Chagas disease - Knowledge (XXG)

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Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela. In endemic areas, due largely to vector control efforts and screening of blood donations, annual infections and deaths have fallen by 67% and more than 73% respectively from their peaks in the 1980s to 2010. Transmission by insect vector and blood transfusion has been completely interrupted in Uruguay (1997), Chile (1999), and Brazil (2006), and in Argentina, vectorial transmission had been interrupted in 13 of the 19 endemic provinces as of 2001. During Venezuela's

53: 1505: 5164: 1316: 864: 1660: 1133: 1514: 689: 653: 396: 1809:, then various locations in Argentina, then national-level programs across Latin America. These programs received a major boost in the 1980s with the introduction of pyrethroid insecticides, which did not leave stains or odors after application and were longer-lasting and more cost-effective. Regional bodies dedicated to controlling Chagas disease arose through support of the 955:. In the heart, this may contribute to arrythmias and other cardiac dysfunction. In the colon and esophagus, loss of nervous system control is the major driver of organ dysfunction. Loss of nerves impairs the movement of food through the digestive tract, which can lead to blockage of the esophagus or colon and restriction of their blood supply. 1771:, the disease was widely referred to as "Chagas disease". Chagas' discovery brought him national and international renown, but in highlighting the inadequacies of the Brazilian government's response to the disease, Chagas attracted criticism to himself and to the disease that bore his name, stifling research on his discovery and likely 1389:, and are generally reversed when treatment is stopped. However, benznidazole is discontinued in up to 29% of cases. Nifurtimox has more frequent side effects, affecting up to 97.5% of individuals taking the drug. The most common side effects are loss of appetite, weight loss, nausea and vomiting, and various 680:

host cell and are released into the bloodstream. Trypomastigotes then disseminate throughout the body to various tissues, where they invade cells and replicate. Over many years, cycles of parasite replication and immune response can severely damage these tissues, particularly the heart and digestive tract.

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In 2019, an estimated 6.5 million people worldwide had Chagas disease, with approximately 173,000 new infections and 9,490 deaths each year. The disease resulted in a global annual economic burden estimated at US$ 7.2 billion in 2013, 86% of which is borne by endemic countries. Chagas disease results

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Though Chagas is traditionally considered a disease of rural Latin America, international migration has dispersed those with the disease to numerous non-endemic countries, primarily in North America and Europe. As of 2020, approximately 300,000 infected people are living in the United States, and in

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was widespread across Latin America. This, combined with successes eliminating the malaria vector through insecticide use, spurred the creation of public health campaigns focused on treating houses with insecticides to eradicate triatomine bugs. The 1950s saw the discovery that treating blood with

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forms called trypomastigotes enter the bloodstream and invade various host cells. Inside a host cell, the parasite transforms into a replicative form called an amastigote, which undergoes several rounds of replication. The replicated amastigotes transform back into trypomastigotes, which burst the

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Chagas disease affected approximately 68,000 to 123,000 people in Europe as of 2019. Spain, which has a high rate of immigration from Latin America, has the highest prevalence of the disease. It is estimated that 50,000 to 70,000 people in Spain are living with Chagas disease, accounting for the

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In addition to classical vector spread, Chagas disease can be transmitted through consumption of food or drink contaminated with triatomine insects or their feces. Since heating or drying kills the parasites, drinks and especially fruit juices are the most frequent source of infection. This oral

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The endemic area of Chagas disease stretches from the southern United States to northern Chile and Argentina, with Bolivia (6.1%), Argentina (3.6%), and Paraguay (2.1%) exhibiting the highest prevalence of the disease. Within continental Latin America, Chagas disease is endemic to 21 countries:

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were the antiparasitic drugs of choice for treating Chagas disease, though benznidazole is the only drug available in most of Latin America. For either drug, treatment typically consists of two to three oral doses per day for 60 to 90 days. Antiparasitic treatment is most effective early in the

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in Latin American countries undergo Chagas screening. Widespread screening is also common in non-endemic nations with significant populations of immigrants from endemic areas, including the United Kingdom (implemented in 1999), Spain (2005), the United States (2007), France and Sweden (2009),

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to encourage multiplication of the parasite. It can take up to six months to obtain the result. Xenodiagnosis involves feeding the blood to triatomine insects, then examining their feces for the parasite 30 to 60 days later. These methods are not routinely used, as they are slow and have low

349:, which usually cure the disease if given shortly after the person is infected, but become less effective the longer a person has had Chagas disease. When used in chronic disease, medication may delay or prevent the development of end-stage symptoms. Benznidazole and nifurtimox often cause 1520:

due to Chagas disease in 2016. Grey indicates no data. Otherwise, colors get increasingly dark red for each order of magnitude increase in DALY burden: 0, white. Up to 1,000 DALYs, yellow. 1,001 to 10,000 DALYs, orange. 10,001 to 100,000 DALYs, light red. Greater than 100,000 DALYs, dark

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from 50 to 80% of people in the acute phase (WHO: "nearly 100 %"), but only 20–60% of those in the chronic phase. Treatment of chronic disease is more effective in children than in adults, and the cure rate for congenital disease approaches 100% if treated in the first year of life.

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recommends screening all children born to infected mothers to prevent congenital infection from developing into chronic disease. Similarly to blood transfusions, many countries with endemic Chagas disease screen organs for transplantation with serological tests.

353:, including skin disorders, digestive system irritation, and neurological symptoms, which can result in treatment being discontinued. New drugs for Chagas disease are under development, and while experimental vaccines have been studied in animal models, a human 807:

route of transmission has been implicated in several outbreaks, where it led to unusually severe symptoms, likely due to infection with a higher parasite load than from the bite of a triatomine bug—a single crushed triatomine in a food or beverage harboring

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Epidemiology of Chagas disease circa 2011: red is endemic countries where spread is through vectors; yellow is endemic countries where spread is occasionally through vectors; blue is non-endemic countries where spread is through blood transfusions and

4863:"Nova tripanozomiase humana: Estudos sobre a morfolojia e o ciclo evolutivo do Schizotrypanum cruzi n. gen., n. sp., ajente etiolojico de nova entidade morbida do homem [New human trypanosomiasis. Studies about the morphology and life-cycle of 1639:, but local transmission is possible. Eleven triatomine species are native to the United States, and some southern states have persistent cycles of disease transmission between insect vectors and animal reservoirs, which include woodrats, possums, 5250: 5235: 5220: 1357:

does not cure the cardiac and gastrointestinal damage caused by chronic Chagas disease, so these conditions must be treated separately. Antiparasitic treatment is not recommended for people who have already developed dilated cardiomyopathy.

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bringing people into closer contact with triatomines and altering the distribution of triatomine species. Orally transmitted Chagas disease is of particular concern in Venezuela, where 16 outbreaks have been recorded between 2007 and 2018.

1044:(PCR). In acute and congenital Chagas disease, PCR is more sensitive than microscopy, and it is more reliable than antibody-based tests for the diagnosis of congenital disease because it is not affected by transfer of antibodies against 1565:

region, the main vector lives in and around human homes. In Central America and Mexico, the main vector species lives both inside dwellings and in uninhabited areas. In both zones, Chagas occurs almost exclusively in rural areas, where

376:, and most do not realize they are infected. Large-scale population migrations have carried Chagas disease to new regions, which include the United States and many European countries. The disease affects more than 150 types of animals. 1651:

majority of European cases. The prevalence varies widely within European countries due to differing immigration patterns. Italy has the second highest prevalence, followed by the Netherlands, the United Kingdom, and Germany.

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to limit exposure to triatomine bugs. Insecticide-spraying programs have been the mainstay of vector control, consisting of spraying homes and the surrounding areas with residual insecticides. This was originally done with

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in 1909 after examining a two-year-old girl with fever, swollen lymph nodes, and an enlarged spleen and liver. Upon examination of her blood, Chagas saw trypanosomes identical to those he had recently identified from the

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as well. In just two years, 1908 and 1909, Chagas published descriptions of the disease, the organism that caused it, and the insect vector required for infection. Almost immediately thereafter, at the suggestion of

1279:-infected mothers during pregnancy reduces the risk of congenital transmission of the infection. To this end, many countries in Latin America have implemented routine screening of pregnant women and infants for 1216:), treatment of domesticated animals (which are also fed on by triatomine bugs) with pesticides, pesticide-impregnated paints, and other experimental approaches. In areas with triatomine bugs, transmission of 1096:

large numbers of people and testing people who cannot access healthcare facilities, but their sensitivity is relatively low, and it is recommended that a second method is used to confirm a positive result.

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Bestetti RB, Martins CA, Cardinalli-Neto A (May 2009). "Justice where justice is due: A posthumous Nobel Prize to Carlos Chagas (1879–1934), the discoverer of American Trypanosomiasis (Chagas' disease)".

1477:, they are monitored using PCR to detect reactivation of the disease. People with Chagas disease who undergo heart transplantation have higher survival rates than the average heart transplant recipient. 411:

stage, which develops over many years. The acute stage is often symptom-free. When present, the symptoms are typically minor and not specific to any particular disease. Signs and symptoms include fever,

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Alarcón de Noya B, Noya Gonzáles O (9 September 2019). "Orally Transmitted Chagas Disease: Biology, Epidemiology, and Clinical Aspects of a Foodborne Infection". In Marcelo Altcheh J, Freilij H (ed.).

