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Chagas: the Sleeping Giant Awakens :

April 5, 2016

As you leaf through April’s Pediatrics in Review, please do not skim past the very important article on Chagas disease by Tustin and Bowman.  Chagas disease should receive the same level of awareness and respect...

As you leaf through April’s Pediatrics in Review, please do not skim past the very important article on Chagas disease by Tustin and Bowman. Chagas disease should receive the same level of awareness and respect that we now give to HIV/AIDS, according to Dr. Three species of kissing bugs that can be found in Texas (from left): Triatoma sanguisuga, Triatoma gerstaeckeri, Triatoma protracta. (Photo: Gabriel L. Hamer)Three species of kissing bugs that can be found in Texas (from left): Triatoma sanguisuga, Triatoma gerstaeckeri, Triatoma protracta. (Photo: Gabriel L. Hamer)Hotez, et al (1). It is an epidemic in the making.

In Central and South America, it is estimated that as many as 8 million people are afflicted with Chagas, and the sad reality is that even decades later, more than 1 million of affected people will manifest heart disease, including dilated cardiomyopathy and potentially fatal ventricular tachyarrhythmia. Then it is too late.

Romaña's sign, the swelling of the child's eyelid, is a marker of acute Chagas disease. The swelling is due to bug feces being accidentally rubbed into the eye, or because the bite wound was on the same side of the child's face as the swelling. Photo courtesy of WHO/TDR. Romaña's sign, the swelling of the child's eyelid, is a marker of acute Chagas disease. The swelling is due to bug feces being accidentally rubbed into the eye, or because the bite wound was on the same side of the child's face as the swelling. Photo courtesy of WHO/TDR. As pediatricians, we had best pay close attention to Tustin and Bowman’s article and at least think about Chagas when a newborn or outpatient presents with low birth weight, respiratory distress, large liver and spleen as well as effusions. Don’t overlook Chagas when considering sepsis. In the older child, unilateral palpebral edema may be a unique physical finding associated with the disease (Romaña sign). And when you adopt that cute little puppy from Mexico, be aware that the Trypanosome can be carried by the animal as a vector to humans.

Chagas disease is an awakening giant and, with the increased travel within the Americas, it will not be restricted just to Border States, such as here in Texas. It can spread throughout the nation.

Consider the awakening giant, Chagas, when you see a patient with findings consistent with the disease.

1.Hotez PJ, Bottazzi ME, Franco-Paredes C, Ault SK, Periago MR (2008) The Neglected Tropical Diseases of Latin America and the Caribbean: A Review of Disease Burden and Distribution and a Roadmap for Control and Elimination. PLoS Negl Trop Dis. 2008;2(9): e300. doi:10.1371/journal.pntd.0000300
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