Management 

As with diagnosis, management of Chagas disease is dependent on the phase of infection, as well as the age of the person infected.11 In all patients presenting with acute Chagas disease, and in patients younger than 18 years with chronic Chagas disease, the CDC recommends treatment with an antiparasitic agent, specifically nifurtimox or benznidazole.  Additionally, antiparasitic treatment should be considered in patients with chronic infection who are younger than 50 years and without advanced Chagas cardiomyopathy.11 In patients with chronic Chagas disease who are 50 years of age or older, use of antiparasitic treatment should only be considered if potential benefits outweigh the risks.11 


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The antiparasitic agents used to treat infection with T cruzi, nifurtimox and benznidazole, are not approved by the FDA and are only available through the CDC.11 Side effects of both drugs include anorexia and weight loss, and both are contraindicated in individuals with severe hepatic and/or renal disease.  Safety has not been established in infants of breastfeeding women, so current recommendations are to withhold treatment while breastfeeding.11 Efficacy of these antiparasitic agents is measured via anti-T cruzi antibody titers; however, reduction in these titers may take many years, resulting in insensitive and lengthy measurement of treatment success.12

Antiparasitic treatment should not be considered in patients with chronic infection who have developed cardiac or gastrointestinal symptoms.10 Management of patients exhibiting cardiac, gastrointestinal, and/or neurologic symptoms includes referral to an appropriate specialist.10

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Conclusion

The outcomes associated with Chagas disease can be devastating if the infection is not diagnosed and managed appropriately.  Practitioners serving large populations of Latin American immigrants and other persons traveling from Latin American countries where Chagas is endemic should be aware of the risk for infection with the T cruzi parasite.  If acute infection is suspected, prompt diagnosis and treatment are necessary to prevent progression to chronic disease and potential life-threatening associated illnesses.  If patients present to their practitioner with chronic infection, appropriate referrals should be made. 

REFERENCES

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  7.  Mayo Clinic. Chagas disease. 2014. https://www.mayoclinic.org/diseases-conditions/chagas-disease/symptoms-causes/syc-20356212. Accessed November 20, 2016.
  8. World Health Organization. Chagas disease (American trypanosomiasis). 2016http://www.who.int/mediacentre/factsheets/fs340/en/. Accessed November 21, 2016.
  9. Bern C, Weller PF, Baron EL. Chagas disease: natural history and diagnosis. 2016. UpToDate (Topic 14005, Version 18.0). Accessed November 20, 2016.
  10. Kirchoff LV. Chagas disease (American trypanosomiasis). 2016. https://www.clinicaladvisor.com/home/decision-support-in-medicine/infectious-diseases/trypanosoma-american/. Accessed November 21, 2016.
  11. Centers for Disease Control and Prevention. American trypanosomiasis2013. http://www.cdc.gov/dpdx/trypanosomiasisAmerican/dx.html. Accessed November 20, 2015.
  12. Viotti R, Noya A, Araujo-Jorge T, et al. Towards a paradigm shift in the treatment of chronic Chagas diseaseAntimicrob Agents Chemother. 2014;58(2):635-639.