Talk:Chagas disease

FAR needed

Improvements since article was submitted to FAR

This article passed FAC in 2005, and doesn't appear to have been significantly updated since about 2010. There are numerous dated statements throughout the article (far too many to list), and a review listed above that has not been incorporated. Other newer reviews are:

• PMID 26222561
  • Bern C (July 2015). "Chagas' disease". N. Engl. J. Med. (Review). 373 (5): 456–66. doi:10.1056/NEJMra1410150. PMID 26222561.
• PMID 31006555
  • Guarner J (May 2019). "Chagas disease as example of a reemerging parasite". Semin Diagn Pathol (Review). 36 (3): 164–169. doi:10.1053/j.semdp.2019.04.008. PMID 31006555.
• PMID 31904415
  • Bivona AE, Alberti AS, Cerny N, Trinitario SN, Malchiodi EL (January 2020). "Chagas disease vaccine design: the search for an efficient Trypanosoma cruzi immune-mediated control". Biochim Biophys Acta Mol Basis Dis (Review). 1866 (5): 165658. doi:10.1016/j.bbadis.2019.165658. PMID 31904415.
• PMID 31862616 "CD is the most common fatal infection in Central and South America affecting, in endemic countries, about eight million people and causing the death of approximately 50,000 individuals each year (WHO, 2018)."
  • Ribeiro V, Dias N, Paiva T, et al. (December 2019). "Current trends in the pharmacological management of Chagas disease". Int J Parasitol Drugs Drug Resist (Review). 12: 7–17. doi:10.1016/j.ijpddr.2019.11.004. PMC 6928327. PMID 31862616. SandyGeorgia (Talk) 22:53, 10 March 2020 (UTC)

The article is quite badly outdated. Also, with the current Crisis in Venezuela, new effects there might be mentioned. [1] SandyGeorgia (Talk) 01:48, 23 January 2020 (UTC)

User:SandyGeorgia I completely agree, though updates disappear / are censored/ discouraged because of our medical WP leader, Doc James, as for example here . He inserts the term unusual even though facts have been emerging that state otherwise. He has even attributed statements to completely different sources as here, disappearing the original ref.

A problem with the 4 refs you suggested is, some are already 4 yrs old. all except one ( Current trends in the pharmacological management of Chagas disease) are behind paywalls. we need good publicly viewable refs (and they regularly get removed by Doc James too, if you check). The other open access "Update on Chagas disease in Venezuela during the period 2003–2018" unfortunately is a review of self selected samples, so it is unclear what prevalence it reflects. -But by all means you should take a stab at working your references into the article! --Wuerzele (talk) 16:41, 25 February 2020 (UTC)

@SandyGeorgia: Yikes! Saw your post at WT:MED, this may be the worst article with the FA star I've seen yet. I should have time and sources to start working on the article this week. I'm unfamiliar with the bureaucratic trappings of FAR, so let me know if there's something I should post there. If the others who commented there are interested in helping, the more the merrier. Thanks for bringing this up, SandyGeorgia! I was just looking for a new chore. Happy editing! Ajpolino (talk) 17:35, 7 March 2020 (UTC)

Hi, Ajpolino; glad to see someone jump in! First, the process, then the changes needed.

Here are the Featured article standards. A medical featured article has the additional need to use the most current WP:MEDRS-compliant sources. FAR measures the article against that list of standards, so when working to retain the star, it is important to maintain a professional level of prose, consistent citations, conformance with WP:MOS, WP:LEAD, etc. If you are not up on MOS or citation formatting, please don't worry about that, as I am able to go through and fix that sort of stuff once sources and text settle down. FAR is divided into three stages, all very deliberate and prodding, with the goal of restoring articles to featured status rather than removing the star. The first stage is to notify the article talk page. If that gets no results, the FAR (review) is opened, with two weeks to identify issues, and maybe fix them without a FARC (removal candidate). Unfortunately, Chagas has already progressed to the FARC phase, so we need to get moving. Fortunately, as long as progress is being made, the Coords give time. But there needs to be steady progress demonstrated. One of the FAR Coords, Casliber is a medical editor, and knows the amount of work that we need to do here. Work is discussed on this page, with only periodic updates to the FAR so the FAR coordinators know we're on it.

Next, what needs to be done. There are numerous very old sources in the article, and some of the content is demonstrably outdated. But it is good to add newer citations on accurate text even if the text hasn't changed (so that five years from now, we're not looking at 20-year-old sources!) So, next is to identify the latest and highest quality secondary broad journal reviews (I added several above), and use them to thoroughly update the article. Textbooks are typically too outdated, although sometimes helpful, and there is rarely the need to use a primary source in a broad overview medical condition.

