Global Expression of Chagas´ Disease - Emerging Opportunities and Impact in Portugal

Abstract

Chagas disease, caused by the protozoan Trypanosoma cruzi is endemic in the countries of Central and South America. Despite vector control programs and other measures taken in the blood banks and maternity hospitals, it is estimated that there are about eight million people infected worldwide. Although traditionally associated with rural life and poverty, the current migration flows transform it into a global public health problem. In Portugal, this problem is poorly known, with an estimated underdiagnosis index that exceeds 99%. In European countries, besides imported cases, autochthonous infections arise through vertical transmission and blood/organ donation. The conventional serological tests for diagnosing Chagas disease and verifying its cure are indirect hemagglutination (IHA), indirect immunofluorescence (IFAT), and enzyme-linked immunoabsorbent assay (ELISA). The hypothesis of autoimmunity as a basic mechanism of this disease and the absence of early markers of cure are the causes of controversy regarding the specific treatment of this disease. The currently available drugs have adverse effects on a large number of patients and parasitological efficacy in chronic disease is suboptimal. The authors reinforce the need of a high level of suspicion in patients with suggestive epidemiology and the need of populational screening of specific high risk groups.