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As of 2018, standard diagnostic tests for Chagas disease were limited in their ability to measure the effectiveness of antiparasitic treatment, as serological tests may remain positive for years after

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While the rate of vector-transmitted Chagas disease has declined throughout most of Latin America, the rate of orally transmitted disease has risen, possibly due to increasing urbanization and

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During chronic Chagas disease, long-term organ damage develops over years due to continued replication of the parasite and damage from the immune system. Early in the course of the disease,

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in the blood. Two positive serology results, using different test methods, are required to confirm the diagnosis. If the test results are inconclusive, additional testing methods such as

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In the chronic stage, treatment involves managing the clinical manifestations of the disease. The treatment of Chagas cardiomyopathy is similar to that of other forms of heart disease.

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can be found in various tissues throughout the body and circulating in the blood. During the initial weeks of infection, parasite replication is brought under control by production of

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could eradicate the parasite, leading to its widespread use in transfusion screening programs in Latin America. Large-scale control programs began to take form in the 1960s, first in

264:, known as "kissing bugs". The symptoms change over the course of the infection. In the early stage, symptoms are typically either not present or mild, and may include fever, swollen 1614:

spp. are unique in that they do not require the triatomine for transmission, completing the life cycle through their own urine and feces. Veterinary transmission also occurs through

432:'s sign" if it is on the eyelid, or a "chagoma" if it is elsewhere on the skin. In rare cases (less than 1–5%), infected individuals develop severe acute disease, which can involve 3211: 1496:) may be performed in more severe cases of esophageal disease, and surgical removal of the affected part of the organ may be required for advanced megacolon and megaesophagus. 571:

or movement. While chronic disease typically develops over decades, some individuals with Chagas disease (less than 10%) progress to heart damage directly after acute disease.

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through less common routes. People infected through ingestion of parasites tend to develop severe disease within three weeks of consumption, with symptoms including fever,

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Moncayo A, Silveria AC (2017). "Current epidemiological trends of Chagas disease in Latin America and future challenges: epidemiology, surveillance, and health policies".

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to her child through the placenta; this occurs in up to 15% of births by infected mothers. As of 2019, 22.5% of new infections occurred through congenital transmission.

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Alba Soto CD, González Cappa SM (9 September 2019). "Trypanosoma cruzi Journey from the Insect Vector to the Host Cell". In Marcelo Altcheh J, Freilij H (eds.).

5370: 1829:, an antiparasitic drug approved for treating African trypanosomiasis, has shown activity against Chagas disease in animal models. As of 2019, it is undergoing 673:, which is typically introduced into humans through the bite of triatomine bugs, also called "kissing bugs". When the insect defecates at the bite site, motile 3798:"A therapeutic preconceptional vaccine against Chagas disease: A novel indication that could reduce congenital transmission and accelerate vaccine development" 821:

during pregnancy. Transfusion with the blood of an infected donor infects the recipient 10–25% of the time. To prevent this, blood donations are screened for

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2018 it was estimated that 30,000 to 40,000 people in the United States had Chagas cardiomyopathy. The vast majority of cases in the United States occur in

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in many countries with endemic Chagas disease, as well as the United States. Similarly, transplantation of solid organs from an infected donor can transmit

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is commonly spread to humans and other mammals by the kissing bug's bite wound and the bug's infected feces. The disease may also be spread through

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for Chagas disease are available. These tests are easily transported and can be performed by people without special training. They are useful for

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replicates in the insect's intestinal tract and is shed in the bug's feces. When an infected triatomine feeds, it pierces the skin and takes in a

632:. Symptoms vary widely based on the size and location of brain abscesses, but typically include fever, headaches, seizures, loss of sensation, or 1702:. Many early written accounts describe symptoms consistent with Chagas disease, with early descriptions of the disease sometimes attributed to 129: 4169: 4628: 4481: 4273: 3981: 3494:"Rapid immunochromatographic tests for the diagnosis of chronic Chagas disease in at-risk populations: A systematic review and meta-analysis" 3460: 3365: 3027: 2447: 1776: 3962:

de Oliveira EC, da Silveira ABM, Luquetti AO (9 September 2019). "Gastrointestinal Chagas Disease". In Marcelo Altcheh J, Freilij H (eds.).

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is eliminated from the body, and PCR may give false-negative results when the parasite concentration in the blood is low. Several potential

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levels in organ transplant recipients and immunosuppressed people, which allows infection or reactivation to be detected at an early stage.

2921:"Chagas cardiomyopathy: an update of current clinical knowledge and management: a scientific statement from the American Heart Association" 1351:

Antiparasitic treatment can also slow the progression of the disease and reduce the possibility of congenital transmission. Elimination of

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Mougabure-Cueto G, Picollo MI (September 2015). "Insecticide resistance in vector Chagas disease: Evolution, machanisms, and management".

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of the heart. As disease progresses, the heart becomes generally enlarged, with substantial regions of cardiac muscle fiber replaced by

1766: 616:-borne disease, but the symptoms may not manifest for anywhere from a week to five months. Chronically infected individuals who become 3172: 3147:"Oral Transmission of Chagas Disease Has Severe Effects (with section 'Seven Things to Know About Orally Transmitted Chagas Disease')" 2792: 5363: 3555: 3072: 2725: 312:(from a mother to her baby). Diagnosis of early disease is by finding the parasite in the blood using a microscope or detecting its 636:

that indicate particular sites of nervous system damage. Occasionally, these individuals also experience acute heart inflammation,

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may be prescribed, but some people with Chagas disease may not be able to take the standard dose of these drugs because they have

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that can result in treatment being discontinued. The most common side effects of benznidazole are skin rash, digestive problems,

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can be transmitted independent of the triatomine bug during blood transfusion, following organ transplantation, or across the

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Alonso-Padilla J, Pinazo MJ, Gascón J (9 September 2019). "Chagas Disease in Europe". In Marcelo Altcheh J, Freilij H (ed.).

3942: 1978: 1761: 1527: 1517: 1405:. Treatment is discontinued in up to 75% of cases. Both drugs are contraindicated for use in pregnant women and people with 963: 519:

Also common in chronic Chagas disease is damage to the digestive system, which affects 10–21% of people. Enlargement of the

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Vermelho AB, Rodrigues GC, Supuran CT (2019). "Why hasn't there been more progress in new Chagas disease drug discovery?".

940:. Areas of active inflammation are scattered throughout the heart, with each housing inflammatory immune cells, typically 461:

chronic Chagas disease. However, over decades with the disease, approximately 30–40% of people develop organ dysfunction (

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of disease, which in most cases does not result in further symptoms. Up to 45% of people with chronic infections develop

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can survive in refrigerated stored blood, and can survive freezing and thawing, allowing it to persist in whole blood,

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Luquetti AO, Schijman AG (9 September 2019). "Diagnosis of Chagas Disease". In Marcelo Altcheh J, Freilij H (ed.).

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in his honor. Serological tests for Chagas disease were introduced in the 1940s, demonstrating that infection with

1538:, vectorial transmission has begun occurring in areas where it had previously been interrupted, and Chagas disease 444:, and may be life-threatening. The acute phase typically lasts four to eight weeks and resolves without treatment. 384: 480:, which occurs in 14–45% of people with chronic Chagas disease. People with Chagas heart disease often experience 1772: 1286: 1041: 811:

can contain about 600,000 metacyclic trypomastigotes, while triatomine fecal matter contains 3,000-4,000 per μL.

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all of which can be infected by the vectors or orally by eating triatomine bugs and other infected animals. For

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Jansen AM, Roque ALR (2010). "11 - Domestic and Wild Mammalian Reservoirs". In Telleria J, Tibayrenc M (eds.).

1002: 948:. Late in the disease, parasites are rarely detected in the heart, and may be present at only very low levels. 372:, have Chagas disease as of 2019, resulting in approximately 9,490 annual deaths. Most people with the disease 1932:

Another research area is the use of biomarkers to predict the progression of chronic disease. Serum levels of

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before meals to relieve esophageal symptoms. Surgery to sever the muscles of the lower esophageal sphincter (

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among triatomine bugs. In response, vector control programs have implemented alternative insecticides (e.g.

269: 146: 1001:, for direct visualization of parasites. Blood smear examination detects parasites in 34–85% of cases. The 5678: 5473: 1470: 1236: 1197: 1033:

is relatively large, which helps to distinguish it from other species of trypanosomes that infect humans.

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and were able to reduce parasite numbers in the blood and heart, but no vaccine candidates had undergone

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in the blood is diagnostic of Chagas disease. During the acute phase of infection, it can be detected by

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after recovering from the acute phase. Most chronic infections are asymptomatic, which is referred to as

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typically have few to no symptoms, but can have mild non-specific symptoms, or severe symptoms such as

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Rassi Jr A, Rassi A, Marcondes de Rezende J (June 2012). "American trypanosomiasis (Chagas disease)".

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or Western blot, has been used as an indicator of early acute and congenital infection. An assay for

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has also been explored. As of 2019, vaccine research has mainly been limited to small animal models.

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that is effective against Chagas disease in mice and is undergoing preliminary toxicity studies, and

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than nifurtimox, and its efficacy is better understood. Both benznidazole and nifurtimox have common

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Prevention focuses on eliminating kissing bugs and avoiding their bites. This may involve the use of

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screening tests has dramatically reduced the risk of infection during blood transfusion. Nearly all

504:), which reduces its ability to pump blood. In many cases the first sign of Chagas heart disease is 5671: 5667: 5629: 5548: 5387: 5379: 5254: 4015:"Preventing the transmission of American trypanosomiasis and its spread into non-endemic countries" 2443:"Antioxidant defence system as a rational target for Chagas disease and Leishmaniasis chemotherapy" 1869: 1535: 585: 441: 373: 112: 4972:

Dias JCP (September 2015). "Evolution of Chagas disease screening programs and control programs".