If you are able to help on all of that, I can be watchlisting to make sure we keep consistent citations, MOS compliance, etc. It is always wise to leave updating the lead to last; once the body of the article is settled, things can be summarized to the lead. If you are on board, I will indicate on the FAR that we are holding for improvements. There is too much work for me to do undertake alone, but if you are able to do most of the updating, I can help with other process issues. And towards the end, we might pull in other editors to review overall. SandyGeorgia (Talk) 20:44, 7 March 2020 (UTC)

I'm interested in helping with this as well. Full disclosure: I have never worked on featured content before and I am fairly inexperienced in general. But I've been watching the WP:MED talk page and I've been very concerned about the issues with medical FAs that have been raised there. This one has some obvious problems ("as of 1993"?!) and addressing some of them seems simple enough. As a start, here are a few recent reviews that weren't linked above:

• Chagas disease - 2018 review in the Lancet
  • Pérez-Molina JA, Molina I (January 2018). "Chagas disease". Lancet (Review). 391 (10115): 82–94. doi:10.1016/S0140-6736(17)31612-4. PMID 28673423.
• Pathology and Pathogenesis of Chagas Heart Disease - 2019 review in Annual Review of Pathology
  • Bonney KM, Luthringer DJ, Kim SA, Garg NJ, Engman DM (January 2019). "Pathology and pathogenesis of Chagas heart disease". Annu Rev Pathol (Review). 14: 421–447. doi:10.1146/annurev-pathol-020117-043711. PMID 30355152.
• Chagas Disease Diagnostic Applications: Present Knowledge and Future Steps - 2017 review in Advances in Parasitology
  • Balouz V, Agüero F, Buscaglia CA (2017). "Chagas disease diagnostic applications: present knowledge and future steps". Adv. Parasitol. (Review). 97: 1–45. doi:10.1016/bs.apar.2016.10.001. PMC 5363286. PMID 28325368.
• Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region 2019 review in Lancet Infectious Diseases
  • Grillet ME, Hernández-Villena JV, Llewellyn MS, et al. (May 2019). "Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region". Lancet Infect Dis (Review). 19 (5): e149–e161. doi:10.1016/S1473-3099(18)30757-6. PMID 30799251.
    • I see you found it! SandyGeorgia (Talk) 22:50, 10 March 2020 (UTC)
• Screening for Trypanosoma cruzi infection in immigrants and refugees: Systematic review and recommendations from the Spanish Society of Infectious Diseases and Clinical Microbiology 2019 review in Eurosurveillance
  • Velasco M, Gimeno-Feliú LA, Molina I, et al. (February 2020). "Screening for Trypanosoma cruzi infection in immigrants and refugees: Systematic review and recommendations from the Spanish Society of Infectious Diseases and Clinical Microbiology". Euro Surveill. (Review). 25 (8). doi:10.2807/1560-7917.ES.2020.25.8.1900393. PMID 32127121.
• Most recent version of the Global Burden of Disease study (2017) - 2015 version is currently cited
  • "Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017". Lancet. 392 (10159): 1789–1858. November 2018. doi:10.1016/S0140-6736(18)32279-7. PMC 6227754. PMID 30496104.
• [2] and [3] two practice guidelines on Chagas and solid organ transplantation (2018 and 2019)
  • La Hoz RM, Morris MI (September 2019). "Tissue and blood protozoa including toxoplasmosis, Chagas disease, leishmaniasis, Babesia, Acanthamoeba, Balamuthia, and Naegleria in solid organ transplant recipients- Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice". Clin Transplant. 33 (9): e13546. doi:10.1111/ctr.13546. PMID 30900295.
  • Pierrotti LC, Carvalho NB, Amorin JP, et al. (February 2018). "Chagas disease recommendations for solid-organ transplant recipients and donors". Transplantation. 102 (2S Suppl 2): S1–S7. doi:10.1097/TP.0000000000002019. PMID 29381572.
• Chagas Disease: A Clinical Approach - this looks like a pretty comprehensive text on the subject, from 2019
  • Jaime Marcelo Altcheh; Hector Freilij (9 September 2019). Chagas Disease: A Clinical Approach. Springer Nature. ISBN 978-3-030-00054-7.

