Phases and forms of Chagas disease

Acute phase
Trypanosoma cruzi detected in the blood or myocardial, esophageal, or skin tissue* Most patients are asymptomatic or have mild nonspecific symptoms (eg, fever and fatigue) A minority of patients have symptoms or signs of acute Chagas myocarditis or myopericarditis with heart failure, pericardial effusion, and/or arrhythmias
Chronic phase
Serologic study positive for IgG antibodies to T. cruzi* Form and stage depends on degree of symptoms and signs and findings on ECG, echo, radiologic, or other studies
	Indeterminate form	Chronic Chagas cardiomyopathy^¶
	Stage A	Stage B1	Stage B2	Stage C	Stage D
Symptoms	No current or prior symptoms or signs of chronic Chagas heart disease or gastrointestinal involvement^Δ	No current or prior symptoms or signs of chronic Chagas heart disease^Δ	No current or prior symptoms or signs of chronic Chagas heart disease^Δ	Current or prior symptoms or signs of chronic Chagas heart disease^Δ(excluding refractory heart failure requiring specialized interventions); NYHA functional class I, II, III, or IV	Refractory symptoms of heart failure with Chagas heart disease^Δ (despite optimized evidence-based therapy) requiring specialized interventions; NYHA functional class IV
ECG	No abnormalities	Variable	Variable	Variable	Variable
Echo	No abnormalities^◊	Regional wall motion abnormalities may be present Normal global LV and RV function	Impaired global LV and/or RV systolic dysfunction; dilated cardiomyopathy	Impaired global LV and/or RV systolic function; dilated cardiomyopathy	Impaired global LV and/or RV systolic function; dilated cardiomyopathy
Other radiologic findings	No abnormalities on chest radiograph No radiologic evidence of gastrointestinal involvement^§	No abnormalities on chest radiograph	Variable	Variable	Variable

ECG: electrocardiogram; echo: echocardiogram; Ig: immunoglobulin; NYHA: New York Heart Association; LV: left ventricular; RV: right ventricular; ACC/AHA: American College of Cardiology/American Heart Association.
* Refer to UpToDate content on methods for detection of T. cruzi parasitemia and serologic methods for detection of IgG antibodies to T. cruzi.
¶ These stages of chronic Chagas cardiomyopathy are similar to the ACC/AHA stages of heart failure.
Δ Clinical manifestations of chronic Chagas heart disease (known as chronic Chagas cardiomyopathy, CCC) include symptoms and signs of heart failure, arrhythmia, and cardioembolic disease.
◊ Criteria for the indeterminate form are controversial. While this table includes echocardiography as a test to exclude structural heart disease in the indeterminate form, the classical approach does not include echocardiography.
§ While strict criteria for the indeterminate form require extensive radiologic gastrointestinal evaluation, clinicians commonly do not require radiologic esophageal study or barium enema in the absence of esophageal symptoms or constipation, as these studies are mostly unnecessary and add to cost.

Graphic 129165 Version 1.0

خرید پکیج

Phases and forms of Chagas disease