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Challenges and opportunities for primary, secondary, and tertiary prevention of Chagas disease
  1. Anis Rassi, Jr (arassijr{at}terra.com.br)
  1. Anis Rassi Hospital, Brazil
    1. Joao Carlos Pinto Dias (jcpdias{at}cpqrr.fiocruz.br)
    1. Oswaldo Cruz Foundation (Ministry of Health), Brazil
      1. Jose Antonio Marin-Neto (marin_neto{at}yahoo.com)
      1. Medical School of Ribeirao Preto, Brazil
        1. Anis Rassi (anisrassi{at}arh.com.br)
        1. Anis Rassi Hospital, Brazil

          Abstract

          One century after its discovery, Chagas disease still represents a major public health challenge in Latin America. Moreover, due to growing population movements, an increasing number of imported Chagas disease cases have now been detected in non-endemic areas, such as North America and some European countries. This parasitic zoonosis, caused by Trypanosoma cruzi, is transmitted to humans by infected triatominae bugs, or occasionally by non-vectorial mechanisms, such as blood transfusion, mother to foetus, or oral ingestion of materials contaminated with parasites. Following the acute phase of the infection, untreated individuals enter a chronic phase that is initially asymptomatic or clinically unapparent. Usually, a few decades later, 40-50% of patients develop progressive cardiomyopathy and/or motility disturbances of the oesophagus and colon. In the last decades several interventions targeting primary, secondary, and tertiary prevention of Chagas disease have been attempted. While control of both vectorial and blood transfusion transmission of T. cruzi (primary prevention) has been successful in many regions of Latin America, early detection and etiological treatment of asymptomatic subjects with Chagas disease (secondary prevention) have been largely underutilized. At the same time, in patients with established chronic disease, several pharmacological and non-pharmacological interventions are currently available and have been increasingly used with the intent to prevent or delay complications of the disease (tertiary prevention). In this review we discuss in detail each one of the above-mentioned issues.

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