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      Chagas Disease: From Discovery to a Worldwide Health Problem

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          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.

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          Chagas disease

          Chagas disease is an anthropozoonosis from the American continent that has spread from its original boundaries through migration. It is caused by the protozoan Trypanosoma cruzi, which was identified in the first decade of the 20th century. Once acute infection resolves, patients can develop chronic disease, which in up to 30-40% of cases is characterised by cardiomyopathy, arrhythmias, megaviscera, and, more rarely, polyneuropathy and stroke. Even after more than a century, many challenges remain unresolved, since epidemiological control and diagnostic, therapeutic, and prognostic methods must be improved. In particular, the efficacy and tolerability profile of therapeutic agents is far from ideal. Furthermore, the population affected is older and more complex (eg, immunosuppressed patients and patients with cancer). Nevertheless, in recent years, our knowledge of Chagas disease has expanded, and the international networking needed to change the course of this deadly disease during the 21st century has begun.
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            Chagas disease

            The Lancet, 375(9723), 1388-1402
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              Clinical and epidemiological aspects of Chagas disease.

              A. Prata (2001)
              Chagas disease is caused by the protozoan parasite Trypanosoma cruzi. During the past decades, after urban migrations, Chagas disease became frequent in cities and a health problem in non-endemic countries, where it can be transmitted vertically and by blood transfusion or organ transplantation. Microepidemics of acute Chagas disease have been reported, probably due to oral transmission. Heart involvement is the major feature of the disease because of its characteristics, frequency, and consequences, and is also the source of most controversies. The indeterminate clinical form, despite its good prognosis on at least a medium-term basis (5-10 years), has acquired increasing importance due to the controversial meaning of the abnormality of some tests and the myocardial focal lesions found in many patients. Simultaneous evaluation of the parasympathetic and of the sympathetic system in the heart has been done by spectral analysis of heart rate. The physiopathological and clinical significance of denervation in Chagas disease is still incompletely understood. There are major divergences of opinion on specific treatment during the chronic phase because of the doubts about cure rates. Changes of Chagas disease prevalence in many countries have been certified by the Pan American Health Organization, and are ascribed to large-scale vector-control programmes with modern pyrethroid insecticides and to improvement in lifestyle.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                02 July 2019
                2019
                : 7
                : 166
                Affiliations
                [1] 1Laboratory of Molecular Immunopathology, Clinical Hospital, Federal University of Paraná , Curitiba, Brazil
                [2] 2Laboratory of Biochemistry of Tryps-LaBTryps, Department of Parasitology, Institute for Biomedical Sciences, University of São Paulo , São Paulo, Brazil
                [3] 3Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná , Curitiba, Brazil
                [4] 4Institute of Tropical Medicine, University of Tübingen , Tübingen, Germany
                Author notes

                Edited by: Alexandre Morrot, Federal University of Rio de Janeiro, Brazil

                Reviewed by: Valter Viana Andrade-Neto, Oswaldo Cruz Foundation (Fiocruz), Brazil; Roberto Coury Pedrosa, Federal University of Rio de Janeiro, Brazil

                *Correspondence: Thaisa Lucas Sandri thaisa.lucas-sandri@ 123456uni-tuebingen.de

                This article was submitted to Infectious Diseases-Surveillance, Prevention and Treatment, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2019.00166
                6614205
                31312626
                8f86b9cb-6ca3-448b-be02-e7b743aeedab
                Copyright © 2019 Lidani, Andrade, Bavia, Damasceno, Beltrame, Messias-Reason and Sandri.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 09 April 2019
                : 05 June 2019
                Page count
                Figures: 3, Tables: 1, Equations: 0, References: 150, Pages: 13, Words: 11329
                Categories
                Public Health
                Review

                chagas disease,epidemiology,trypanosoma cruzi,chagas cardiomyopathy,neglected disease

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