Prognosis

The number of deaths related to Chagas disease is estimated at 10,000 to 12,500 per year.[27][28]​​[29]​​[226] There are an estimated 546,000 to 806,000 disability-adjusted life years lost.[227][228][229]

Antiparasitic treatment is almost 100% effective in curing the disease but only if it is administered as soon as possible after infection at the onset of the acute phase. Efficacy diminishes the longer a person has been infected. Morbidity and mortality rates in patients with oral transmission are higher than in acute cases caused by other modes of transmission.[9]

The overall prognosis among patients with the indeterminate phase is excellent.[72]​[134]​​​ From 10-20 years after the acute phase, the indeterminate form progresses to cardiomyopathy at an annual rate of 1.9%.[230] Patients who have experienced acute symptomatic Chagas disease but have not received trypanocidal treatment face a higher risk of developing the cardiac form, with an estimated annual progression rate of 4.6%.[2][230]

Cardiomyopathy is the leading cause of death in patients with the cardiac form of chronic disease, due to heart failure, cardioembolic stroke, or sudden death.[4][13][14][231]

The case fatality rate in patients with reactivation is high, especially if diagnosis is delayed.​​[6][8][232]​​ Diagnosis should be made quickly, as the early administration of specific treatment increases prognosis considerably.[4]​​​​​​[8]​​

The criteria for cure are based on achieving negative serology. The time to reach negative serology varies depending on the phase of disease: from 3-5 years in acute Chagas disease; about 1 year for congenital infection; 5-10 years for recent chronic-phase disease; and ≥20 years for long-term chronic-phase disease.[175][233]​ In the chronic phase, a sustainable and progressive decline of serologic titers (≥3 dilutions in serologic titers) may occur, suggesting future negative serology. At any stage of disease evolution, positive parasitologic testing indicates failure of treatment. Spontaneous cure in chronic cases of Chagas disease is usually not observed, although some cases have been registered in Costa Rica, Uruguay, and Brazil.[234][235][236]

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