I will read through the FARC instructions and take a look at the article over the next few days. SpicyMilkBoy (talk) 17:36, 9 March 2020 (UTC)

Thanks for jumping in SpicyMilkBoy; I am glad the negative comments at WT:MED did not discourage you. I have not kept up with your edits, but will review all of them as I find time. I gave an overview of the FAR process in a post just above this one, so that should answer your questions. With several people now willing to work on this article, the FAR is not in danger of being closed while progress is being made. The most important thing needed is to update the article to the most recent, high quality secondary reviews, which I see you are doing. Perhaps others will join in reviewing now: @Graham Beards, Ajpolino, Wuerzele, Colin, and Jfdwolff:. It is my impression that other than being out of date, the article is not in terrible shape, and this bronze star is saveable. SandyGeorgia (Talk) 15:13, 10 March 2020 (UTC)

Biosthmors might also want to jump in now. SandyGeorgia (Talk) 15:15, 10 March 2020 (UTC)

SpicyMilkBoy don't worry about citation formatting; I can easily fix that, and am glad you are doing the real work. If anyone can locate the

Lancet report mentioned in this news article, it is important to look into the WHO data in depth, since it is unlikely that Venezuela is accurately reporting to them. This might be the Lancet article referenced. If there is a contradiction with the Lancet article, we might mention it. With the largest-ever crisis in the western hemisphere, with food and medicine weaponized, these diseases will resurge, and cross borders because of the emigration crisis. (see Crisis in Venezuela)

Somewhere we should mention that it is called "mal de Chagas" throughout Latin America-- the article now mentions only Brazil. I don't know why we have the Spanish names of the bugs in the lead; is it not sufficient to have that info somewhere in the body?

It affects more than 150 animals, but we have no section on Animals (see WP:MEDMOS). SandyGeorgia (Talk) 22:29, 10 March 2020 (UTC)

• • SpicyMilkBoy, I see you found the Venezuelan Lancet review above. I added all the cite journal templates for you (above), to save you one step in the process. SandyGeorgia (Talk) 22:50, 10 March 2020 (UTC)

• Vague, throw-away sentence in the lead, what does this add? "These areas have also seen an increase in the years up to 2014." SandyGeorgia (Talk) 22:40, 10 March 2020 (UTC)

• Many thanks for your help, SandyGeorgia. What's the protocol fir when sources disagree? For example, the 2017 GBD report puts the global prevalence at 6.2 million, while the 2019 WHO report says 8 million; GBD says 7,900 deaths per year, WHO says 10,000, and one of the sources above says 50,000 (!) I put "6 to 8 million" in the lead based on the WHO and GBD sources but that seems a bit sloppy/WP:SYNTH. I am inclined to trust the GBD data more because they actually explain how they arrived at those numbers but it is a bit old. I removed that pointless sentence from the lead BTW.

A few things that I noticed are missing. 1) There's no alt text - I was under the impression that FAs are required to have this. I can write alt text for the some of the photos but I'm not sure how to describe the heart image or what to say for the Rhodinus prolixor photo besides "it's a bug". 2) No discussion of the effects of congenital Chagas disease, and the coverage of drug treatment in pregnant women is not very detailed compared to what is in the sources. 3) I may be biased as someone who stares at microscope slides all day but since this is supposed to be a comprehensive article there should probably be some description of the parasite morphology in the "Diagnosis" section. 4) No discussion of specific vectors outside of an unsourced image caption; the article only talks about triatomine bugs in general. SpicyMilkBoy (talk) 00:51, 11 March 2020 (UTC)

Theoretically, yes, FAs should have alt text. This is an older FA, though, and back then, no one was adding alt text. For many years (around 2008 to 2010), FAC was careful about making sure FAs had alt text, but when the editor who was the main advocate for and best writer of alt text left Wikipedia, it stopped being enforced as much. If you are able to add it, please do; I would not send an article to FAR over missing alt text alone, though.

On the things you see missing, it would not hurt to add that content.

On the source data discrepancy, if you can't convince yourself that the newest is the most accurate, we can report both. I wouldn't advise fudging as the solution. Either we directly state in the text that A says B but C says D, or we can do that via a footnote. As an example for how to footnote conflicting text, see the notes I added at Georges Gilles de la Tourette, where older sources say he was shot in the head, but newer sources say neck.) I have not looked at either source or their methodology, but the serious health and immigration crisis (5 million people displaced, and immigration throughout South America) in Venezuela started in 2018, so I would wonder if the data has accounted for the explosion in infectious diseases there. So glad you are taking this on! SandyGeorgia (Talk) 03:12, 11 March 2020 (UTC)

• Thoughts on eMedicine as a source? This [4] is currently cited quite a bit. They are peer reviewed and all, and I've used them before when I need a quick citation for obvious stuff, but I'm not sure if this is up to the FA standard or if we should be sticking to review papers and textbooks. SpicyMilkBoy (talk) 16:42, 15 March 2020 (UTC)

• I think it is fine to use eMed sparingly for non-controversial information. SandyGeorgia (Talk) 17:54, 15 March 2020 (UTC)
  • SandyGeorgia Thanks! I don't understand the inline comment you placed for this source [5] - it is indeed a secondary review article. SpicyMilkBoy (talk) 03:32, 16 March 2020 (UTC)

