Trypanosoma cruzi infection: a review with emphasis on cutaneous manifestations

Abstract

Chagas disease, an infection caused by the protozoan Trypanosoma cruzi and transmitted by the Reduuvid insect vector, remains a major cause of morbidity in Central and South America over a century after its discovery in 1909. Though major advances in preventing the spread of this disease have been made in recent decades, millions of individuals remain chronically infected due to prior exposure to T. cruzi and are at risk for future complications from the disease. Dermatologic manifestations of acute infection may include localized swelling at the site of inoculation (chagoma), conjunctivitis (Romaña's sign), and a generalized morbilliform eruption (schizotrypanides). Reactivation of quiescent infection in immunocompromised hosts due to the acquired immunodeficiency syndrome or organ transplantation can present with fever and skin lesions including panniculitis. The widespread emigration of chronic carriers of T. cruzi to North America, Europe, and Australia makes it imperative that dermatologists worldwide be familiar with this entity to ensure proper diagnosis and treatment.

Figure 1

The triatomine and human stages of the life cycle of Trypanosoma cruzi (courtesy of CDC)

Figure 2

Erythematous plaque in a renal transplantation patient with reactivation Chagas disease (Gallerano, 2007)

Figure 3

Lower extremity plaques in a cardiac transplantation patient with reactivation Chagas disease in North America (courtesy of Eva Parker)

Figure 4

Intracellular amastigotes visualized on an H&E stain from a skin biopsy specimen from the patient in Fig. 3 (courtesy of Eva Parker)

Figure 5

Trypomastigotes in a Giemsa smear (×650) prepared from the blood of an infected mouse