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likely circulated in South American mammals long before the arrival of humans on the continent.

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is too low to be reliably detected by microscopy or PCR, so the diagnosis is usually made using

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In the acute phase of the disease, signs and symptoms are caused directly by the replication of

4897:(in Portuguese with German full translation as "Ueber eine neue Trypanosomiasis des Menschen.") 1273:

Other modes of transmission have been targeted by Chagas disease prevention programs. Treating

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Blood transfusion was formerly the second-most common mode of transmission for Chagas disease.

1132: 1111:, or by inoculating animals with the person's blood. In the blood culture method, the person's 5840: 5703: 5597: 5541: 5305: 5276: 5229: 5141: 5089: 5081: 5032: 5024: 4989: 4925: 4888: 4816: 4766: 4694: 4634: 4624: 4615:. Birkhäuser Advances in Infectious Diseases. Switzerland: Springer Nature. pp. 111–123. 4588: 4539: 4521: 4477: 4387: 4346: 4328: 4279: 4269: 4226: 4125: 4046: 3987: 3977: 3924: 3870: 3829: 3778: 3729: 3673: 3615: 3525: 3466: 3456: 3408: 3361: 3336: 3280: 3262: 3195: 3128: 3068: 3064: 3033: 3023: 2977: 2942: 2862: 2837:

Despommier DD, Griffin DO, Gwadz RW, Hotez PJ, Knirsch CA (2019). "American Trypanosomiasis".

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from the body, and symptomatic treatment to address the effects of the infection. As of 2018,

781:, preferring moist surfaces near the eyes or mouth. A triatomine bug can become infected with 737: 652: 617: 609: 497: 489: 429: 408: 301: 292:, may also occur in up to 21% of people, and up to 10% of people may experience nerve damage. 273: 253: 248: 182: 170: 124: 3968:. Birkhäuser Advances in Infectious Diseases. Switzerland: Springer Nature. pp. 243–62. 3447:. Birkhäuser Advances in Infectious Diseases. Switzerland: Springer Nature. pp. 141–58. 5625: 5425: 5131: 5123: 5071: 5016: 4981: 4917: 4878: 4806: 4756: 4746: 4684: 4676: 4616: 4578: 4570: 4529: 4513: 4469: 4461: 4377: 4336: 4318: 4261: 4218: 4151: 4115: 4107: 4036: 4026: 3969: 3914: 3906: 3860: 3819: 3809: 3768: 3760: 3719: 3709: 3663: 3655: 3605: 3597: 3515: 3505: 3448: 3398: 3390: 3326: 3318: 3270: 3254: 3187: 3118: 3108: 3015: 3014:. Birkhäuser Advances in Infectious Diseases. Switzerland: Springer Nature. pp. 25–59. 2969: 2932: 2750: 2678: 2627: 2587: 2569: 2525: 2507: 2466: 2456: 2380: 2295: 2174: 1926: 1842: 1683: 1072: 1051: 729:

for human infection are the species of triatomine bugs that inhabit human dwellings, namely

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infection can have particularly severe and distinct disease, most commonly characterized by

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Echeverria LE, Morillo CA (February 2019). "American Trypanosomiasis (Chagas Disease)".

2530: 2495: 428:. Sometimes, people develop a swollen nodule at the site of infection, which is called " 5774: 5759: 5694: 5468: 5463: 5327: 5136: 5111: 4761: 4734: 4689: 4664: 4583: 4558: 4534: 4501: 4473: 4341: 4306: 4155: 4120: 4095: 4041: 4014: 3919: 3894: 3824: 3797: 3773: 3748: 3724: 3697: 3668: 3643: 3520: 3493: 3331: 3306: 3275: 3242: 3123: 3096: 2592: 2557: 2471: 2442: 1912: 1802: 1787: 1783: 1742: 1687: 1539: 1489: 1434: 1410: 1386: 1378: 1366: 1304: 1294: 1256: 1149: 1144: 1112: 1009:

are used to concentrate the blood. On microscopic examination of stained blood smears,

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for travellers from the International Association for Medical Assistance to Travellers

5076: 5059: 4222: 4111: 3601: 3394: 3173:"Congenital Chagas disease: current diagnostics, limitations, and future perspectives" 2754: 2574: 2178: 1921:, and markers of physiological changes caused by the parasite, such as alterations in 1682:

has been detected in ancient human remains across South America, from a 9000-year-old

5809: 5615: 5556: 4646: 4462: 4291: 4256:. Birkhäuser Advances in Infectious Diseases. Switzerland: Springer Nature. pp. 3999: 3478: 3045: 2655: 1725: 1663: 1562: 1554: 1493: 1450: 1426: 1406: 1382: 1120: 1108: 1104: 986: 878: 715: 629: 528: 524: 505: 380: 369: 285: 281: 277: 155: 151: 5259: 5044: 4883: 4828: 4811: 4790: 4399: 4238: 3207: 2989: 2698: 2416: 2326: 1984:

Association for the Promotion of Independent Disease Control in Developing Countries

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There is no vaccine against Chagas disease. Several experimental vaccines have been

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rekindled Chagas disease research, describing over a thousand cases in Argentina's

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Robertson LJ, Deveesschauwer B, de Noya BA, Gozalez ON, Togerson PR (June 2016).

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commonly infects more than 100 species of mammals across Latin America including

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and by housing improvements that prevent triatomine bugs from colonizing houses.

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An acute Chagas disease infection with swelling of the right eye (Romaña's sign)

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Mild gastrointestinal disease may be treated symptomatically, such as by using

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A number of experimental vaccines have been tested in animals. In addition to

1699: 1543: 1485: 1454: 1442: 1340: 1320: 1252: 1205: 1161: 990: 982: 941: 904: 641: 597: 493: 346: 265: 213: 204: 5196: 5085: 5028: 4892: 4638: 4525: 4332: 4283: 3991: 3714: 3470: 3266: 3097:"Trypanosoma cruzi: Time for International Recognition as Foodborne Parasite" 3037: 2838: 2639: 2583: 2521: 2461: 2186: 5725: 5415: 5311: 5244: 5112:"Chagas disease diagnostic applications: present knowledge and future steps" 4947: 4751: 4096:"Global economic burden of Chagas disease: a computational simulation model" 3551: 1898: 1587: 1446: 1209: 1157: 1016: 548: 536: 520: 289: 258: 159: 5145: 5093: 5036: 4993: 4929: 4820: 4770: 4698: 4592: 4543: 4517: 4391: 4350: 4230: 4129: 4050: 3928: 3874: 3849:"Status of vaccine research and development of vaccines for Chagas disease" 3833: 3782: 3733: 3677: 3619: 3529: 3412: 3340: 3284: 3199: 3132: 2981: 2946: 2762: 2690: 2647: 2601: 2539: 2480: 2394: 2307: 2194: 1948:

have been studied as indicators of the prognosis of Chagas cardiomyopathy.

1659: 1504: 4574: 2299: 5545: 5478: 5420: 5395: 3659: 3258: 1591: 1481: 1394: 1248: 1196:. Vector control in some regions has been hindered by the development of 1185: 1068: 916: 908: 888: 818: 721: 709: 664: 601: 581: 338: 321: 188: 4202:

Grillet ME, Hernández-Villena JV, Llewellyn MS, et al. (May 2019).

5443: 5410: 5400: 4382: 4365: 3610: 3403: 3381:

Schijman AG (August 2018). "Molecular diagnosis of Trypanosoma cruzi".

1834: 1730: 1640: 1579: 1223: 1213: 1177: 1136: 951:

In the heart, colon, and esophagus, chronic disease leads to a massive

900: 593: 413: 354: 5348: 5212: 5168:

Knowledge (XXG)'s health care articles can be viewed offline with the

4946:(in Spanish). Asociación Lucha Contra el Mal de Chagas. Archived from 4174:

Special Programme for Research and Training in Tropical Diseases (TDR)

2494:

Porta, Exequiel O. J.; Kalesh, Karunakaran; Steel, Patrick G. (2023).

1954:

shed acute-phase antigen (SAPA), which can be detected in blood using

5239: 5224: 4559:"Neglected Parasitic Infections in the United States: Chagas Disease" 3305:

Bonney KM, Luthringer DJ, Kim SA, Garg NJ, Engman DM (January 2019).

1964:

antigens in urine has been developed to diagnose congenital disease.

1599: 1458: 1260:

Switzerland (2012), and Belgium (2013). Serological tests, typically

1165: 945: 568: 361: 61: 4557:

Montgomery SP, Starr MC, Cantey PT, Edwards MS, Meymandi SK (2014).

3895:"Current trends in the pharmacological management of Chagas disease" 2558:"Immunity and vaccine development efforts against Trypanosoma cruzi" 407:

stage, which develops one to two weeks after the insect bite, and a

5336: 4663:

Velasco M, Gimeno-Feliú LA, Molina I, et al. (February 2020).

2556:

Rios LE, Vázquez-Chagoyán JC, Pacheco AO, Zago MP, Garg NJ (2019).

1833:

for chronic Chagas disease in Spain. Other drug candidates include

1139:

can be used in endemic areas to prevent bites from triatomine bugs.