Images

Not really a FAR issue - but Chagas' 1909 paper, accessible here [6], has some nice illustrations of T. cruzi by someone named "Castro Silva". If the illustrator died over 70 years ago, the illustrations would be public domain per c:COM:BRAZIL and we could use them in the article. If anyone has the time to track down this illustrator and figure out when he died, it would be appreciated - it's difficult for me as I don't speak Portuguese. Not a pressing issue of course, I just like the pretty pictures. SpicyMilkBoy (talk) 21:12, 12 March 2020 (UTC)

@Fvasconcellos: for Portuguese help and SUM1 for image help. SandyGeorgia (Talk) 21:27, 12 March 2020 (UTC)

@SpicyMilkBoy: @SandyGeorgia: So I don't know if this issue has been solved yet somewhere else (just stumbled upon it), but the autor of the pictures is Manoel de Castro Silva (you can check pages 340 and 343 in this paper about illustrators in science) and he has died in 1934. RetiredDuke (talk) 17:00, 3 May 2020 (UTC)

I am nowhere when it comes to images :) Have always been afraid of them-- others will have to address that one. SandyGeorgia (Talk) 17:13, 3 May 2020 (UTC)

Thank you so much, RetiredDuke. That's 86 years ago, so we're good. For some reason the site isn't letting me download the PDF right now, but I'll add the images when I can access them. SpicyMilkBoy (talk) 17:16, 3 May 2020 (UTC)

You're welcome, glad I could help. RetiredDuke (talk) 20:37, 3 May 2020 (UTC)

Causes section under construction

Hi all, I'm working on adding a "Causes" section to cover why T. cruzi infection leads to disease. It's somewhat hard for me to predict my schedule this week (due to disruption of everything by coronavirus), so I may be working in fits and starts. Pardon my dust during the process, and feel free to edit the section as I go. I've left a couple of comments in the wiki-markup as calls for help and reminders to myself. If I can't find the answers, I'll remove them and rephrase sentences if necessary. It's great to see the work going into this article (especially from SpicyMilkBoy)! Thanks all! Ajpolino (talk) 18:58, 15 March 2020 (UTC)

Just putting this here so I don't lose it while I move things around: Bonney KM, Luthringer DJ, Kim SA, Garg NJ, Engman DM (January 2019). "Pathology and Pathogenesis of Chagas Heart Disease". Annu Rev Pathol (Review). 14: 421–47. doi:10.1146/annurev-pathol-020117-043711. PMID 30355152. Ajpolino (talk) 04:22, 26 March 2020 (UTC)

Just a note to those watching the page, sorry for the trimming in Signs & symptoms - I'm going to move the heart pathology material to a brief section on pathogenesis, and the sudden death thing to an outcomes section. I'm certainly open to other suggestions if folks prefer the old way. Thanks! Ajpolino (talk) 04:55, 26 March 2020 (UTC)

Parking this here momentarily as well. I'll move on to the Causes section tomorrow: The clinical manifestations of Chagas disease are due to cell death in the target tissues that occurs during the infective cycle, by sequentially inducing an inflammatory response, cellular lesions, and fibrosis. For example, intracellular amastigotes destroy the intramural neurons of the autonomic nervous system in the intestine and heart, leading to megaintestine and heart aneurysms, respectively. If left untreated, Chagas disease can be fatal, in most cases due to heart muscle damage. (ref emed)

Sorry for the disruption! Ajpolino (talk) 05:25, 26 March 2020 (UTC)

CNS involvement?

Hi all, we currently have this sentence in Signs & symptoms: Isolated cases exhibit central nervous system involvement, including dementia, confusion, chronic encephalopathy and sensory and motor deficits. cited to this 2010 review in Neurological Research. I can't find mention of CNS involvement (outside of reactivation in HIV-positive folks) in the 2018 Lancet review the 2015 NEJM review, or the 2019 edition of the textbook Parasitic Diseases. Does anyone have further insight into this? Otherwise I'd probably feel more comfortable leaving it out for now. Ajpolino (talk) 17:04, 26 March 2020 (UTC)

Plenty of reviews for dementia, but I find no recent mention of the rest. Google scholar search limited to 2016 forward. SandyGeorgia (Talk) 18:48, 26 March 2020 (UTC)

@SandyGeorgia: Um... One of us may have our wires crossed. When I click on that link it takes me to a search for "Huntington" and "dementia". If I switch the text to "Chagas" I don't get much. Ajpolino (talk) 19:39, 26 March 2020 (UTC)

Well, fiddlesticks. Doing too much at once, forgot which article I was on. Here you go: [7] Perhaps this one? Cerebral Trypanosomiasis in an Immunocompromised Patient: Case Report and Review of the Literature, M Kaushal, S Shabani, EJ Cochran, H Samra… - World neurosurgery, 2019 - Elsevier This literature review focuses on the CNS manifestations of Chagas disease (American trypanosomiasis … mild infection with few or no symptoms to a severe presentation of chagasic encephalitis.6 … neurologic signs.6, 51 Involvement of the CNS in chronic Chagas disease infection … SandyGeorgia (Talk) 19:44, 26 March 2020 (UTC)

