://fullerlaboratories.com/products/veterinary/international/iv-trypanosoma/

 LABORATORY DIAGNOSIS
XENODIAGNOSIS

• Used in the latent or chronic phase of the disease

• Nymph vectors (immature forms) or uninfected triatomine bugs which are bred
in the laboratory and fed with T. cruzi infected blood.
• After 4 to 6 weeks, the gut of the insect and its contents are examined
microscopically for the presence of T. cruzi.
 LABORATORY DIAGNOSIS
XENODIAGNOSIS FOR CHAGAS DISEASE

Retrieved from:https://theconversation.com/explainer-what-is-chagas-disease-40047
 LABORATORY DIAGNOSIS
ENZYME LINKED IMMUNOSORBENT ASSAY (ELISA)

The basis of the test is to detect patient antibodies against T. cruzi antigens. This
serological test is a reaction in which an enzyme gives a colorful result if the
serum sample has the target anti-body.
-Abs in patient’s serum binds to Ags in test well during incubation
-Enzyme complex binds to Ag-Ab complex during second incubation
-Unbound enzymes are removed through washing
-Substrate is added in the presence of enzyme complex and peroxide
-As a result of the combination- substrate color turns blue
 PROPHYLAXIS

• There is no vaccine to prevent Chagas disease.

• There are preventive measures that can be taken. They are classed as:
Primary Prevention
 Secondary Prevention
 TREATMENT

• Benznidazole
• Nifurtimox
 REFERENCES
• CHAGAS DISEASE (AMERICAN TRYPANOSOMIASIS). [ONLINE]. RETRIEVED FROM:
HTTPS://EMEDICINE.MEDSCAPE.COM/ARTICLE/214581-OVERVIEW#SHOWALL ACCESSED 8TH OCTOBER, 2019.
• ANTONIO R. L. TEIXEIRA, MARIANA M. HECHT, MARIA C. GUIMARO, ALESSANDRO O. SOUSA, AND NADJAR NITZ. (2011). PATHOGENESIS
OF CHAGAS’ DISEASE: PARASITE PERSISTENCE AND AUTOIMMUNITY. CLINICAL MICROBIOLOGY REVIEWS, 24(3): 592-630.
• FERREIRA AW, ÁVILA S. LABORATORY DIAGNOSIS OF CHAGAS' HEART DISEASE. SAO PAULO MEDICAL JOURNAL. 1995; 113 (2).
• CHAGAS DISEASE (AMERICAN TRYPANOSOMIASIS) WORKUP. MEDSCAPE. [INTERNET] RETRIEVED OCTOBER 08, 2019 FROM:
HTTPS://EMEDICINE.MEDSCAPE.COM/ARTICLE/214581-WORKUP#C5
• DBBM.FIOCRUZ.BR. (2019). EPIDEMIOLOGY OF CHAGAS DISEASE. [INTERNET] RETRIEVED OCTOBER 6, 2019 FROM:
HTTP://WWW.DBBM.FIOCRUZ.BR/TROPICAL/CHAGAS/CHAPTER4.HTML [ACCESSED].
• AGUILAR, H., ABAD-FRANCH, F., DIAS, J., JUNQUEIRA, A. AND COURA, J. (2019). CHAGAS DISEASE IN THE AMAZON REGION
• WORLD HEALTH ORGANIZATION. (2019). EPIDEMIOLOGY. [INTERNET] RETRIEVED OCTOBER 6, 2019 FORM:
HTTPS://WWW.WHO.INT/CHAGAS/EPIDEMIOLOGY/EN/
• WILTON H. KAWAGUCHI, LETICIA BONANCIO CERQUEIRA, MARIANA MILLAN FACHI, MICHEL L. CAMPOS, IARA J. MESSIAS REASON
AND ROBERTO PONTAROLO. 2018. EFFICACY AND SAFETY OF CHAGAS DISEASE DRUG THERAPY AND TREATMENT PERSPECTIVES. 121-
151.
• CHAGAS DISEASE PREVETION. EPOCRATES. [INTERNET] RETRIEVED OCTOBER 7, 2019 FROM
HTTPS://ONLINE.EPOCRATES.COM/DISEASES/1160/CHAGAS-DISEASE
• WORLD HEALTH ORGANIZATION. (2019). EPIDEMIOLOGY. [ONLINE] AVAILABLE AT:
HTTPS://WWW.WHO.INT/CHAGAS/EPIDEMIOLOGY/EN/ [ACCESSED 6 OCT. 2019].