Within the framework of World Chagas Disease Day , which is commemorated this April 14 , and due to the high number of people at risk of suffering from this disease in the country, the Argentine Society of Cardiology (SAC) recommended to those who live in endemic areas or have an infected family member, make a medical consultation in order to verify if they also contracted the disease and thus prevent serious cardiological disorders that the infection can cause in the long term.
According to the Consensus on Chagas Disease prepared in 2019 by the SAC itself, and based on figures estimated by the Pan American Health Organization (PAHO), in Argentina there are approximately 7 million people at risk of becoming infected. 1,500,000 already infected with the parasite that causes chagas ( Trypanosoma Cruzi ) and between 350,000 and 500,000 who have already developed heart disease linked to the progression of the disease.
Currently, the vinchuca is found in 10 Argentine provinces : Catamarca, Chaco, Córdoba, Formosa, Jujuy, La Rioja, Mendoza, Salta, San Juan and Santiago del Estero, detailed the Ministry of Health of the Nation in Epidemiological Bulletin No. 616 August 2022.
Meanwhile, as of the date of that bulletin, another 9 had obtained PAHO certification of interruption of Chagas vector transmission: Corrientes, Entre Ríos, La Pampa, Misiones, Neuquén, Río Negro, Santa Fe, San Luis and Tucumán .
“The number of potentially infected people includes both those who are infected and do not yet know it, as well as those people who, because they have a direct family member with the disease or live in an endemic area, there is a possibility that they will become infected at some point. All of them should evaluate the possibility of undergoing a study to prevent or diagnose it before symptoms appear,” explained Dr. Ahmad Sabra , cardiologist, specialist in cardiology clinic and therapist, Director of the Chagas Council of the Argentine Society of Cardiology ( SAC).
To know if a person contracted the disease, a specific serological study for Chagas must be performed , that is, a blood test that detects the antibodies generated by the organism due to the presence of the parasite that causes the disease, Trypanosoma Cruzi.
In individuals without symptoms, there are different techniques to detect specific Chagas antibodies, among which the Elisa test stands out; The SAC Consensus recommends, in all cases, performing more than one test.
If the analysis is positive, “in children up to 13 years old, antiparasitic treatment is curative, because it eliminates the parasite from the body; After this age, the possibility of performing it decreases,” said Dr. Damián Holownia , cardiologist, specialist in vascular echo-doppler, echocardiogram and oncological cardiology and member of the Argentine Society of Cardiology.
One of the forms of transmission of Chagas is vector, through the bite of the insect popularly known as vinchuca, of which the species ’ Triatoma infestans ’ predominates in the Southern Cone of Latin America.
“Another form of contagion is vertical or transplacental, that is, from the pregnant mother to the child at any time during the pregnancy. For this reason, National Law 26,281 establishes that free Chagas tests can be done for all pregnant women and newborns,” said Holownia.
Law 26,281, approved by the National Congress in 2007, assigned a priority within the policies of the Ministry of Health to the “prevention and control of all forms of transmission of Chagas disease, until its definitive eradication” in the country. The standard establishes the performance and notification of diagnostic tests in all pregnant women, in newborns, children of infected mothers up to the first year of life, and in the rest of the children under 14 years of age of the same mothers, with controls particularly at 6 and 12 years of age.
Dr. Holownia , who works in the province of Tucumán, also maintained that in recent years vector contagion has decreased, while “transmission during pregnancy allows the disease to reach places where the vector (vinchuca) does not exist,” due to their migration.”
In addition to the forms already mentioned, there is also transmission through blood transfusion or organ transplant from an infected donor, “but this type of transmission, thanks to current controls, has greatly decreased,” Holownia commented. “A special parenthesis are immunosuppressed patients who at some point were in contact with Chagas, who are prone to reactivation and suffer its complications. Those can be the most complicated cases,” he added.
In the first days after infection, this disease presents an acute phase characterized by a high number of parasites in the blood and manifests itself with symptoms such as fever, swollen glands, abdominal, headache, muscle or chest pain, as well as nausea, diarrhea or vomiting.
After this stage, which can last for a few days or a few weeks, the chronic phase follows, which does not present symptoms and can last for years, decades or a lifetime, since a percentage will never develop symptoms. However, it is estimated - as reported by PAHO - that 10% of people will present digestive damage and 30%, potentially very severe cardiological conditions.
Cardiological damage caused by Chagas can be “any type of arrhythmia - whether high or low frequency -, heart failure and sudden death. Chagas is one of the pathologies that causes the most sudden death,” Sabra warned.
Chagas treatment generally includes a combination of two antiparasitics that, administered early, are usually curative, while in older people they help delay the progression and complications of the disease.
For those who already have heart conditions, other drugs are incorporated into the treatment, which act against the symptoms, eventually also including the placement of pacemakers or other devices to control the heart rhythm and even different surgical interventions according to the needs of each case. particular. Digestive complications are treated with dietary modifications and/or corticosteroid medications, among others.
According to figures from the Directorate of Health Statistics and Information (DEIS), dependent on the Ministry of Health of the Nation, in 2020 324 people died from Chagas, which represents almost one death per day . But specialists emphasize that this figure may be far below reality, since the deaths of those infected are caused by heart disease, such as heart failure or sudden death, and are recorded in this way, without subsequently investigating whether the person I had Chagas.
"For all this, it is key to work on asymptomatic patients, since this allows us to monitor the patient more strictly, with more frequent controls and, for example, detect an arrhythmia before it becomes a major disorder or other incipient alterations. that show possible complications that the individual may develop in the future,” concluded Dr. Sabra.