395: 1983: 1955: 1658: 1644: 1512: 1503: 1314: 1261: 1169: 1131: 962: 862: 687: 651: 608:, and heart problems. People infected through organ transplant or 544: 394: 5187: 2843:(7 ed.). New York: Parasites Without Borders. pp. 71–84 1861:

parasites or organisms that express some of the same antigens as

4500:

Turabelidze G, Vasudevan A, Rojas-Moreno C, et al. (2020).

2919:

Nunes MC, Beaton A, Acquatella H, et al. (September 2018).

2741:

Rassi A, Rassi A, Marin-Neto JA (April 2010). "Chagas disease".

1745:, who showed the bite of the infected triatomine could transmit 1542:

rates have increased. Transmission rates have also risen in the

1181: 933: 867:

Large scale anatomy of a heart damaged by chronic Chagas disease

753:. These insects are known by a number of local names, including 5514: 5352: 3243:"Chagas Disease in the United States: a Public Health Approach" 379:

The disease was first described in 1909 by Brazilian physician

308:, consuming food or drink contaminated with the parasites, and 5178: 3847:

Beaumier CM, Gillespie PM, Strych U, et al. (June 2016).

3698:"Chagas disease: from discovery to a worldwide health problem" 1915:

testing to detect antibodies against different life stages of

1603: 1595: 937: 621: 3642:

Angheben A, Boix L, Buonfrate D, et al. (October 2015).

3492:

Angheben A, Buonfrate D, Cruciani M, et al. (May 2019).

272:. After four to eight weeks, untreated individuals enter the 90: 87: 4795:

and Chagas disease (1908–1909): tropical medicine in Brazil"

993:, for motile parasites; or by preparation of thin and thick 841:

75–100% of the time, and less so for transplantation of the

707:

can be transmitted by various triatomine bugs in the genera

383:, after whom it is named. Chagas disease is classified as a 4305:

Hotez PJ, Basáñez MG, Acosta-Serrano A, Grillet ME (2017).

1437:. To manage irregular heartbeats, people may be prescribed 1413:. As of 2019, resistance to these drugs has been reported. 1027:

are visible inside the parasite's body; the kinetoplast of

96: 4455: 4453: 4307:"Venezuela and its rising vector-borne neglected diseases" 3696:

Lidani KCF, Andrade FA, Bavia L, et al. (July 2019).

1164:. These programs have drastically reduced transmission in 1143:

Efforts to prevent Chagas disease have largely focused on

3893:

Ribeiro V, Dias N, Paiva T, et al. (December 2019).

1015:

trypomastigotes appear as S or U-shaped organisms with a

280:

10–30 years after the initial illness, which can lead to

93: 5007:

Deeks ED (2019). "Fexinidazole: First Global Approval".

3943:"Chagas disease (also known as American trypanosomiasis" 1561:

Chagas exists in two different ecological zones. In the

803:-laden feces into the bite wound, initiating infection. 563:. Up to 10% of chronically infected individuals develop 492:, people with Chagas heart disease most frequently have 4867:, etiological agent of a new morbid entity of man]" 1901:

of treatment response are under investigation, such as

4094:

Lee BY, Bacon KM, Bottazzi ME, Hotez PJ (April 2013).

1160:

insecticides, which were supplanted in the 1980s with

465:

chronic Chagas disease), which most often affects the

5821:

Parasitic infestations, stings, and bites of the skin

3241:

Bern C, Messenger LA, Whitman JD, Maguire JH (2019).

2226:"Global Health Metrics: Chagas disease—Level 3 cause" 1724:

The formal description of Chagas disease was made by

1172:, and eliminated major vectors from certain regions: 512:, or chest pain associated with abnormalities in the 99: 5202: 3307:"Pathology and Pathogenesis of Chagas Heart Disease" 2369:"Chagas disease as example of a reemerging parasite" 2329:. Centers for Disease Control (CDC). 30 April 2019. 2165:

Pérez-Molina JA, Molina I (2018). "Chagas disease".

