New Delhi: As World Chagas Disease Day is observed on April 14, health experts in India emphasised for a massive awareness drive for the little-known disease.
Naming the theme for 2024 as 'Tackling Chagas disease: detect early and care for life,' the World Health Organization (WHO) has also highlighted increasing public awareness of Chagas disease and securing greater funding and support for early diagnosis and life-long, comprehensive follow-up care initiatives.
WHO's view on Chagas: According to the WHO, an estimated 6–7 million people worldwide are infected with Trypanosoma cruzi, the parasite that causes Chagas disease, leading to some 12,000 deaths every year. At least 75 million people are at risk of infection, with annual incidence estimated to be about 30–40 000 cases. However, in many countries, detection rates are low (less than 10 per cent and often less than 1 per cent) and people suffering from the disease often encounter significant barriers to diagnosis and adequate healthcare.
Naming of Chagas: Chagas disease is named after Carlos Chagas, a Brazilian physician and researcher who on April 14, 1909 diagnosed the disease in a person for the first time.
Distribution: Chagas disease was once entirely confined to continental rural areas of the Americas. Due to increased population mobility, most infected people now live in urban settings and the infection has been detected in 44 countries (including Canada, the United States of America, and many European and some Western Pacific, African and Eastern Mediterranean countries).
Signs and symptoms: Chagas disease presents in two phases. The initial acute phase lasts for about two months after infection. Although a high number of parasites can circulate in the blood, in most cases symptoms are absent or mild and non-specific (fever, headache, enlarged lymph glands, pallor, muscle pain, difficulty in breathing, swelling, and abdominal or chest pain). Much less frequently people bitten by a triatomine bug show the characteristic first visible signs, which can be a skin lesion or a purplish swelling of the lids of one eye.
During the chronic phase, the parasites are hidden mainly in the heart and digestive muscles. One to three decades after infection, up to a third of patients suffer from cardiac disorders and up to 1 in 10 suffer from digestive (typically enlargement of the oesophagus or colon), neurological or mixed alterations. In later years these patients may experience the destruction of the nervous system and heart muscle, consequent cardiac arrhythmias or progressive heart failure, and sudden death.
Indian Perspective: Talking to ETV Bharat, Dr Suneela Garg, Chair Programme Advisory Committee of the National Institute of Health and Family Welfare (NIHFW) said, “Human trypanosomiasis is endemic in Africa and Latin America known as sleeping sickness caused by Trypanosoma brucei. Animal trypanosomiasis is endemic in India. In India trypanosomiasis was detected in young infants in 2016. Ironically there is no vaccine for the disease. There is a definite need for awareness creation.”
"Elimination of Bugs spraying Insecticides is important. One should take precautions while travelling to the Chagas endemic area. Avoid sleeping outdoors and using insecticides. Avoiding blood transfusions and organ transplants in Chagas endemic areas,” said Dr Garg.
Experts Opinion: “While Chagas disease (human trypanosomiasis) is not historically known to exist in India, cases have been reported in countries beyond Latin America due to immigration and global travel. Although India is not an endemic region for Chagas disease, raising awareness remains crucial to prevent its potential spread,” said Dr Tamorish Kole, past president of the Asian Society for Emergency Medicine.
He said that Human trypanosomiasis, also known as sleeping sickness (caused by Trypanosoma brucei), is endemic in Africa. Similarly, in Latin America, it manifests as Chagas disease (caused by T. cruzi). Human trypanosomiasis is not known to exist in India but animal trypanosomiasis is endemic here. It is caused by either T. evansi in cattle and horses or T. lewisi in rats. Although sporadic cases of human infection with animal trypanosomes have been reported in India, the disease is not widespread among the human population.
"Raising awareness about this condition is crucial for several reasons including early diagnosis is essential to initiate timely treatment. Avoiding potentially toxic anti-trypanosomal therapy in patients who are stable or improving and monitoring changes in the epidemiology of this rare zoonotic infection,” Dr Kole said.
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