South American trypanosomiasis

Discuss the cardiovascular complications of chronic South American trypanosomiasis. 

Space constraints do not allow detailed discussions of the world of parasites, and clinicians and students are directed to some excellent resources for further details on parasites and parasitic diseases.1,2 Discussion in this chapter will include those parasitic diseases that are more likely to be seen in the United States and will include gastrointestinal parasites (primarily giardiasis and amebiasis), protozoan infections (malaria and South American trypanosomiasis), some common helminthic... 

Chagas disease, the South American variety of trypanosomiasis, is caused by Trypanosoma cruzi. It is quite different from African trypanosomiasis in its clinical and pathological presentation and in its failure to respond to many agents effective in that disease. It has both an acute and chronic phase. The latter frequently results in gastrointestinal and myocardial disease that ends in death. 

Nifurtimox (Lampit, Bayer 2502) South American trypanosomiasis Gl Anorexia, nausea CNS Peripheral neuritis, psychosis Hemat Hemolysis in GOPD deficiency patients Monitor pulmonary function and hematologic parameters 24, 74, 76... 

T. cruzi (South American trypanosomiasis, Chagas disease)... 

Chagas disease, the South American form of trypanosomiasis, is unaffected by any of the above drugs, but both acute and chronic cases respond well to a nitrofuran, nifurtimox (6.20) (Tampit ) (Bock et al., 1972). If irreversible organic lesions have not yet occurred, the cure rate is high. 

The South American form of trypanosomiasis is due to the parasite T, cruzi and is responsible for Chagas disease, which afflicts up to twenty million people and for which there is no known effective therapy. The status of chemotherapeutic agents has been reviewed [100]. The ethidium tetrachloroplatinate complex mentioned above has curative activity in mice, probably for the same reasons as in T, rhodesiense — increased dose due to less toxicity [101]. Early reports of the ability of cisplatin to inhibit infectivity were not substantiated [102] and are incorrect [103]. A survey of metal complexes for in vitro activity showed some complexes with positive results [104] and the mode of interaction studied [105]. The ability to inhibit motility does not, however, imply ability to stop reproduction. Indeed, a general problem with parasites is that, although bloodstream forms are more easily studied, the reproductive forms are intracellular. 

American trypanosomiasis, known as Chagas Disease, is limited to South and Central America, where it affects 16—18 million people aimuaHy in an area where 90 million are at risk. Although only an estimated 1% of infected individuals contract the disease, poverty and poor housing exacerbate it. There is a particularly high incidence of the disease in children. 

T. cruzi is the agent that causes American trypanosomiasis. American trypanosomiasis is transmitted by a number of species of a reduviid bug (Triatoma infestans, Rhodrium prolixus) that live in wall cracks of houses in rural areas of North, Central, and South America. 

American trypanosomiasis, or Chagas disease, is caused by Trypanosoma cruzi. It affects -20 million people from Mexico to South America, where the chronic form of the disease is a major cause of cardiomyopathy, megaesophagus, megacolon, and death. Bloodsucking triatomid bugs most commonly transmit this infection to young children transplacental transmission also may occur in endemic areas. 

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