1845:, which has had promising results in animal models. 5758: 5733: 5724: 5693: 5614: 5573: 5564: 5555: 5487: 5434: 5386: 5291: 5206: 2327:"DPDx – Trypanosomiasis, American. Fact Sheet" 1381:. These side effects can sometimes be treated with 1019:connected to the body by an undulating membrane. A 574:Signs and symptoms differ for people infected with 360:It is estimated that 6.5 million people, mostly in 227: 219: 203: 195: 181: 165: 145: 135: 123: 84: 72: 42: 37: 4728: 3796:Dumonteil E, Herrera C, Buekens P (January 2019). 2869:. CDC-Centers for Disease Control and Prevention. 4726: 4724: 4722: 4720: 4718: 4716: 4714: 4712: 4710: 4708: 4426:"Trypanosomiasis in Animals - Circulatory System" 4419: 4417: 4415: 4413: 4411: 4409: 1852:, some approaches have involved vaccination with 527:are the most common digestive issues. Those with 442:inflammation of the brain and surrounding tissues 199:Eliminating kissing bugs and avoiding their bites 5060:"Drug discovery for Chagas disease: A viewpoint" 3166: 3164: 3162: 3160: 3090: 3088: 3086: 3084: 1694:, to an 1100-year-old mummy as far north as the 1546:region due to insecticide resistance and in the 4502:"Autochthonous Chagas Disease — Missouri, 2018" 3957: 3955: 3637: 3635: 3633: 3631: 3629: 3436: 3434: 3432: 3430: 3003: 3001: 2999: 2613: 2611: 663:Chagas disease is caused by infection with the 4658: 4656: 4197: 4195: 4141: 4139: 3888: 3886: 3884: 1741:. He sent infected triatomine bugs to Cruz in 1572:also circulates in wild and domestic animals. 833:to the recipient. This is especially true for 5526: 5364: 5105: 5103: 4604: 4602: 3691: 3689: 3687: 3300: 3298: 3296: 3294: 3059:Maudlin I, Holmes PH, Miles MA, eds. (2004). 2914: 2912: 2910: 2908: 2716:(2nd ed.). Dordrecht: Springer. p. 2160: 2158: 2156: 2154: 2152: 2150: 2148: 2146: 2144: 2142: 2140: 2138: 2136: 2134: 2132: 2130: 2128: 2126: 2124: 2122: 2120: 2118: 2116: 2114: 2112: 2110: 2108: 2106: 2104: 2102: 2100: 2098: 2096: 2094: 2092: 2090: 2088: 2086: 2084: 2082: 1103:parasites can be grown from blood samples by 8: 4784: 4782: 4780: 3583: 3581: 3579: 3577: 3575: 3573: 2906: 2904: 2902: 2900: 2898: 2896: 2894: 2892: 2890: 2888: 2080: 2078: 2076: 2074: 2072: 2070: 2068: 2066: 2064: 2062: 1737:in honor of his mentor, Brazilian physician 1469:surgery. Because transplant recipients take 1461:. Chronic heart disease caused by untreated 640:, and disease of the stomach, intestine, or 268:, headaches, or swelling at the site of the 4967: 4965: 4844:Vorläufige Mitteilung Arch Schiff Tropenhyg 4506:MMWR. Morbidity and Mortality Weekly Report 3548:"Chagas disease (American Trypanosomiasis)" 3236: 3234: 3232: 3230: 3228: 3226: 3224: 2962:Infectious Disease Clinics of North America 2671:Infectious Disease Clinics of North America 2551: 2549: 2436: 2434: 2281: 2279: 2277: 2275: 2273: 2271: 2037:"Chagas disease (American trypanosomiasis)" 757:in Argentina, Bolivia, Chile and Paraguay, 476:The most common long-term manifestation is 5730: 5570: 5561: 5533: 5519: 5511: 5371: 5357: 5349: 5203: 4176:(Press release). WHO. 2004. Archived from 3063:. Wallingford: CAB International. p. 2269: 2267: 2265: 2263: 2261: 2259: 2257: 2255: 2253: 2251: 2031: 2029: 2027: 2025: 2023: 2021: 2019: 612:tend to have symptoms similar to those of 320:. Chronic disease is diagnosed by finding 51: 34: 5135: 5110:Balouz V, Agüero F, Buscaglia CA (2017). 5075: 4882: 4810: 4760: 4750: 4688: 4582: 4533: 4381: 4340: 4322: 4170:"The Southern Cone Initiative: an update" 4148:American Trypanosomiasis – Chagas Disease 4119: 4040: 4030: 3918: 3864: 3823: 3813: 3772: 3723: 3713: 3667: 3609: 3519: 3509: 3402: 3360:. John Wiley & Sons. pp. 165–7. 3330: 3274: 3122: 3112: 2936: 2591: 2573: 2529: 2511: 2470: 2460: 2384: 2362: 2360: 2358: 2356: 2354: 2352: 2350: 2348: 2220: 2218: 2216: 2214: 2212: 2017: 2015: 2013: 2011: 2009: 2007: 2005: 2003: 2001: 1999: 496:. As the disease progresses, the heart's 4150:(2 ed.). Elsevier. pp. 59–88. 4066:"Disease burden and mortality estimates" 1867:but do not cause human disease, such as 1790:. In Argentina, the disease is known as 1264:, are used to detect antibodies against 1251:. The development and implementation of 567:that can result in numbness and altered 403:Chagas disease occurs in two stages: an 284:. Digestive complications, including an 257:. It is spread mostly by insects in the 5192:Drugs for Neglected Diseases initiative 4495: 4493: 4089: 4087: 3541: 3539: 2832: 2830: 2286:Bern C (July 2015). "Chagas' disease". 1995: 1974:Drugs for Neglected Diseases Initiative 1762:Faculdade de Medicina do Rio de Janeiro 1361:Benznidazole is usually considered the 1065:concentration of parasites in the blood 4842:Chagas C (1909). "Neue Trypanosomen". 4681:10.2807/1560-7917.ES.2020.25.8.1900393 3180:Current Opinion in Infectious Diseases 2863:"Chagas Disease – Detailed Fact Sheet" 2828: 2826: 2824: 2822: 2820: 2818: 2816: 2814: 2812: 2810: 881:'s response to it. During this phase, 488:, due to irregular heart function. By 2333:from the original on 5 September 2019 2321: 2319: 2317: 849:(0–19%). An infected mother can pass 111: 7: 4364:Morel CM, Lazdins J (October 2003). 3323:10.1146/annurev-pathol-020117-043711 2795:from the original on 4 December 2014 547:, and weight loss. Individuals with 5710:Primary amoebic meningoencephalitis 4944:"Enfermedad de Chagas – Mazza" 4910:International Journal of Cardiology 2873:from the original on 16 August 2019 2244:from the original on 18 March 2022. 1344:course of infection: it eliminates 1222:can be prevented by sleeping under 787:when it feeds on an infected host. 451:, individuals remain infected with 438:fluid accumulation around the heart 4474:10.1016/B978-0-12-384876-5.00011-3 4438:from the original on 28 March 2022 4156:10.1016/B978-0-12-801029-7.00004-6 3558:from the original on 12 March 2020 3217:from the original on 5 March 2020. 2448:Memórias do Instituto Oswaldo Cruz 187:Finding the parasite, its DNA, or 141:Fever, large lymph nodes, headache 25: 5077:10.1016/j.actatropica.2019.105107 3899:Int J Parasitol Drugs Drug Resist 3602:10.1016/j.actatropica.2015.05.014 3395:10.1016/j.actatropica.2018.02.019 2575:10.1016/j.actatropica.2019.105168 1465:infection is a common reason for 1023:and a smaller structure called a 895:, particularly cells that target 5162: 4311:PLOS Neglected Tropical Diseases 4013:Liu Q, Zhou XN (December 2015). 3802:PLOS Neglected Tropical Diseases 3498:PLOS Neglected Tropical Diseases 3101:PLOS Neglected Tropical Diseases 2620:Expert Opinion on Drug Discovery 2373:Seminars in Diagnostic Pathology 1811:Pan American Health Organization 1690:, to remains of various ages in 1327:Chagas disease is managed using 1005:increases if techniques such as 909:inflammation-signaling molecules 588:, cough, and pain in the chest, 434:inflammation of the heart muscle 80: 4884:10.1590/S0074-02761909000200008 4812:10.1590/s0104-59702009000500002 4735:"The history of Chagas disease" 2043:. 17 April 2019. Archived from 1946:angiotensin-converting enzyme 2 1610:animals this is a common mode. 1063:In chronic Chagas disease, the 1054:). PCR is also used to monitor 777:in Venezuela. The bugs tend to 656:Life cycle and transmission of 4468:. Elsevier. pp. 249–276. 4100:The Lancet Infectious Diseases 4019:Infectious Diseases of Poverty 3546:Kirchhoff OV (26 April 2019). 3357:Blood Cells: A Practical Guide 2409:"Prevention of Chagas disease" 1979:Chagas: Time to Treat campaign 1528:disability-adjusted life years 1518:Disability-adjusted life years 1484:for constipation, or taking a 1007:microhematocrit centrifugation 68:trypomastigotes in human blood 1: 4789:Kropf SP, Sá MR (July 2009). 