Since 2019, World Chagas Disease Day is celebrated on April 14. For researchers, NGOs (non-governmental organizations) and other initiatives, the creation of the date is seen as an achievement. It is a way of bringing more visibility to a disease that 28 million people in the world are at risk of contracting, according to PAHO (Pan American Health Organization).
And that may seem like “bullshit”, but it’s actually a way to get more investment, especially when the disease in question is considered neglected. This means that it receives little attention from researchers and the pharmaceutical industries. These are conditions that affect the poorest regions, with the most needy populations, without access to basic sanitation and drinking water, for the most part.
“April 14th was recognized by the WHO (World Health Organization) and it is a struggle of several movements that we have. This generated a certain visibility, even because of the issue of globalization of the disease. Now, we are beginning to see, including , international investments”, says Andréa Silvestre, researcher at INI (National Institute of Infectious Diseases Evandro Chagas), at Fiocruz (Fundação Oswaldo Cruz)
She is even the cardiologist who takes care of the Cuida Chagas project, an international initiative that aims to contribute to the elimination of congenital transmission (children infected at birth), in addition to expanding access to diagnosis, treatment and comprehensive care in Bolivia, Brazil, Colombia and Paraguay.
“We are used to seeing this type of work and investment in other diseases, but this practically did not exist for a neglected disease like Chagas”, says the researcher.
He discovered Chagas and needed a pacemaker
In Brazil, the disease is more common in the North or Northeast regions, especially in rural areas, with wattle and daub houses and/or straw, without adequate covering. This is even the reality of many people, as was the reality of retired Fernando Guedes de Moura, 67.
He lived until he was 19 years old in the northeast of Paraíba in a house with this type of material. He never had any health problems or any manifestation of Chagas disease.
In 2017, when I was already living in suzano, a city in Greater São Paulo, participated in the Blue November campaign, focused on men’s health. He had blood tests that caught the attention of doctors. Afterwards, he performed a specific one for the disease, which soon confirmed the diagnosis.
As soon as he discovered Chagas disease, Fernando, who was 62 years old at the time, began to faint and experience arrhythmia, lack of rhythm in his heartbeat. “One day, I went for an endoscopy, but I was prevented because my heart had a lot of arrhythmia”, recalls the retiree.
With that, the doctor decided to perform other tests on the heart, which showed an organ already contaminated and affected by the protozoan that causes the disease, the Trypanosoma cruzi.
The problem is that Fernando felt worse and worse, with frequent fainting, high blood pressure and fatigue. “My heart was weak, I couldn’t do anything. I couldn’t even go up a street, for example.”
That’s when the doctors decided to hospitalize the retiree. First, they put in a pacemaker while he was in the ICU (Intensive Care Unit) to see if they could lessen the impacts on his heart.
“I stayed in the hospital for 22 days, 4 using the device, but I went back home and didn’t get any better. That’s why I had surgery to place the internal pacemaker. Since then, I’ve never had anything else,” he says.
According to cardiologist Edmo Atique Gabriel, columnist for VivaBem and professor at Unilago (União das Faculdades dos Grandes Lagos), in São Paulo, the device is indicated for patients with Chagas disease when the heart begins to fail — exactly what happened with Fernando.
“One of the faults is the heart rate, which starts to drop and the person starts to faint and dizzy, in addition to feeling weak. This is an injury caused by inflammation caused by Chagas disease. It is not possible to reverse the problem if not with the device that artificially recovers the patient’s natural heart rate”, says the doctor, also a specialist in cardiovascular surgery.
Most do not know they have Chagas disease
In the Americas, it is estimated that 6 to 8 million people are already infected, 3 million of whom have the disease in its chronic stage. In addition, every year, 56,000 new cases are reported, mainly in children.
In Brazil, according to the 2021 epidemiological bulletin, 146 cases of Chagas were confirmed in 2020 – only the acute cases, therefore, diagnosed precociously—, with all deaths (3) occurring in the state of Pará. The North had the highest incidence rate of the disease.
However, according to the Ministry of Health with data from last year, at least 1 million people would be chronically infected with the disease – most may not even know about the condition.
Locating infected patients is a challenge
Fernando does not know where and when he was infected, although he lived in a place considered to be at risk for the condition. This is the great challenge of Chagas disease: identifying who the infected people are and, with that, treating them.
“The first thing we need to do is to know who are the people affected by the disease to confirm the diagnosis and think about treatments. Mainly because it is a recognized chronic condition”, explains the researcher from Fiocruz.
This means that people in the acute phase of the disease, with symptoms such as fever, malaise, lack of appetite, edema (swelling) located in the eyelid or other parts of the body, will not relate, at first, with the disease. Most often do not have any of the symptoms at this stage.
The most common is that patients present manifestations after 30, 40 years, and, consequently, with greater involvement of organs such as the heart, esophagus and intestine.
Another problem is that, unlike other conditions considered neglected, such as tuberculosis, HIV and leprosy, Chagas disease only in an acute form — therefore, much more difficult to diagnose — is notifiable, that is, health agencies are informed of the case and, in the future, this information is included in epidemiological bulletins.
This is how it is possible to identify populations at greater risk, in addition to thinking about awareness campaigns in places most impacted by the problem.
“Recently, we managed to develop the implementation of notification to the states of chronic Chagas disease, but, in practice, it is still not effectively happening”, says Silvestre.
Symptoms of the disease go unnoticed
According to experts consulted by Live wellit is common for a person infected with Trypanosoma cruzi die of other causes —cancer, accident, among others — before knowing he had Chagas.
“She can have a fever, for example, and after this phase, she enters the asymptomatic stage and stays like that for decades. About 60% of people stay like this all their lives, which we call positive serology”, explains the Fiocruz researcher. . “But 30%, 40% will have the complications of the disease, usually heart disease or impacts on the digestive system.”
The protozoan affects the whole body, but some organs tend to be more impacted, as they become dilated and fail to function properly. “That’s why we have megaesophagus, megacolon (part of the intestine) and megacardio, which is the enlarged heart”, explains the cardiologist.
Some symptoms for these conditions involve weight loss, constant reflux, severe and progressive colds, distended abdomen, cardiac arrhythmia, fainting, and frequent tiredness.
As said, depending on the organ affected, it is possible to treat only the symptoms. The drug, now available through the SUS, is only indicated for the initial stages of the problem, such as in children, for example.
Transmission and prevention
Chagas disease is transmitted by the barber’s feces that come into contact with the human body through the skin, mouth, nose or wounds and cuts on the body. There is still another way, according to Tânia Chaves, an infectious disease specialist and consultant at SBI (Brazilian Society of Infectious Diseases) and professor at the Faculty of Medicine at UFPA (Federal University of Pará).
“The vector, when biting the individual, defecates. Afterwards, the person scratches at the bite site, which is the moment when the infective forms of the trypanosome cruzi reach the bloodstream”, he explains.
There is contamination via food contaminated by the insect and by blood transfusion, if the donor is a carrier of the disease. There is also transmission from the mother with Chagas disease to the child via the placenta.
The prevention of the disease is based on public measures to control the barber, in addition to offering more adequate housing through plastering and filling cracks and crevices, as well as screens on doors and windows. Informing relatives and acquaintances about the disease and preventive measures are also important issues.