Risk of COVID-19 in Chagas Disease Patients: What Happen with Cardiac Affectations?

Abstract

Background: Chagas disease is considered a neglected tropical disease. The acute phase of Chagas disease is characterized by several symptoms: fever, fatigue, body aches, headache and cardiopathy's. Chronic phase could be asymptomatic or symptomatic with cardiac compromise. Since the emergence of the pandemic caused by the SARS-CoV-2 virus, the cardiovascular involvement has been identified as a complication commonly reported in coronavirus disease 2019 (COVID-19). Due to the lack of knowledge of the cardiac affectations that this virus could cause in patients with Chagas disease, the aim of this review is to describe the possible cardiac affectations, as well as the treatment and recommendations that patients with both infections should carry out.

Methods: The authors revised the recent and relevant literature concerning the topic and discussed advances and limitations of studies on COVID-19 and their impact in Chagas disease patients, principally with cardiac affectations.

Results: There currently exists little information about the consequences that Chagas disease patients can suffer when they are infected with COVID-19.

Conclusions: This review highlights the emerging challenges of access to medical care and future research needs in order to understand the implications that co-infections (SARS-CoV-2 or other viruses) can generate in Chagas disease-infected people.

Keywords: COVID-19; Chagas disease; cardiac complications; cardiopathies; coinfections.

Figure 1

Representation of the biological cycle of Trypanosoma cruzi. Infection is generated when hematophagous bugs reach a mammalian host to feed (1), infected bug feces (containing the parasite in their form as metacyclic trypomastigotes) are released on the skin (near the bite wound) or in the mucosa of the host. Through micro-wounds caused by scratching excessive or by mucosa route, the parasite reaches the bloodstream (2 and 3) and invades different types of nucleated cells (4) (phagocytic and nonphagocytic). The parasitophorous vacuole is formed inside the infected cells to eliminate the parasite; however, T. cruzi trypomastigotes escape this vacuole and differentiate in amastigotes, which are the replicative forms of the parasite in the mammalian host. After several rounds of replication in the cytosol, the amastigotes differentiate into trypomastigotes, and then, the infected cells burst, and the parasites are subsequently released into the bloodstream where they can disseminate to several tissues, mainly the heart, colonizing the cardiac cells and forming the so-called amastigote nests (5a), or they can reinvade the blood cells. Finally, the circulating forms can be taken up by a new triatomine vector during a blood meal, and this vector can infect to another healthy host (5b). In other hand, cardiac affectations can be observed in the acute phase or in the chronic phase; these affectations can be in different degrees of severity (6) (see text) culminating in a heart attack, which can cause the death of the host.

Figure 2

Reported cases of Chagas disease in Mexico and their possible correlations with cardiopathies from the period 2017–2020.