4424:Wilkowsky SE (9 March 2022). 4223:10.1016/S1473-3099(18)30757-6 4112:10.1016/S1473-3099(13)70002-1 3866:10.1016/j.vaccine.2016.03.074 3247:Clinical Microbiology Reviews 3171:Messenger LA, Bern C (2018). 2785:"Neglected Tropical Diseases" 2755:10.1016/S0140-6736(10)60061-X 2632:10.1080/17460441.2020.1681394 2179:10.1016/S0140-6736(17)31612-4 1733:of triatomine bugs and named 1637:immigrants from Latin America 891:and activation of the host's 4986:10.1016/j.gheart.2015.06.003 4922:10.1016/j.ijcard.2008.12.197 4324:10.1371/journal.pntd.0005423 4266:10.1007/978-3-030-00054-7_11 3974:10.1007/978-3-030-00054-7_12 3911:10.1016/j.ijpddr.2019.11.004 3815:10.1371/journal.pntd.0006985 3511:10.1371/journal.pntd.0007271 3192:10.1097/QCO.0000000000000478 3114:10.1371/journal.pntd.0004656 2938:10.1161/CIR.0000000000000599 1526:in the loss of over 800,000 5659:Mucocutaneous leishmaniasis 5183:Centers for Disease Control 5171:Medical Knowledge (XXG) app 5128:10.1016/bs.apar.2016.10.001 4799:Hist Cienc Saude Manguinhos 4621:10.1007/978-3-030-00054-7_5 4064:World Health Organization. 3453:10.1007/978-3-030-00054-7_7 3354:Bain BJ (20 January 2015). 3020:10.1007/978-3-030-00054-7_2 2441:Santi AM, Murta SM (2022). 2386:10.1053/j.semdp.2019.04.008 1934:tumor necrosis factor alpha 1119:and added to a specialized 1050:from a mother to her baby ( 928:is found frequently in the 5857: 5197:Chagas disease information 4733:Steverding D (July 2014). 3702:Frontiers in Public Health 2714:Encyclopedia of entomology 2513:10.3389/fphar.2023.1233253 1942:atrial natriuretic peptide 1773:frustrating his nomination 1550:due to oral transmission. 1377:, weakness, headache, and 970:trypomastigotes seen in a 628:and surrounding tissue or 385:neglected tropical disease 5454:African sleeping sickness 5021:10.1007/s40265-019-1051-6 4032:10.1186/s40249-015-0092-7 2974:10.1016/j.idc.2018.10.015 2712:Capinera JL, ed. (2008). 2683:10.1016/j.idc.2012.03.002 2500:Frontiers in Pharmacology 2413:World Health Organization 2041:World Health Organization 1287:World Health Organization 1270:proteins in donor blood. 1042:polymerase chain reaction 634:other neurological issues 626:inflammation in the brain 557:blockage of the intestine 555:, and may develop severe 535:) or trouble swallowing ( 357:has not been developed. 318:polymerase chain reaction 109:Portuguese pronunciation: 59: 50: 4464:American Trypanosomiasis 3765:10.1051/parasite/2014012 3747:Bonney KM (March 2014). 3715:10.3389/fpubh.2019.00166 2462:10.1590/0074-02760210401 1831:phase II clinical trials 1760:, then professor of the 1719:Theodoro J. H. Langgaard 1393:including mood changes, 773:in Central America, and 418:enlargement of the liver 242:American trypanosomiasis 46:American trypanosomiasis 27:Mammal parasitic disease 5645:Cutaneous leishmaniasis 5590:African trypanosomiasis 5500:Priority review voucher 4752:10.1186/1756-3305-7-317 4739:Parasites & Vectors 4431:Merck Veterinary Manual 1666:, in his laboratory at 1471:immunosuppressive drugs 1453:may be used to prevent 1115:are separated from the 1040:DNA can be detected by 897:intracellular pathogens 531:often experience pain ( 5679:Visceral leishmaniasis 4518:10.15585/mmwr.mm6907a4 3941:WHO. (13 April 2022). 2367:Guarner J (May 2019). 1670: 1668:Instituto Oswaldo Cruz 1618:through the placenta, 1522: 1510: 1391:neurological disorders 1365:because it has milder 1324: 1307:in humans as of 2016. 1237:packed red blood cells 1198:insecticide resistance 1140: 1090:rapid diagnostic tests 974: 930:striated muscle fibers 868: 750:Panstrongylus megistus 701: 660: 502:dilated cardiomyopathy 400: 5826:Insect-borne diseases 5769:Trichomonas vaginalis 4871:Mem Inst Oswaldo Cruz 4575:10.4269/ajtmh.13-0726 2300:10.1056/NEJMra1410150 1662: 1630:Non-endemic countries 1616:vertical transmission 1516: 1507: 1467:heart transplantation 1439:anti-arrhythmic drugs 1403:peripheral neuropathy 1318: 1135: 985:examination of fresh 966: 953:loss of nerve endings 893:inflammatory response 866: 697:, a common vector of 691: 655: 398: 310:vertical transmission 306:organ transplantation 5783:Dientamoeba fragilis 4950:on 16 September 2011 4865:Schizotripanum cruzi 4180:on 22 September 2009 3660:10.2450/2015.0040-15 3259:10.1128/CMR.00023-19 1839:proteasome inhibitor 1363:first-line treatment 1176:from Brazil, Chile, 1071:tests, which detect 606:respiratory distress 447:Unless treated with 18:Chagas' disease 5388:Diseases of poverty 5380:Diseases of poverty 4072:on 10 February 2020 3061:The Trypanosomiases 2419:on 11 February 2018 1870:Trypanosoma rangeli 1792:mal de Chagas-Mazza 1708:Luís Gomes Ferreira 1704:Miguel Diaz Pimenta 1536:humanitarian crisis 1329:antiparasitic drugs 1285:infection, and the 1075:antibodies against 586:shortness of breath 449:antiparasitic drugs 60:Photomicrograph of 5831:Protozoal diseases 5436:Neglected diseases 5421:Diarrheal diseases 5292:External resources 5188:Chagas information 5179:Chagas information 4805:(Suppl 1): 13–34. 4791:"The discovery of 4383:10.1038/nrmicro735 2840:Parasitic Diseases 2749:(9723): 1388–402. 2047:on 20 January 2020 1876:Phytomonas serpens 1671: 1523: 1511: 1431:low blood pressure 1375:decreased appetite 1325: 1174:Triatoma infestans 1141: 975: 869: 837:, which transmits 744:Triatoma dimidiata 732:Triatoma infestans 702: 694:Triatoma infestans 661: 529:enlarged esophagus 482:heart palpitations 401: 391:Signs and symptoms 286:enlarged esophagus 223:6.5 million (2019) 156:enlarged esophagus 130:Infectious disease 5836:Tropical diseases 5803: 5802: 5799: 5798: 5720: 5719: 5704:Naegleria fowleri 5689: 5688: 5542:Parasitic disease 5508: 5507: 5346: 5345: 5058:Kratz JM (2019). 4861:Chagas C (1909). 4793:Trypanosoma cruzi 4630:978-3-030-00054-7 4563:Am J Trop Med Hyg 4483:978-0-123-84876-5 4370:Nat Rev Microbiol 4275:978-3-030-00054-7 4211:Lancet Infect Dis 3983:978-3-030-00054-7 3859:(26): 2996–3000. 3648:Blood Transfusion 3462:978-3-030-00054-7 3367:978-1-118-81733-9 3029:978-3-030-00054-7 2931:(12): e169–e209. 1905:against specific 1735:Trypanosoma cruzi 1696:Chihuahuan Desert 1643:, armadillos and 1624:organ transplants 1620:blood transfusion 1379:sleeping problems 1295:tested in animals 1190:Rhodnius prolixus 738:Rhodnius prolixus 610:blood transfusion 596:. Those infected 551:often experience 500:become enlarged ( 490:electrocardiogram 302:blood transfusion 254:Trypanosoma cruzi 249:parasitic disease 235: 234: 183:Diagnostic method 171:Trypanosoma cruzi 66:Trypanosoma cruzi 32:Medical condition 16:(Redirected from 5848: 5731: 5675: 5641: 5626:Leishmania major 5571: 5562: 5535: 5528: 5521: 5512: 5373: 5366: 5359: 5350: 5204: 5166: 5150: 5149: 5139: 5107: 5098: 5097: 5079: 5055: 5049: 5048: 5004: 4998: 4997: 4969: 4960: 4959: 4957: 4955: 4940: 4934: 4933: 4904: 4898: 4896: 4886: 4858: 4852: 4851: 4839: 4833: 4832: 4814: 4786: 4775: 4774: 4764: 4754: 4730: 4703: 4702: 4692: 4660: 4651: 4650: 4606: 4597: 4596: 4586: 4554: 4548: 4547: 4537: 4497: 4488: 4487: 4467: 4457: 4448: 4447: 4445: 4443: 4421: 4404: 4403: 4385: 4366:"Chagas disease" 4361: 4355: 4354: 4344: 4326: 4302: 4296: 4295: 4249: 4243: 4242: 4217:(5): e149–e161. 