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Llenas
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Chagas Disease/ N. Llenas
Introduction
In 1909, Brazilian Dr. Carlos Chagas, then working for the Oswald Cruz institute
mysterious disease. Upon discovering large infestations of the “assassin” bugs in their
mud and thatch huts, Dr. Chagas discovered the source of their ailments, triatomine
vectors. Chagas disease (Trypanosoma cruzi), one of the most prevalent diseases in
South and Central America in the early 1990’s, is a major public health concern to
countries that harbor the triatomine vector. Several countries, such as Columbia,
Venezuela and Brazil have attempted to eradicate domestic vectors successfully in urban
areas and met with resistance in rural, poor areas in regards to both domestic and sylvatic
vectors.
parasitic feces and urine near the injection site of their victim, which is subsequently
wiped or scratched into the puncture unknowingly. At that point, the victim enters the
acute phase (6-8 weeks) of Chagas, characterized by swelling at the injection site and
febrile symptoms. Fifty to seventy percent of patients then progress into an indeterminate
chronic phase which may last up to 30 years, while others progress to the cardiac phase,
most of who succumb to the disease by means of heart failure, after the parasite has
In light of recent changes due to urban sprawl and migration, many communities
and public health officials are once again dealing with the fear of Chagas causing
triatomine vectors. This report examines the countries directly affected by Chagas and
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Chagas vectors, the barriers to solving the Chagas dilemma, and organizations involed,
Literature Review
History
Although Chagas was discovered in the early 1900’s, Aufderheide, et al., (2004)
successfully traced Chagas back to 7050 B.C, pre-Spanish conquest, using the
mummified remains of the Chinchorros, Maitas, Incas and eight other ancient subgroups.
Aufderheide, et al., extracted DNA and PCR to test for the presence of T. cruzi cells and,
remarkably, 40.6 percent of the tested mummies were positive for Chagas. Although that
actual vector is unknown, many of these subgroups lived in underground caves that
Dias, Silveira & Schofield (2002), noted that during the last century, combating
Chagas became a top priority for both political figures in Latin America, as well as public
health organizations and non-profits around the world. In the 1940s, awareness was
heightened as poor villages were surveyed and sprayed against triatomine vectors
Rhodnius, Triatoma and Panstrongylus using the insecticide BHC, which was quite
they required smaller applications for maximal results, leaving less unpleasantries for the
The commentary of Dias (2007) details the many attempts to control Chagas
throughout Latin America before, during and after the implementation of the Southern
Cone Initiative (SCI). During the 1960’s, no priority was given and localities were using
their own local officers and resources to attempt eradication, proving far too costly to
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Chagas Disease/ N. Llenas
maintain at such a high rate for many of the endemic countries, and Chagas, although
Subsequently in 1991, the (SCI), under the umbrella of the Pan-American Health
Argentina, Bolivia, Brazil, Chile, Paraguay and Uruguay, to combat this disease. SCI
and PAHO realized that transmission was preventable through vector control, serology,
and education. This initiative thrust Chagas awareness into the social fabric of at-risk
In June of 1991, it was decided by the SCI Ministers, that the initiative would
Without a format for controlling triatomine vectors, Brazil and Argentina spearheaded the
research and funding for action and awareness, even forming joint ventures with the ill
equipped Uruguay, Paraguay and Bolivia. Successes were reported in each country.
