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Chronic Chagas’ heart disease: a disease on its way to becoming a worldwide health problem: epidemiology, etiopathology, treatment, pathogenesis and laboratory medicine

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Abstract

Chagas’ disease, caused by Trypanosoma cruzi infection, is ranked as the most serious parasitic disease in Latin America. Nearly 30% of infected patients develop life-threatening complications, and with a latency of 10–30 years, mostly Chagas’ heart disease which is currently the major cause of morbidity and mortality in Latin America, enormously burdening economic resources and dramatically affecting patients’ social and labor situations. Because of increasing migration, international tourism and parasite transfer by blood contact, intrauterine transfer and organ transplantation, Chagas’ heart disease could potentially become a worldwide problem. To raise awareness of this problem, we reflect on the epidemiology and etiopathology of Chagas’ disease, particularly Chagas’ heart disease. To counteract Chagas’ heart disease, in addition to the general interruption of the infection cycle and chemotherapeutic elimination of the infection agent, early and effective causal or symptomatic therapies would be indispensable. Prerequisites for this are improved knowledge of the pathogenesis and optimized patient management. From economic and logistics viewpoints, this last prerequisite should be performed using laboratory medicine tools. Consequently, we first summarize the mechanisms that have been suggested as driving Chagas’ heart disease, mainly those associated with the presence of autoantibodies against G-protein-coupled receptors; secondly, we indicate new treatment strategies involving autoantibody apheresis and in vivo autoantibody neutralization; thirdly, we present laboratory medicine tools such as autoantibody estimation and heart marker measurement, proposed for diagnosis, risk assessment and patient guidance and lastly, we critically reflect upon the increase in inflammation and oxidative stress markers in Chagas’ heart disease.

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Notes

  1. The disease was named in honour of the Brazilian physician Carlos Chagas (born in 1879 in Oliveira, died in 1934 in Rio de Janeiro) who, in 1909, discovered a new trypanosome species in the intestine of the triatomine bug, which he named T. cruzi in honour of his mentor Oswaldo Cruz. A biographical sketch of Carlos Chagas was recently published in memory of the discovery of T. cruzi 100 years before (Moncayo A (2010) Carlos Chagas: biographical sketch. Acta Trop 115:1–4).

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Acknowledgments

We are grateful to “Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin” and “Europäischer Fonds für regionale Entwicklung” for supporting S.G. Munoz Saravia.

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  1. Santa Barbara Hospital Sucre, Sucre, Bolivia

    Silvia Gilka Muñoz-Saravia

  2. Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Silvia Gilka Muñoz-Saravia, Annekathrin Haberland, Gerd Wallukat & Ingolf Schimke

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  1. Silvia Gilka Muñoz-Saravia
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Correspondence to Ingolf Schimke.

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Muñoz-Saravia, S.G., Haberland, A., Wallukat, G. et al. Chronic Chagas’ heart disease: a disease on its way to becoming a worldwide health problem: epidemiology, etiopathology, treatment, pathogenesis and laboratory medicine. Heart Fail Rev 17, 45–64 (2012). https://doi.org/10.1007/s10741-010-9211-5

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