4208: 4199: 4190: 4189: 4187: 4185: 4166: 4160: 4159: 4143: 4134: 4133: 4123: 4091: 4082: 4081: 4079: 4077: 4068:. Archived from 4061: 4055: 4054: 4044: 4034: 4010: 4004: 4003: 3959: 3950: 3939: 3933: 3932: 3922: 3890: 3879: 3878: 3868: 3844: 3838: 3837: 3827: 3817: 3793: 3787: 3786: 3776: 3744: 3738: 3737: 3727: 3717: 3693: 3682: 3681: 3671: 3639: 3624: 3623: 3613: 3585: 3568: 3567: 3565: 3563: 3543: 3534: 3533: 3523: 3513: 3489: 3483: 3482: 3438: 3425: 3424: 3406: 3378: 3372: 3371: 3351: 3345: 3344: 3334: 3302: 3289: 3288: 3278: 3238: 3219: 3218: 3216: 3177: 3168: 3155: 3154: 3143: 3137: 3136: 3126: 3116: 3092: 3079: 3078: 3056: 3050: 3049: 3005: 2994: 2993: 2957: 2951: 2950: 2940: 2916: 2883: 2882: 2880: 2878: 2859: 2853: 2852: 2850: 2848: 2834: 2805: 2804: 2802: 2800: 2781: 2775: 2774: 2738: 2732: 2731: 2709: 2703: 2702: 2666: 2660: 2659: 2615: 2606: 2605: 2595: 2577: 2553: 2544: 2543: 2533: 2515: 2491: 2485: 2484: 2474: 2464: 2438: 2429: 2428: 2426: 2424: 2415:. Archived from 2405: 2399: 2398: 2388: 2364: 2343: 2342: 2340: 2338: 2323: 2312: 2311: 2288:N. Engl. J. Med. 2283: 2246: 2245: 2243: 2230: 2222: 2207: 2206: 2173:(10115): 82–94. 2162: 2057: 2056: 2054: 2052: 2033: 1963: 1927:lipid metabolism 1920: 1910: 1896: 1887:Diagnostic tests 1866: 1860: 1850:subunit vaccines 1799: 1770: 1753:marmoset monkeys 1750: 1716: 1684:Chinchorro mummy 1681: 1577: 1571: 1356: 1349: 1302: 1284: 1278: 1269: 1234: 1221: 1080: 1073:immunoglobulin G 1059: 1052:passive immunity 1049: 1032: 1014: 977:The presence of 927: 886: 876: 854: 835:heart transplant 832: 826: 802: 792: 786: 678: 672: 618:immunosuppressed 579: 514:microvasculature 484:, and sometimes 471:digestive system 456: 416:, headache, and 329: 299: 240:, also known as 115: 113:[ˈʃaɡɐs] 110: 106: 105: 102: 101: 98: 95: 92: 89: 86: 55: 35: 21: 5856: 5855: 5851: 5850: 5849: 5847: 5846: 5845: 5806: 5805: 5804: 5795: 5789:Dientamoebiasis 5754: 5744:Giardia lamblia 5716: 5685: 5665: 5653:L. braziliensis 5623: 5610: 5575:Trypanosomiasis 5566:Trypanosomatida 5551: 5539: 5509: 5504: 5483: 5469:River blindness 5459:Schistosomiasis 5430: 5382: 5377: 5347: 5342: 5341: 5287: 5286: 5215: 5175: 5167: 5159: 5154: 5153: 5116:Adv. Parasitol. 5109: 5108: 5101: 5057: 5056: 5052: 5006: 5005: 5001: 4971: 4970: 4963: 4953: 4951: 4942: 4941: 4937: 4906: 4905: 4901: 4860: 4859: 4855: 4841: 4840: 4836: 4788: 4787: 4778: 4732: 4731: 4706: 4662: 4661: 4654: 4631: 4608: 4607: 4600: 4556: 4555: 4551: 4499: 4498: 4491: 4484: 4459: 4458: 4451: 4441: 4439: 4423: 4422: 4407: 4363: 4362: 4358: 4317:(6): e0005423. 4304: 4303: 4299: 4276: 4251: 4250: 4246: 4206: 4201: 4200: 4193: 4183: 4181: 4168: 4167: 4163: 4145: 4144: 4137: 4093: 4092: 4085: 4075: 4073: 4063: 4062: 4058: 4012: 4011: 4007: 3984: 3961: 3960: 3953: 3940: 3936: 3892: 3891: 3882: 3846: 3845: 3841: 3808:(1): e0006985. 3795: 3794: 3790: 3746: 3745: 3741: 3695: 3694: 3685: 3641: 3640: 3627: 3587: 3586: 3571: 3561: 3559: 3545: 3544: 3537: 3504:(5): e0007271. 3491: 3490: 3486: 3463: 3440: 3439: 3428: 3380: 3379: 3375: 3368: 3353: 3352: 3348: 3311:Annu Rev Pathol 3304: 3303: 3292: 3240: 3239: 3222: 3214: 3175: 3170: 3169: 3158: 3153:. 1 March 2024. 3145: 3144: 3140: 3107:(6): e0004656. 3094: 3093: 3082: 3075: 3058: 3057: 3053: 3030: 3007: 3006: 2997: 2959: 2958: 2954: 2918: 2917: 2886: 2876: 2874: 2861: 2860: 2856: 2846: 2844: 2836: 2835: 2808: 2798: 2796: 2791:. 6 June 2011. 2783: 2782: 2778: 2740: 2739: 2735: 2728: 2711: 2710: 2706: 2668: 2667: 2663: 2617: 2616: 2609: 2555: 2554: 2547: 2493: 2492: 2488: 2440: 2439: 2432: 2422: 2420: 2407: 2406: 2402: 2366: 2365: 2346: 2336: 2334: 2325: 2324: 2315: 2285: 2284: 2249: 2241: 2228: 2224: 2223: 2210: 2164: 2163: 2060: 2050: 2048: 2035: 2034: 1997: 1992: 1970: 1959: 1916: 1906: 1892: 1889: 1881:DNA vaccination 1862: 1856: 1824: 1819: 1795: 1764: 1746: 1710: 1677: 1657: 1632: 1573: 1567: 1502: 1475:organ rejection 1455:thromboembolism 1419: 1387:corticosteroids 1367:adverse effects 1352: 1345: 1313: 1305:clinical trials 1298: 1280: 1274: 1265: 1257:blood donations 1245:cryoprecipitate 1230: 1217: 1194:Central America 1180:, and parts of 1154:organophosphate 1130: 1113:red blood cells 1076: 1055: 1045: 1036:Alternatively, 1028: 1010: 961: 923: 882: 872: 861: 859:Pathophysiology 850: 828: 822: 798: 788: 782: 686: 674: 668: 650: 630:brain abscesses 575: 510:thromboembolism 452: 393: 366:Central America 325: 295: 119: 108: 83: 79: 33: 28: 23: 22: 15: 12: 11: 5: 5854: 5852: 5844: 5843: 5838: 5833: 5828: 5823: 5818: 5816:Chagas disease 5808: 5807: 5801: 5800: 5797: 5796: 5794: 5793: 5792: 5791: 5779: 5778: 5777: 5775:Trichomoniasis 5764: 5762: 5760:Trichomonadida 5756: 5755: 5753: 5752: 5739: 5737: 5728: 5722: 5721: 5718: 5717: 5715: 5714: 5713: 5712: 5699: 5697: 5695:Schizopyrenida 5691: 5690: 5687: 5686: 5684: 5683: 5682: 5681: 5663: 5662: 5661: 5649: 5648: 5647: 5620: 5618: 5612: 5611: 5609: 5608: 5607: 5606: 5604:Chagas disease 5594: 5593: 5592: 5579: 5577: 5568: 5559: 5553: 5552: 5540: 5538: 5537: 5530: 5523: 5515: 5506: 5505: 5503: 5502: 5497: 5491: 5489: 5485: 5484: 5482: 5481: 5476: 5471: 5466: 5464:Dracunculiasis 5461: 5456: 5451: 5449:Chagas disease 5446: 5440: 5438: 5432: 5431: 5429: 5428: 5423: 5418: 5413: 5408: 5403: 5398: 5392: 5390: 5384: 5383: 5378: 5376: 5375: 5368: 5361: 5353: 5344: 5343: 5340: 5339: 5330: 5328:Chagas disease 5319: 5308: 5296: 5295: 5293: 5289: 5288: 5285: 5284: 5273: 5262: 5247: 5232: 5216: 5211: 5210: 5208: 5207:Classification 5201: 5200: 5194: 5185: 5161: 5160: 5158: 5157:External links 5155: 5152: 5151: 5099: 5050: 5015:(2): 215–220. 4999: 4980:(3): 193–202. 4961: 4935: 4899: 4877:(2): 159–218. 4853: 4834: 4776: 4704: 4669:Euro Surveill. 4652: 4629: 4612:Chagas Disease 4598: 4569:(5): 814–818. 4549: 4512:(7): 193–195. 4489: 4482: 4449: 4405: 4356: 4297: 4274: 4254:Chagas Disease 4244: 4191: 4161: 4135: 4083: 4056: 4005: 3982: 3965:Chagas Disease 3951: 3934: 3880: 3839: 3788: 3739: 3683: 3625: 3569: 3535: 3484: 3461: 3444:Chagas Disease 3426: 3373: 3366: 3346: 3290: 3220: 3156: 3138: 3080: 3073: 3051: 3028: 3011:Chagas Disease 2995: 2968:(1): 119–134. 2952: 2884: 2854: 2806: 2776: 2733: 2726: 2704: 2661: 2626:(2): 145–158. 2607: 2545: 2486: 2430: 2400: 2344: 2313: 2247: 2208: 2058: 1994: 1993: 1991: 1988: 1987: 1986: 1981: 1976: 1969: 1966: 1913:flow cytometry 1888: 1885: 1823: 1820: 1818: 1815: 1803:crystal violet 1788:Chaco Province 1784:Salvador Mazza 1782:In the 1930s, 1743:Rio de Janeiro 1688:Atacama Desert 1656: 1653: 1631: 1628: 1540:seroprevalence 1501: 1498: 1490:metoclopramide 1451:Blood thinners 1435:low heart rate 1427:ACE inhibitors 1418: 1415: 1411:kidney failure 1383:antihistamines 1312: 1309: 1297:infected with 1150:organochlorine 1145:vector control 1129: 1126: 989:blood, or its 987:anticoagulated 960: 957: 860: 857: 725:. The primary 685: 682: 649: 646: 549:enlarged colon 392: 389: 330:in the blood. 290:enlarged colon 238:Chagas disease 233: 232: 229: 225: 224: 221: 217: 216: 207: 201: 200: 197: 193: 192: 185: 179: 178: 167: 163: 162: 160:enlarged colon 149: 143: 142: 139: 133: 132: 127: 121: 120: 118: 117: 76: 74: 70: 69: 57: 56: 48: 47: 44: 40: 39: 38:Chagas disease 31: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 5853: 5842: 5839: 5837: 5834: 5832: 5829: 5827: 5824: 5822: 5819: 5817: 5814: 5813: 5811: 5790: 5787: 5786: 5785: 5784: 5780: 5776: 5773: 5772: 5771: 5770: 5766: 5765: 5763: 5761: 5757: 5750: 5746: 5745: 5741: 5740: 5738: 5736: 5735:Diplomonadida 5732: 5729: 5727: 5723: 5711: 5708: 5707: 5706: 5705: 5701: 5700: 5698: 5696: 5692: 5680: 5677: 5676: 5674: 5673: 5669: 5664: 5660: 5657: 5656: 5655: 5654: 5650: 5646: 5643: 5642: 5640: 5639: 5635: 5634:L. aethiopica 5631: 5627: 5622: 5621: 5619: 5617: 5616:Leishmaniasis 5613: 5605: 5602: 5601: 5600: 5599: 5595: 5591: 5588: 5587: 5586: 5585: 5581: 5580: 5578: 5576: 5572: 5569: 5567: 5563: 5560: 5558: 5557:Discicristata 5554: 5550: 5547: 5543: 5536: 5531: 5529: 5524: 5522: 5517: 5516: 5513: 5501: 5498: 5496: 5493: 5492: 5490: 5488:Miscellaneous 5486: 5480: 5477: 5475: 5474:Leishmaniasis 5472: 5470: 5467: 5465: 5462: 5460: 5457: 5455: 5452: 5450: 5447: 5445: 5442: 5441: 5439: 5437: 5433: 5427: 5424: 5422: 5419: 5417: 