Misc wording

@SpicyMilkBoy: Welcome back! I hope all is well. Question about this edit to restore "determinate Chagas disease". Where do you see symptomatic chronic disease referred to that way? I see "indeterminate" several places, but I can't recall seeing the opposite referred to as "determinate". When I CTRL+F on the cited source (the Lancet review) there's no use of "determinate" I can find. But maybe my eyes just glazed over it on other sources. Sorry for the flurry of activity. I hope everything is clear enough to follow. Ajpolino (talk) 17:53, 27 March 2020 (UTC)

Ajpolino thanks, everything's fine here, I've just been working a lot. I should have more time to work on the article next week. You're right that that isn't in the Lancet source - thanks for catching that. It's used here, so I added that as a source. Thanks for all your work, it looks great so far. SpicyMilkBoy (talk) 18:40, 27 March 2020 (UTC)

Query

Please ignore me if this commentary is premature, but is anyone able to deal with the sections needing Update, so we can have a look at whether the FARC can be closed? There is no hurry, but wondering if anyone is able to deal with those sections. SandyGeorgia (Talk) 19:31, 29 March 2020 (UTC)

Perhaps I don't understand your query? We're working on it as time permits; I can jump around to target the tags, but it looks like the whole article needed to be updated, not just the tagged sections, so Spicy and I are slogging our way through. Are you wondering if the sections can be updated? If so, I think the answer is yes, there seem to be plenty of recent sources for those marked sections. If instead, contrary to what you said above, there is some rush (e.g. I saw your concern here linked from WT:MED), then I'm happy to work on the tags first if that helps some other administrative process run more smoothly. Just let me know. Thanks for all your help and attention to this article so far! I hope all is well! Ajpolino (talk) 20:45, 29 March 2020 (UTC)

I want you to proceed in the way that is easiest for you, but keep in mind the following: the article does not have to be at a "perfect" place yet for the FAR to be closed. As soon as you all feel it is close enough, I can start reviewing the little stuff, but for now, I don't want to get in your way. If going in order is easiest on you, ignore my query :) If updating the tagged sections with the idea that it might be possible to close the FAR sooner rather than later, that is another alternative. Do what you think best ! SandyGeorgia (Talk) 20:54, 29 March 2020 (UTC)

History section

I was just trying to complete some of the citations in the History section, but I will hold off to see if better sources can be found. A number of the Spanish-language sources are so-so and can probably be replaced. If you all are unable to replace them with newer, better, English-language sources, please let me know as I speak fluent Spanish. I can check these sections out and upgrade the citations, but preferable would be to eliminate most of those sources. For example, the Argentine Federation of Cardiology no longer even owns the FAC.org website. SandyGeorgia (Talk) 22:36, 29 March 2020 (UTC)

• PMID 32001300, PMID 26433162 and PMID 19185367 might do the job for a History rewrite to better sources. SandyGeorgia (Talk) 00:31, 30 March 2020 (UTC)

Looking for a source

Does anyone have access to "Systematic Review of the Epidemiology of Chagas Disease in the Americas: a Call for Standardized Reporting of Chagas Disease Prevalence". Current Tropical Medicine Reports. 6. April 2019. doi:10.1007/s40475-019-00177-y.? I'm not sure if it has anything worthwhile for the Epidemiology section here because I can't get past the abstract. Thanks! Ajpolino (talk) 23:54, 2 April 2020 (UTC)

Ajpolino Emailed you. SpicyMilkBoy (talk) 13:29, 8 April 2020 (UTC)

@SpicyMilkBoy: Excellent! Thank you; I'd never seen that Firefox Send feature before. That's nifty. Ajpolino (talk) 22:48, 8 April 2020 (UTC)

Odds & ends

Hi all, a couple small things I wanted to bring up here for opinions:

• Does anyone know why {{bots|deny=Monkbot7}} is at the top of the page? It says <!-- keep Monkbot from visiting this page -->, but I'm not sure why someone wanted to keep that bot away, or indeed if it's even still active.

• There were many problems with it in the past ... can probably be removed now. SandyGeorgia (Talk) 22:54, 12 April 2020 (UTC)

• I removed the paragraph on Charles Darwin from the History section since it seems like he probably didn't have Chagas disease, and it's covered at length elsewhere. Happy to discuss if folks miss it.

• I'm good with that, unless the case for him is as strong as the case for Samuel Johnson at Tourette syndrome, where his own writings and those of Boswell solidly document his TS. SandyGeorgia (Talk) 22:54, 12 April 2020 (UTC)

• This comment is at the top of the references section: <!--This article uses the Cite.php citation mechanism. If you would like more information on how to add references to this article, please see http://meta.wikimedia.org/wiki/Cite/Cite.php -->. I assume that's dated and is from the good old days?

