1. Aaron Manning

2. Overview Also called American trypanosomiasis and the Kiss of Death A tropical parasitic disease caused by the flagellate protozoan Trypanosoma cruzi. Spread to humans through the bite of an insect vector

3. Signs and Symptoms Acute Stage Nonspecific symptoms i.e. fever, diarrhea, vomiting Swelling and inflammation Romaña's sign

4. Signs and Symptoms Chronic Stage About 30% develop medical problems Cardiac damage Digestive system damage Neurological disorders Potentially fatal if untreated

5. Diagnosis T. cruzi in blood smears PCR to ID strains

6. Discovery Brazilian physician Carlos Chagas - 1909 Chagas’ work unique Darwin

7. Epidemiology 1960s 16–18 million people affected as of 2008 ~100 million at risk Kills around 20,000 annually

8. 18 countries from US to Argentina Occurs almost exclusively in rural areas Why?

9. The Vector Blood-sucking insects of the subfamily Triatominae vinchuca, barbeiro, chinche, the kissing bug

10. Transmission A triatomine becomes infected Hides during day Emerges at night Bites, feeds, then defecates

11. Transmission Scratching Blood transfusions, organ transplants, or breast milk Congenital Transmission 13% of stillborn deaths in parts of Brazil

12. T. Cruzi Life Cycle

13. Clinical Manifestations Cell death in target tissues Inflammatory response

14. Treatment and Prevention

15. Prevention Most effective approach Insecticides Improving housing conditions Testing of blood donors No vaccine

16. Treatment and Management Two approaches Antiparasitic treatment Symptomatic treatment

17. Antiparasitic Treatment Most effective early Drugs include azole or nitro derivatives Resistance

18. Symptomatic Treatment Disease cannot be cured in chronic phase Managing the clinical manifestations Pacemakers and anti-arrhythmia drugs Surgery for megaintestine. Heart transplantation surgery

19. On the Horizon New Drugs New vaccines being tested Stem cell therapy

20. Resources Antonio RL Teixeira; Nascimento; Sturm. Evolution and pathology in Chagas disease - a review. Mem. Inst. Oswaldo Cruz vol.101 no.5 Rio de Janeiro Aug. 2006 Centers for Disease Control. http://www.cdc.gov/chagas/ Prata A. Clinical and epidemiological aspects of Chagas disease. Lancet Infect Dis. 2001 Sep;1(2):92-100. Vanessa Leiria Campo, Carvalho, Allman, Davis and Robert A. Field. Chemical and chemoenzymatic synthesis of glycosyl-amino acids and glycopeptides related to Trypanosoma cruzi mucins Org. Biomol. Chem., 2007, 5, 2645 Wikipedia. http://en.wikipedia.org/wiki/Chagas_disease World Health Organization. www.who.int/tdr/svc/diseases/chagas