5414: 5412: 5409: 5407: 5404: 5402: 5399: 5397: 5394: 5393: 5391: 5389: 5385: 5381: 5374: 5369: 5367: 5362: 5360: 5355: 5354: 5351: 5338: 5334: 5331: 5329: 5325: 5324: 5320: 5318: 5314: 5313: 5309: 5307: 5303: 5302: 5298: 5297: 5294: 5290: 5283: 5279: 5278: 5274: 5272: 5268: 5267: 5263: 5261: 5257: 5256: 5252: 5248: 5246: 5242: 5241: 5237: 5233: 5231: 5227: 5226: 5222: 5218: 5217: 5214: 5209: 5205: 5198: 5195: 5193: 5189: 5186: 5184: 5180: 5177: 5176: 5173: 5172: 5165: 5156: 5147: 5143: 5138: 5133: 5129: 5125: 5121: 5117: 5113: 5106: 5104: 5100: 5095: 5091: 5087: 5083: 5078: 5073: 5069: 5065: 5061: 5054: 5051: 5046: 5042: 5038: 5034: 5030: 5026: 5022: 5018: 5014: 5010: 5003: 5000: 4995: 4991: 4987: 4983: 4979: 4975: 4968: 4966: 4962: 4949: 4945: 4939: 4936: 4931: 4927: 4923: 4919: 4915: 4911: 4903: 4900: 4894: 4890: 4885: 4880: 4876: 4872: 4868: 4866: 4857: 4854: 4849: 4845: 4838: 4835: 4830: 4826: 4822: 4818: 4813: 4808: 4804: 4800: 4796: 4794: 4785: 4783: 4781: 4777: 4772: 4768: 4763: 4758: 4753: 4748: 4744: 4740: 4736: 4729: 4727: 4725: 4723: 4721: 4719: 4717: 4715: 4713: 4711: 4709: 4705: 4700: 4696: 4691: 4686: 4682: 4678: 4674: 4670: 4666: 4659: 4657: 4653: 4648: 4644: 4640: 4636: 4632: 4626: 4622: 4618: 4614: 4613: 4605: 4603: 4599: 4594: 4590: 4585: 4580: 4576: 4572: 4568: 4564: 4560: 4553: 4550: 4545: 4541: 4536: 4531: 4527: 4523: 4519: 4515: 4511: 4507: 4503: 4496: 4494: 4490: 4485: 4479: 4475: 4471: 4466: 4465: 4456: 4454: 4450: 4437: 4433: 4432: 4427: 4420: 4418: 4416: 4414: 4412: 4410: 4406: 4401: 4397: 4393: 4389: 4384: 4379: 4375: 4371: 4367: 4360: 4357: 4352: 4348: 4343: 4338: 4334: 4330: 4325: 4320: 4316: 4312: 4308: 4301: 4298: 4293: 4289: 4285: 4281: 4277: 4271: 4267: 4263: 4259: 4255: 4248: 4245: 4240: 4236: 4232: 4228: 4224: 4220: 4216: 4212: 4205: 4198: 4196: 4192: 4179: 4175: 4171: 4165: 4162: 4157: 4153: 4149: 4142: 4140: 4136: 4131: 4127: 4122: 4117: 4113: 4109: 4105: 4101: 4097: 4090: 4088: 4084: 4071: 4067: 4060: 4057: 4052: 4048: 4043: 4038: 4033: 4028: 4024: 4020: 4016: 4009: 4006: 4001: 3997: 3993: 3989: 3985: 3979: 3975: 3971: 3967: 3966: 3958: 3956: 3952: 3948: 3944: 3938: 3935: 3930: 3926: 3921: 3916: 3912: 3908: 3904: 3900: 3896: 3889: 3887: 3885: 3881: 3876: 3872: 3867: 3862: 3858: 3854: 3850: 3843: 3840: 3835: 3831: 3826: 3821: 3816: 3811: 3807: 3803: 3799: 3792: 3789: 3784: 3780: 3775: 3770: 3766: 3762: 3758: 3754: 3750: 3743: 3740: 3735: 3731: 3726: 3721: 3716: 3711: 3707: 3703: 3699: 3692: 3690: 3688: 3684: 3679: 3675: 3670: 3665: 3661: 3657: 3654:(4): 540–50. 3653: 3649: 3645: 3638: 3636: 3634: 3632: 3630: 3626: 3621: 3617: 3612: 3607: 3603: 3599: 3595: 3591: 3584: 3582: 3580: 3578: 3576: 3574: 3570: 3557: 3553: 3549: 3542: 3540: 3536: 3531: 3527: 3522: 3517: 3512: 3507: 3503: 3499: 3495: 3488: 3485: 3480: 3476: 3472: 3468: 3464: 3458: 3454: 3450: 3446: 3445: 3437: 3435: 3433: 3431: 3427: 3422: 3418: 3414: 3410: 3405: 3400: 3396: 3392: 3388: 3384: 3377: 3374: 3369: 3363: 3359: 3358: 3350: 3347: 3342: 3338: 3333: 3328: 3324: 3320: 3316: 3312: 3308: 3301: 3299: 3297: 3295: 3291: 3286: 3282: 3277: 3272: 3268: 3264: 3260: 3256: 3252: 3248: 3244: 3237: 3235: 3233: 3231: 3229: 3227: 3225: 3221: 3213: 3209: 3205: 3201: 3197: 3193: 3189: 3186:(5): 415–21. 3185: 3181: 3174: 3167: 3165: 3163: 3161: 3157: 3152: 3148: 3142: 3139: 3134: 3130: 3125: 3120: 3115: 3110: 3106: 3102: 3098: 3091: 3089: 3087: 3085: 3081: 3076: 3074:9780851990347 3070: 3066: 3062: 3055: 3052: 3047: 3043: 3039: 3035: 3031: 3025: 3021: 3017: 3013: 3012: 3004: 3002: 3000: 2996: 2991: 2987: 2983: 2979: 2975: 2971: 2967: 2963: 2956: 2953: 2948: 2944: 2939: 2934: 2930: 2926: 2922: 2915: 2913: 2911: 2909: 2907: 2905: 2903: 2901: 2899: 2897: 2895: 2893: 2891: 2889: 2885: 2872: 2868: 2864: 2858: 2855: 2842: 2841: 2833: 2831: 2829: 2827: 2825: 2823: 2821: 2819: 2817: 2815: 2813: 2811: 2807: 2794: 2790: 2786: 2780: 2777: 2772: 2768: 2764: 2760: 2756: 2752: 2748: 2744: 2737: 2734: 2729: 2727:9781402062421 2723: 2719: 2715: 2708: 2705: 2700: 2696: 2692: 2688: 2684: 2680: 2677:(2): 275–91. 2676: 2672: 2665: 2662: 2657: 2653: 2649: 2645: 2641: 2637: 2633: 2629: 2625: 2621: 2614: 2612: 2608: 2603: 2599: 2594: 2589: 2585: 2581: 2576: 2571: 2567: 2563: 2559: 2552: 2550: 2546: 2541: 2537: 2532: 2527: 2523: 2519: 2514: 2509: 2505: 2501: 2497: 2490: 2487: 2482: 2478: 2473: 2468: 2463: 2458: 2454: 2450: 2449: 2444: 2437: 2435: 2431: 2418: 2414: 2410: 2404: 2401: 2396: 2392: 2387: 2382: 2378: 2374: 2370: 2363: 2361: 2359: 2357: 2355: 2353: 2351: 2349: 2345: 2332: 2328: 2322: 2320: 2318: 2314: 2309: 2305: 2301: 2297: 2294:(5): 456–66. 2293: 2289: 2282: 2280: 2278: 2276: 2274: 2272: 2270: 2268: 2266: 2264: 2262: 2260: 2258: 2256: 2254: 2252: 2248: 2240: 2236: 2235: 2227: 2221: 2219: 2217: 2215: 2213: 2209: 2204: 2200: 2196: 2192: 2188: 2184: 2180: 2176: 2172: 2168: 2161: 2159: 2157: 2155: 2153: 2151: 2149: 2147: 2145: 2143: 2141: 2139: 2137: 2135: 2133: 2131: 2129: 2127: 2125: 2123: 2121: 2119: 2117: 2115: 2113: 2111: 2109: 2107: 2105: 2103: 2101: 2099: 2097: 2095: 2093: 2091: 2089: 2087: 2085: 2083: 2081: 2079: 2077: 2075: 2073: 2071: 2069: 2067: 2065: 2063: 2059: 2046: 2042: 2038: 2032: 2030: 2028: 2026: 2024: 2022: 2020: 2018: 2016: 2014: 2012: 2010: 2008: 2006: 2004: 2002: 2000: 1996: 1989: 1985: 1982: 1980: 1977: 1975: 1972: 1971: 1967: 1965: 1962: 1957: 1953: 1949: 1947: 1943: 1939: 1935: 1930: 1928: 1924: 1919: 1914: 1909: 1904: 1900: 1895: 1886: 1884: 1882: 1878: 1877: 1872: 1871: 1865: 1859: 1855: 1851: 1846: 1844: 1840: 1836: 1832: 1828: 1821: 1816: 1814: 1812: 1808: 1804: 1798: 1793: 1789: 1785: 1780: 1778: 1774: 1768: 1763: 1759: 1754: 1749: 1744: 1740: 1736: 1732: 1727: 1726:Carlos Chagas 1722: 1720: 1714: 1709: 1705: 1701: 1697: 1693: 1689: 1685: 1680: 1675: 1669: 1665: 1664:Carlos Chagas 1661: 1654: 1652: 1648: 1646: 1642: 1638: 1629: 1627: 1625: 1621: 1617: 1613: 1609: 1608:entomophagous 1605: 1601: 1597: 1593: 1589: 1585: 1581: 1576: 1570: 1564: 1563:Southern Cone 1559: 1556: 1555:deforestation 1551: 1549: 1545: 1541: 1537: 1531: 1529: 1519: 1515: 1506: 1499: 1497: 1495: 1494:cardiomyotomy 1491: 1487: 1483: 1478: 1476: 1472: 1468: 1464: 1460: 1456: 1452: 1448: 1444: 1440: 1436: 1432: 1428: 1424: 1423:Beta blockers 1417:Complications 1416: 1414: 1412: 1408: 1404: 1400: 1396: 1392: 1388: 1384: 1380: 1376: 1372: 1368: 1364: 1359: 1355: 1348: 1342: 1338: 1334: 1331:to eliminate 1330: 1322: 1317: 1310: 1308: 1306: 1301: 1296: 1291: 1288: 1283: 1277: 1271: 1268: 1263: 1258: 1254: 1250: 1246: 1242: 1238: 1233: 1227: 1225: 1220: 1215: 1211: 1207: 1203: 1199: 1195: 1191: 1188:, as well as 1187: 1183: 1179: 1175: 1171: 1167: 1163: 1159: 1155: 1151: 1146: 1138: 1134: 1127: 1125: 1124:sensitivity. 1122: 1121:growth medium 1118: 1114: 1110: 1109:xenodiagnosis 1106: 1105:blood culture 1102: 1098: 1095: 1091: 1086: 1085:can be used. 1084: 1079: 1074: 1070: 1066: 1061: 1058: 1053: 1048: 1043: 1039: 1034: 1031: 1026: 1022: 1018: 1013: 1008: 1004: 1000: 997:stained with 996: 992: 988: 984: 980: 973: 969: 965: 958: 956: 954: 949: 947: 943: 939: 935: 931: 926: 920: 918: 914: 910: 906: 902: 898: 894: 890: 885: 880: 879:immune system 875: 865: 858: 856: 853: 848: 845:(0–29%) or a 844: 840: 836: 831: 825: 820: 816: 812: 810: 804: 801: 796: 791: 785: 780: 779:feed at night 776: 772: 769:in Colombia, 768: 765:) in Brazil, 764: 760: 756: 752: 751: 746: 745: 740: 739: 734: 733: 728: 724: 723: 718: 717: 716:Panstrongylus 712: 711: 706: 700: 696: 695: 690: 683: 681: 677: 671: 666: 659: 654: 647: 645: 643: 639: 635: 631: 627: 623: 619: 615: 611: 607: 603: 599: 595: 591: 587: 583: 578: 572: 570: 566: 562: 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