Chagas Disease: From Discovery to a Worldwide Health Problem

Abstract

Carlos Chagas discovered American trypanosomiasis, also named Chagas disease (CD) in his honor, just over a century ago. He described the clinical aspects of the disease, characterized by its etiological agent (Trypanosoma cruzi) and identified its insect vector. Initially, CD occurred only in Latin America and was considered a silent and poorly visible disease. More recently, CD became a neglected worldwide disease with a high morbimortality rate and substantial social impact, emerging as a significant public health threat. In this context, it is crucial to better understand better the epidemiological scenarios of CD and its transmission dynamics, involving people infected and at risk of infection, diversity of the parasite, vector species, and T. cruzi reservoirs. Although efforts have been made by endemic and non-endemic countries to control, treat, and interrupt disease transmission, the cure or complete eradication of CD are still topics of great concern and require global attention. Considering the current scenario of CD, also affecting non-endemic places such as Canada, USA, Europe, Australia, and Japan, in this review we aim to describe the spread of CD cases worldwide since its discovery until it has become a global public health concern.

Keywords: Chagas cardiomyopathy; Chagas disease; Trypanosoma cruzi; epidemiology; neglected disease.

Figure 1

(A) Berenice: the first patient diagnosed with Chagas disease. (B) Brazilian newspaper reporting the history of Chagas disease and Berenice, saying “Chagas disease was discovered here” (up), and: “And this is the first case” (down). Source: Archives of the Instituto Oswaldo Cruz.

Figure 2

Timeline with the first human cases of Chagas Disease (CD) reported in Latin America. Following the report of the first patient confirmed with CD (Berenice) in Brazil by Carlos Chagas in 1909, cases were reported in several countries such as El Salvador, Venezuela, Peru, Costa Rica, Paraguay, Guatemala, Chile, Mexico, Bolivia, Colombia, Nicaragua, Argentina, and Honduras, with essential findings in paleoparasitology field. In 1935, the Romaña signal was associated with the acute form of CD and the xenodiagnosis was proposed. Only in 1960, government programs were implemented to control CD in Latin America.

Figure 3

Current estimated number of immigrants with T. cruzi infection in non-endemic countries. Estimation based on data for the United States (2007) and Canada (2006) (93), Europe (2008–2011) (94), Japan (2007) (95), Australia (2011), and New Zealand (2006) (92).