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Chagas Disease/ N. Llenas
studied the intense sampling of endemic areas outside of the initial SCI which provided
templates for countries like Colombia as years past. In the case of Colombia, areas were
divided into varying degrees of risk, by collecting serum samples from children rather
than adults, as infection rates in children paint an accurate and up-to date picture of recent
activity. At this point it became clear, that frequent sampling of endemic regions
Outside of Latin America, the United States is currently dealing with Chagas
infected persons as a result of migration and in some southern states, due to triatomine
vectors. Bern, et al. (2007), provides a detailed clinical review for the American clinician
who may come in contact with Chagas Disease. Current research and assessment skills
are outlined mostly for cardiac phase patients, who are routinely screened by way of the
heart failure. The author, however, fails to address actual patient education, which in a
Current Control
Currently, control efforts have been largely focused on newly endemic regions,
such as the Amazonian region of Brazil and the Andean sub regions of Columbia,
Ecuador, Peru and Venezuela. Both efforts seek to eradicate secondary vectors such as
brethesi. According to the most recent workshop sponsored by the Oswald Cruz
Memorial Institute (2007), several regional initiatives are currently working closely to
increase surveillance and control mechanism throughout Latin America and Mexico,
taking into account the recent increases in migration to countries ill-equipped to handle
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Chagas Disease/ N. Llenas
large number of patients presenting Chagas disease and the future transmission. The
methods as well as new technology and science. (Oswaldo Cruz Memorial Institute,
2007)
Chagas disease, initially identified in Brazil, has plagued all of Latin America at
some point in the 20th century, continuing now in many rural areas as one of the major
causes of myocarditis. As Chagas disease spreads across rural South and Central
America, even into the southwestern United States, many organizations have become
synonymous with fighting the disease. All current projects stem from the partnership
between PAHO and SCI, which began in 1991. Since then, each geographical region
now boasts its own cooperative initiative to control the spread of Chagas disease, in
addition to various multinational organizations that currently contribute both funds and
knowledge to this effort. According to the most recent World Health Organization
technical report in 2002, Chagas transmitting vectors are present in the every country in
South and Central America, with each presenting several different species. To date, there
and Panama.
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and Venezuela.
Institute, 2007)
and Argentina, threats of dengue, fever, AIDS, and leishmaniasis disease repeatedly have
Budgetary concerns also impact disease control and education programs and for
that reason, countries like Uruguay and Paraguay, joined initiatives spear-headed by their
larger, wealthier neighbors. Although, the initial outlay may be of concern to smaller
countries, the return on investment has been documented and shows promise. According
to the Oswald Cruz Memorial Institute (p. 605), Argentina saw a 64% return on
Additionally, location may serve as one of the most detrimental factors in the
fight for interruption of Chagas. Substandard-housing (thatch roofs, mud walls, and
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wood slat floors) and proximity to infested villages are some of the characteristics first
noticed by Dr. Chagas at discovery. While a low-risk village may be diligent, in its
spraying activities and education, the surrounding medium-risk villages may harbor both
domestic and sylvatic vectors at an alarming rate, causing transport of vectors between
communities, re-infecting those previously believed to be safe. One example comes from
the Gran Chaco study, in which new infections were scarce, peaking only when a local
Dias (2002, p. 610) also provides a concise list of the challenges for control of
Chagas. He notes issues among countries without national programs who are trying to
already established countries. Some of the problems these programs and their
constituents may face include a lack of political interest, archaic surveillance methods,
lack of control over secondary vectors, lack of serological testing of 100% of transfused
blood, and a need for improved medical and social care of those already infected.
Many agencies located outside of the endemic regions are putting forth effort to
stop Chagas prevelance. The Chagas Space Project, started in 1995, enlists the help of
six universities and two biomedical science institutes from Chile, Argentina, Uruguay,
Costa Rica and the United States. Its chief partner, NASA leads the efforts to find
minerals, which may block receptors in the body that respond to the parasite, by
developing a naturally flawless crystal in space that may unlock the key to the Chagas
Also, Moto Medic International and Fundacion Pilotos Solidarios have also joined
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forces to bring quality healthcare to rural regions of Latin America, with a hard focus on
prevention of transmission of Chagas. Moto Medic regularly hosts benefits, which can
be seen on You Tube, asking for donations to support its bed-net program, EKG testing
supplies, blood and water quality tests, as well as fumigation. These bed-nets protect
users from triatomine vectors for up to three years, making them a viable option for areas
One of the largest organizations reaching out to endemic regions in South and
Central America is Japan International Cooperative Agency (JICA). In 2000, JICA began
the proper authorities. The project has most recently spread to Honduras, El Salvador and
While several organizations serve as action and funding groups, few others may
have raised the awareness to the level of Argentine director Ricardo Preve and actress
Mia Maestro. Preve produced and directed the film, “Chagas: the Hidden Affliction”,
which premiered throughout many prominent cities in the Unites States, Argentina,
Brazil, El Salvador, Canada, and Italy (Schedule). The two are seeking to bring a true
face to Chagas disease, especially in rich countries that historically donate to charities.
