Case history
Case history #1
A 40-year-old man originally from Mexico, who has been living in Miami for 22 years, presents with positive serology for Trypanosoma cruzi. This was detected by enzyme-linked immunosorbent assay and confirmed by radioimmunoprecipitation assay after a routine screening process for blood donors. He had been a blood donor for 14 years, but has now been excluded from the donation process. He denies cardiac or gastrointestinal symptoms, and there are no specific signs on physical examination.
Case history #2
A 50-year-old man from the US (born in Nebraska) has been living and working in a rural area of Argentina (Chaco province) since 1985. During a holiday visit to his US family, he is admitted to an emergency unit with reports of palpitations and syncope. He denies digestive symptoms. Physical exam reveals hypotension, cardiomegaly, and generalized edema.
Other presentations
Patients who are immunosuppressed (e.g., AIDS, hematologic cancers, postorgan transplantation, high-dose immunosuppressive therapy) may present with meningoencephalitis, myocarditis, or, less commonly, dermatologic manifestations, due to reactivation of Trypanosoma cruzi infection.[8][16][19][20][21] However, these are less common in people living with HIV who are on modern antiretroviral therapy.
Outbreaks of acute orally transmitted Chagas disease can present with atypical signs and symptoms, including rash, gastrointestinal bleeding, jaundice, elevated liver function tests, and cardiac failure. More severe manifestations, including pericardial effusion, myocarditis, and hemorrhagic symptoms have also been reported in patients in the Amazon and adjacent regions due to inoculation with a high number of parasites.[9][22][23][24][25] Morbidity and mortality rates in these patients are higher than in acute cases caused by other modes of transmission.[9]
Gastric dilation and megaureter have been described in immunocompetent patients with Chagas disease. However, these manifestations are rare.[26]
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