# Chagas Disease (American Trypanosomiasis) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Chagas Disease - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK459272/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.01 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Recognition & Referral) ## Complete treatment card ```text CHAGAS DISEASE (AMERICAN TRYPANOSOMIASIS) Sources: Chagas Disease - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK459272/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.01 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Patients rarely recall or mention the triatomine bug bite itself - Acute illness often brings fever, localized swelling, enlarged lymph nodes, muscle aches, pallor, breathlessness and abdominal or chest pain [abdominal pain · breathlessness · chest pain · fever · lymphadenopathy · muscle pain · pallor] - A minority develop an anaphylactic-type reaction to the bite, with hives, flushing, wheeze, nausea, vomiting and diarrhea [diarrhoea · nausea · urticaria · vomiting · wheeze] - Congenital transmission can cause prematurity, low birth weight, fever, anemia and reduced muscle tone [anaemia · fever] - Chronic cardiac disease can present with fever, an enlarged heart, apical aneurysms, ECG changes, or frank heart failure [fever] - Chronic GI-phase Chagas can present with fever, megaesophagus, megacolon and constipation [constipation · fever] SIGNS - what you find (5) - One-sided conjunctivitis with purplish eyelid swelling, called Romana sign or a chagoma, is a hallmark finding [eyelid swelling] - Cardiomegaly can show up as a displaced apical impulse, narrowed pulse pressure or sinus tachycardia [tachycardia] - Right heart failure can bring bibasilar lung crackles and pitting swelling of both legs [crackles] - The abdomen can be distended but soft, with quiet bowel sounds, and rectal exam may find impacted stool - Exam may find an enlarged liver and spleen plus conjunctival pallor from chronic anemia [anaemia · hepatomegaly · pallor] TESTS (7) - Acute diagnosis relies on seeing the parasite by microscopy in fresh anticoagulated blood or buffy coat - PCR can turn positive days to weeks before a routine blood smear picks up circulating parasites - ECG, chest x-ray and echocardiography can all show cardiomegaly, and echo can reveal a reduced ejection fraction - ECG often shows first-degree AV block and atrial flutter or fibrillation, plus conduction defects such as right bundle branch block or left anterior fascicular block - Abdominal x-rays can show bowel pseudo-obstruction or an enlarged megacolon - Barium swallow or enema studies can be used to further evaluate GI symptoms - Chronic infection is confirmed by finding IgG antibodies against T. cruzi IF NOT THIS - what else fits (11) - Esophageal motility disorders belong on the differential list - Esophageal rupture belongs on the differential list - Esophageal spasm belongs on the differential list - Esophagitis belongs on the differential list - Gastroesophageal reflux disease belongs on the differential list - Leishmaniasis belongs on the differential list - Malaria belongs on the differential list - Meningitis belongs on the differential list - Myocardial infarction belongs on the differential list - Myocardial rupture belongs on the differential list - Congestive heart failure belongs on the differential list Source StatPearls "Chagas Disease" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line] Adult Chronic protozoal infection spread by triatomine ('kissing') bugs found only in the Americas. Not a Cairo diagnosis except in someone who lived in or travelled extensively through Latin America; the specific drugs (benznidazole, nifurtimox) are not marketed in Egypt, so any suspected case needs referral to a tropical medicine centre. - Refer Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Chronic protozoal infection spread by triatomine ('kissing') bugs found only in the Americas. Not a Cairo diagnosis except in someone who lived in or travelled extensively through Latin America; the specific drugs (benznidazole, nifurtimox) are not marketed in Egypt, so any suspected case needs referral to a tropical medicine centre. Caution Not endemic in Egypt. Relevant to a returning traveller or an imported case; consider the travel history before anything else. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - An acute febrile illness with periorbital swelling (Romana's sign) after a relevant exposure, or unexplained cardiomyopathy, megacolon or megaoesophagus in a patient with a relevant Latin American residence history: refer for specialist assessment. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)