• Holy moly, yes, the good old days-- can be removed. SandyGeorgia (Talk) 22:54, 12 April 2020 (UTC)

• Further reading - we have a section just to host a link to an editorial by Peter Hotez, et al. from 2012. It's a nice article, but I don't know how much it adds for readers. I'd favor chopping it, but don't feel strongly either way.

• No strong opinion either. SandyGeorgia (Talk) 22:54, 12 April 2020 (UTC)

• The first external link is from Curlie which I'd never heard of. Is this a resource we typically link to? If not, it doesn't look all that useful and I'd be happy removing it.

• Yes, typical, see WP:MEDMOS-- it helps keep out the cruft. Those seeking support can go to those links. SandyGeorgia (Talk) 22:54, 12 April 2020 (UTC)

Thanks all for all the work! I'm excited to see this article improving! Ajpolino (talk) 22:17, 12 April 2020 (UTC)

Removing the Charles Darwin stuff seems like a good call to me and I agree with you on the further reading section. Curlie is linked in a lot of medical articles (and other ones, apparently: see Special:WhatLinksHere/Template:Curlie). I personally find it odd that it's so widespread on Wikipedia - it seems like a relic of Web 1.0 to me and I've rarely found it useful. But there is certainly precedent for it. (There's some interesting discussion at Wikipedia:Templates for discussion/Log/2019_May_6#Template:Curlie). I could take it or leave it when it comes to this article. SpicyMilkBoy (talk) 22:27, 12 April 2020 (UTC)

• There are also several inline comments that need to be reviewed ... you can find them by ctrl-f on <!--
• If you are both satisfied with the text, I can ping in some very good prose people next.

Best, SandyGeorgia (Talk) 22:57, 12 April 2020 (UTC)

Oops, sorry-- see you are not done yet, as there are still maintenance tags ... SandyGeorgia (Talk) 22:58, 12 April 2020 (UTC)

We're nearly there! I'm looking through the comments now, and Spicy seems to be cleaning up the research section. Ajpolino (talk) 23:00, 12 April 2020 (UTC)

• Oh wait, I had one more question for you both, the History section currently ends in In Argentina, the disease is known as mal de Chagas-Mazza, in honor of Salvador Mazza. because I didn't know where else to put it. Has anyone come across other local names for Chagas? Thoughts on where to put that info? Ajpolino (talk) 23:07, 12 April 2020 (UTC)

• I can look around in Spanish for other local names, but I have always and only heard mal de Chagas. The MEDMOS Classification section tends to be a dumping ground for nomenclature and terminology, but I see this article has no Classification section (should it?). Otherwise, History works ... ping me please if I forget to come back on other names, as I'm kinda busy. SandyGeorgia (Talk) 23:16, 12 April 2020 (UTC)

• I see that Dengue fever, closest FA to this one, also lacks a Classification section, so probably the name is OK in History. SandyGeorgia (Talk) 23:18, 12 April 2020 (UTC)

• I integrated that sentence with the main paragraph, which talks about Salvador Mazza - it seems to fit more naturally there. SpicyMilkBoy (talk) 23:25, 12 April 2020 (UTC)

The text in the epidemiology section looks updated so I removed the tag. Remaining issues in that section:

• I can't find a newer better map than our somewhat mysterious 2012 one. If anyone has data they like, I can draw up a new one.

• Ajpolino, I was thinking that we could just colour in the 21 endemic countries. How does that sound to you? SpicyMilkBoy (talk) 21:17, 15 April 2020 (UTC)

• Fix ping: Ajpolino. SpicyMilkBoy (talk) 21:18, 15 April 2020 (UTC)

• Meh, since a map of endemic countries colored would just be all of Latin America (excepting Caribbean islands) colored a single color, I prefer the current map even if dated and mysterious. But it's really just a question of personal preference. If others prefer a more updated map of more certain provenance, I'm certainly not opposed to an endemic countries map. Thanks for fixing all the other image problems! Looks super! Ajpolino (talk) 00:44, 16 April 2020 (UTC)

• Right, I didn't really think that through. There is a nice map based on 2014 data in the 2018 Lancet paper, but I think there might be copyright concerns with reproducing such a detailed map. The paper states the map is "Adapted from the Pan American World Health Organization Chagas disease control programme" but I haven't been able to find the data they're referring to on the PAHO site. There might be something here [8] but I couldn't find anything at a glance. SpicyMilkBoy (talk) 01:07, 16 April 2020 (UTC)

• I found the PAHO map. But again, I'm not sure if we are allowed to reproduce it. SpicyMilkBoy (talk) 01:25, 16 April 2020 (UTC)

• WHO has 2016 data on Chagas disease burden estimates by country here. Someone on Commons used the 2012 version of this data to make a map: [9]. Seems like it would take considerable work to convert the data into a map though. SpicyMilkBoy (talk) 01:40, 16 April 2020 (UTC)

• Ajpolino just pinging to make sure you've seen this - any thoughts about this data? :) I've removed the old map for now per the feedback in the image review. SpicyMilkBoy (talk) 01:39, 26 April 2020 (UTC)

• Has anyone seen newer data for cases per transmission path? I moved the sentence on congenital cases in 2010 to the bottom since it's somewhat out of place now, and would support removing it altogether.