All of the proceeds from the film go directly to the Chagas Foundation located in
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Chagas Disease/ N. Llenas
The control of Chagas transmission and vectors varies by country and its
implementing and managing spray routines and funding the search for a cure. All of the
current regional initiatives pattern themselves after the SCI model and seek to follow
their lead closely, which is their biggest strength, as the SCI initiative has served as a
model to African nations battling malaria, African sleeping sickness and dengue.
disease and are rewarded with fewer new cases each year in mostly urban areas.
However, problems lie in the newly developed rural areas of the Amazon, where sylvatic
and secondary species are present. In addition, Mexico has recently formed a task force
to combat Chagas, likely due to the increase in immigrants moving thru the country from
El Salvador, Honduras, and others, on their way to America. Also, in areas covered by
the Andean Pact Initiative, such as Columbia, have no specific plan for dealing with
large-scale infestation, like those of the SCI (Guhl et al., p.261-262). These regions must
from the risks of Chagas. Such protections should include regular testing of high and low
risk populations, consistent spraying to include spraying at the sight of triatomine vectors,
immediate medical and social care to those infected, education on prevention, serology
testing of both blood and organ donors, as well as political protection for the program’s
focus.
shifting towards secondary vectors with the help of outside organizations, their volunteers
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Chagas Disease/ N. Llenas
and donations. As awareness grows throughout the world, and Latin Americans migrate
towards more established countries such as the U.S. and Canada, richer nations will begin
to educate themselves on the severity of Chagas, prompting more serious action than the
localized initiatives within. Recent reports on California news stations are already
prompting some awareness for the Chagas migration into the U.S. as evident by the
increasing interest in scholarly reports on serological testing, blood bank awareness and
While the search for a cure for Chagas seems as far off as outer space, there is one
last ray of hope in Dr. James McKerrow at University of California at San Francisco.
Combining a background in cancer research and the love of parasites, the director of the
Sandler Center for Basic Research in Parasitic Disease hopes to find a cure for not on
Chagas but other parasitic diseases plaguing Latin America, the Middle East and Africa.
By combining technology and already F.D.A. approved drugs, his research may be the
last hope for Chagas victims and their families (Dreifus, 2005). Unfortunately many of
them may not see this cure in their lifetime, but hope reigns in the minds of each
Bibliography
Aufderheide, A. C., Salo, W., Madden, M., Streitz, J., Buikstra, J., Guhl, F., et al. (2004,
February 17). A 9,000-year record of Chagas' disease. Retrieved June 11, 2008,
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Chagas Disease/ N. Llenas
http://www.pnas.org/cgi/content/full/101/7/2034?
maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=peru&searchid
=1116928801623_853&stored_search=&FIRSTINDEX=0&journalcode=pnas
Bern, C., Montgomery, S. P., Herwaldt, B. L., Rassi, A., Marin-Neto, J. A., Dantas, R.
O., et al. (2007). Evaluation and treatment of Chagas disease in the United States.
Dias, J. C. (2007). Southern Cone Initiative for the elimination of domestic populations
Dias, J., Silveira, A., & Schofield, C. (2002). The Impact of Chagas disease control in
Dreifus, C. (2005, July 26). A Lab builds better barriers against invading parasites. The
Guhl, F., Restepo, M., Angulo, V. M., Antunes, C. M., Lendrun-Campbell, D., & Davies,
Gurtler, R. E., Kitron, U., Cecere, M. C., Segura, E. L., & Cohen, J. E. (2007).
Sustainable vector control and management of Chagas disease in the Gran Chaco,
16199.
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http://www.jica.go.jp/english/about/policy/reform/human/ca.html
Moto Medics. (n.d.). Our programs. Retrieved June 11, 2008, from Moto Medics
International: http://www.motomedicsinternational.org/programs.asp
control policy in Latin America. Memorial Institute of Oswaldo Cruz. 102, pp. 5-
Schedule. (n.d.). Retrieved June 13, 2008, from Chagas The Movie:
http://www.chagasthemovie.com/schedule.php
The Chagas Disease Foundation. (n.d.). Supporters. Retrieved June 18, 2008, from
The Chagas space project. (n.d.). Retrieved June 11, 2008, from The crystallization
process: http://www.chagaspace.org/eng/theproject/crystallization.htm
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