About 1.2 million Brazilians have Chagas disease, but most are unaware

Chagas disease affects about 1.2 million people in Brazil and another 6 million in the rest of the world. However, more than 70% of patients do not know they have the disease, according to data from PAHO (Pan American Health Organization) presented this month by the SBC (Brazilian Society of Cardiology).

Considered a neglected tropical disease by the WHO (World Health Organization), it is caused by the protozoan Trypanosoma cruzi. If left untreated, it can affect the heart, the digestive tract, including the esophagus and intestine, or both.

In only about 30% to 40% of cases, Chagas disease manifests symptoms, but even in these cases they can take 10 to 30 years to appear, a time considered to be high to reverse a more serious complication, explains cardiologist Anis Rassi.

“That’s why early diagnosis is essential, because the chance of cure if it is done in the first days of transmission is up to 100%, and progressively decreases over the years”, explains the doctor.

The main route of transmission of the trypanosome is through the contaminated feces of the barbeiro, a bed bug (genus Triatoma) which, by biting humans, also eliminates the parasite in the feces, but the number of Chagas cases through other transmission routes has grown worldwide. “The main one that we have seen growing, mainly in the Amazon region, is through oral ingestion, in the consumption of fruits and drinks such as açaí or sugar cane. In these cases, the lethality is greater because the barber is ground together, and the amount of protozoa that are ingested is very high”, says Rassi.

The other recognized transmission routes are through the passage of the parasite from the mother to the baby during pregnancy, by blood transfusion, organ transplantation and by laboratory accident. In the case of congenital Chagas disease, the risk indicated in Brazil is one baby in every thousand mothers with the disease (about 2%).

That’s how, however, retired seamstress Lourdes Maria de Souza Pilati, 75, discovered the condition in her youngest son, accountant André Pilati, 45. Lourdes was infected with Chagas as a child — she doesn’t know the exact age, but says believe that around the age of two—, when he was still living with his family in a house with dirt floors in the interior of São Paulo.

The manifestation of her symptoms came only 18 years later, when she turned 20, and they were mainly intestinal. “I had to have surgery and remove 35 centimeters of the intestine. The doctor said I would only live until I was 40 years old, but I turned 75 and I no longer have Chagas problem”, she says.

The path, however, was arduous. From the moment of her diagnosis to the definitive cure, the seamstress says that she went through at least three different doctors until she was able to carry out the treatment. “I would go 12 days without going to the bathroom,” she says.

After a conversation with a doctor in Santa Cruz do Rio Pardo, a municipality in the interior of São Paulo, he started treatment with the only two existing medications (benznidazole and nifurtimox, both are not available at the Popular Pharmacy), whose side effects may include weight loss. , lack of energy and weakness. “I came to think: if I die, at least I will die doing the treatment”.

Lourdes managed to complete the 90-day cycle of the drug. Gradually, she was gaining weight again. She had three children, the youngest of them the only one who had the Chagas serotype in his blood. “Until he was six months old, I took him to Rubião Jr. [Hospital das Clínicas da Faculdade de Medicina da Unesp] to collect blood and perform tests, until he ‘disappeared'”. Today, his son is a blood donor and does not have Chagas

This is, in fact, one of the most frequent ways of making the diagnosis of Chagas, recalls Rassi. “When donating blood, serotyping for Chagas is mandatory. The diagnosis of the disease is simple, the test is not complex and is available in blood banks. However, doctors themselves are sometimes unaware and do not ask”, he says.

It is for this reason that SBC has released a new guideline for disease awareness. According to the note, released during the 77th Brazilian Congress of Cardiology, held from the 13th to the 15th of this month in Rio de Janeiro, the disease is the most lethal among the neglected ones that affect the heart.

Although the incidence has reduced considerably in the last 40 years due to improvements especially in housing and vector control, the disease continues to have a high lethality. The WHO hopes to eradicate the disease by 2050.

If identified at the beginning, even without the manifestation of symptoms, the treatment is much more effective, reminds the cardiologist. However, treatment when symptoms are severe is, in general, more expensive and painful.

According to Rassi, the recent cases that have emerged in countries where there is no bed bug — such as the US, which currently has around 300,000 registered cases, with a higher incidence outside a tropical country — should stimulate research into drugs and even vaccines against Chagas disease. . “Unfortunately, we know that there is no commercial interest for pharmaceutical companies to investigate treatments for neglected diseases, unless they become a health problem, also occurring in rich countries”, he reports.