Ajpolino I found this WHO report from 2015, which gives a figure of 8668 congenital infections per year. It's a primary source but it's where the 22.5% estimate from [10] comes from. The issue is that this is actually an estimate of how many cases there were in 2010. :/ SpicyMilkBoy (talk) 21:43, 13 April 2020 (UTC)

Ok, I removed the sentence for now. Maybe there just aren't good recent estimates for infections by each mode of transmission :( Ajpolino (talk) 22:21, 13 April 2020 (UTC)

• A couple of sentences are commented out just before the non-endemic countries subsection. I'm removing them now, and am looking to add another sentence on how T. cruzi infects other animals.

Good work all! Home stretch on the large-scale (re)building phase! Ajpolino (talk) 17:23, 13 April 2020 (UTC)

Noticed this while working on the lead:

• Most people with the disease are poor, and most do not realize they are infected.

This isn't covered in the body. Should we add something about it to the Epidemiology section? SpicyMilkBoy (talk) 21:21, 13 April 2020 (UTC)

References

Prose check

Pinging Outriggr, the King of the Copyedit. Riggr, this article is at FAR, and was just entirely rewritten by the good folk above. It has already been TFA mainpage, so only needs a cursory review for FA-standard prose, if I could interest you in a quick run-through. Best, always, SandyGeorgia (Talk) 01:34, 14 April 2020 (UTC)

I looked at the lead, and made some edits[11]. Taking them in order from first paragraph to last:

I found the first paragraph confusing because the percentages didn't match, so I removed two of the figures. I can see they are given lower down in the article, where they are more fully explained; so, I think they can be removed from the lead without great loss.

I moved the first description of the disease to the second paragraph (on diagnosis), since description and diagnosis are related. The paragraph begins "commonly spread to other mammals", so I've also moved the sentence "affects more than 150 other animals" to this paragraph.

In the last paragraph "...as of 2017. In 2017,..." appeared unnecessarily repetitive, so I merged the two sentences.

I did note that there is a repetition: 'It is spread mostly by insects known as Triatominae, or "kissing bugs" ... T. cruzi is commonly spread to humans and other mammals by the blood-sucking "kissing bugs" of the subfamily Triatominae.' Should these sentences be merged?

If these edits seem reasonable to editors more familiar with the topic area, I'll see if I can find time to look at other sections. DrKay (talk) 14:04, 19 April 2020 (UTC)

DrKay the edits look good to me. I agree with your last point and I've revised the second sentence to avoid repetition. Thanks for your work. SpicyMilkBoy (talk) 16:41, 19 April 2020 (UTC)

Image check

Nikkimaria, are you interested in doublechecking the images here? This FAR is almost good to Keep, after a complete rewrite. SandyGeorgia (Talk) 01:34, 14 April 2020 (UTC)

• File:Rhodnius_prolixus70-300.jpg: the source states the image is courtesy of Erwin Huebner; that isn't the same as saying Erwin releases it into the public domain
• File:Chagas_disease._Awareness_%26_prevention_campaign_poster._French_Guiana_2008.JPG: seems unlikely that the uploader is the author of the poster - more likely it's just the photo
• File:Distribution_of_Chagas'_disease.svg: this image is dated 2012 - is it still accurate?
• File:Carlos_chagas_2.jpg needs an author date of death and a US PD tag. Nikkimaria (talk) 01:56, 14 April 2020 (UTC)

Oof, not good. I'll look into the Carlos Chagas pic and see what I can do to replace the Rhodnius prolixus and awareness poster images. SpicyMilkBoy (talk) 02:05, 14 April 2020 (UTC)

SMB, actually there's a nicer version of that Chagas pic on Commons File:Carlos Chagas.png. Zeiss claims to own it for some reason, and it was released under CC-BY-SA a few years ago. Will that work?Ajpolino (talk) 02:18, 14 April 2020 (UTC)

