(Chagas Disease)

Patients can have acute or chronic disease. The early phase of this disease commonly is asymptomatic. However, children are more likely to exhibit symptoms than are adults. In some patients, a red nodule known as a chagoma develops at the site of the original inoculation, usually on the face or arms. The surrounding skin becomes indurated and, later, hypopigmented. Unilateral firm edema of the eyelids, known as Romaña sign, is the earliest indication of the infection when the portal of entry is the conjunctiva; it is not always present. The edematous skin is violaceous and associated with conjunctivitis and enlargement of the ipsilateral preauricular lymph node. A few days after appearance of Romaña sign, fever, generalized lymphadenopathy, and malaise can develop. In rare instances, acute myocarditis, hepatosplenomegaly, edema, and meningoencephalitis can follow. In nearly all cases, acute Chagas disease resolves after 1 to 3 months, and an asymptomatic or indeterminate period follows. In 20% to 30% of cases, serious sequelae, consisting of cardiomyopathy, megaesophagus, and/or megacolon, develop many years after the initial infection (chronic phase). Cardiomyopathy causes conduction system abnormalities, arrhythmias, and eventually congestive heart failure. Patients with Chagas cardiomyopathy may die suddenly from ventricular arrhythmias or complete heart block or may die from intractable congestive heart failure or embolic phenomena. Congenital disease may be characterized by low birth weight, hepatosplenomegaly, and/or meningoencephalitis with seizures and tremors, but most infants infected in utero have no signs or symptoms of disease. Reactivation may occur, especially in immunocompromised people, including people infected with human immunodeficiency virus and those who are immunosuppressed after transplantation.