I did some googling and I believe this is about the J. Pinto who took that photo; I don't speak Portuguese but O serviço de fotografia do Instituto Oswaldo Cruz would seem to indicate that this is our guy. This source (which wouldn't be RS on wp, but maybe it's ok for commons purposes?) states he died in 1951, which means that according to Brazil's copyright rules, this image will not be public domain until next year. If Zeiss obtained the rights to the photo and released it under a Creative Commons license then it should be okay, but it's not clear from that Flickr page whether they actually own the rights or not. The Commons page says Images donated as part of a GLAM collaboration with Carl Zeiss Microscopy - please contact Andy Mabbett for details. Pigsonthewing, are you able to clarify this? SpicyMilkBoy (talk) 03:23, 14 April 2020 (UTC)

I can confirm that the image was part of a set released by Carl Zeiss Microscopy as stated on Commons. Andy Mabbett (Pigsonthewing); Talk to Andy;Andy's edits 10:44, 14 April 2020 (UTC)

Ok, I've replaced the original image with that one. SpicyMilkBoy (talk) 21:14, 15 April 2020 (UTC)

Thanks! Pardon my ignorance here. A couple of questions:

• The source of File:Rhodnius prolixus70-300.jpg is archived here from around the time of upload. Is the declaration on that page sufficient? If not, there are other (slightly lower quality) images of the bugs we can substitute, so no big deal.

• I'd suggest not relying on that declaration, since it isn't crystal clear as to how it translates into a licensing statement. Alternatively I could ask Erwin. Nikkimaria (talk) 02:21, 14 April 2020 (UTC)
• I've replaced it with a picture of Triatoma infestans for now. This one has an OTRS release so we should be good. SpicyMilkBoy (talk) 04:02, 14 April 2020 (UTC)

• File:Chagas_disease._Awareness_&_prevention_campaign_poster._French_Guiana_2008.JPG, almost certainly true, although the editor has been silent since 2008, so we can't follow-up. Am I to assume from the stamps at the bottom of the poster, that it's a work of the French government, and so Commons:Copyright rules by territory/France applies? Or are there more relaxed rules for photographs of copyrighted works?

• France doesn't have freedom of panorama for 3D works, never mind 2D. However, the text at the bottom of the poster suggests it may actually be the product of the university named rather than the government? Nikkimaria (talk) 02:21, 14 April 2020 (UTC)

• @Nikkimaria: Hmmm is there anything that would make you feel comfortable that this image is usable here? I can reach out to the university, but I'm not sure who would have the authority to release the image. Should we just consider this image unsuitable in its current form? Ajpolino (talk) 02:32, 14 April 2020 (UTC)

Thanks again! Ajpolino (talk) 02:11, 14 April 2020 (UTC)

• Bottom line is at present the image is mistagged. To determine whether there is an appropriate tag and what it might be we need more information about the provenance of the original poster - who created it, when, etc. Incidentally there are what appear to be much clearer images of this same poster indexed in Google Images, just unfortunately not with any more useful source information. Nikkimaria (talk) 02:46, 14 April 2020 (UTC)

• I've replaced the image with a picture of a bed net. It seems unlikely that the university would release the poster under a free license, so I don't think we should keep it in the article for now. Might be a good idea to nominate it for deletion on Commons and see what they have to say. SpicyMilkBoy (talk) 03:03, 14 April 2020 (UTC)

Not sure if Nikkimaria is watching, so pinging her to followup questions ... I don’t speak images. SandyGeorgia (Talk) 02:13, 14 April 2020 (UTC)

Image sizes

James has adjusted up all of the image sizes, to a level that causes MOS:SANDWICH to come back, after I corrected all of that once. FAs must comply with MOS. The image sizes are also overpowering the text; Wikipedia is not a picture book. SandyGeorgia (Talk) 18:20, 15 April 2020 (UTC)

Yah I am unable to make out the text here. Doc James (talk · contribs · email) 21:37, 15 April 2020 (UTC)

Yeah these CDC lifecycles are pretty ubiquitous across parasitology, but unfortunately they're so text heavy that you can't read them unless they're hugely expanded. My personal preference is to leave it small and have readers click-to-expand if they're interested. I don't think the life cycle stage names are so critical that we need a huge image. If folks feel differently, I can try to find a simpler life cycle diagram. Ajpolino (talk) 22:19, 15 April 2020 (UTC)

I can make out the middle one a little easier but agree these are not great as thumbnails. Doc James (talk · contribs · email) 22:33, 15 April 2020 (UTC)

I don't think they are generally going to be readable anyway (I can't read any of them, but I'm not a youngster), and the reader will have to click on them to read them, so see no reason to have them take over the article. I have to click on them, and then even expand them, to be able to read them, and most of our readers probably are not going to be that interested, so it makes little sense to have the image dominate the page.

Also, since you all are still working on image issues above, is it premature to deal with SANDWICH until you know which images you will settle on? Or is that all settled now? SandyGeorgia (Talk) 22:39, 15 April 2020 (UTC)

Map

(1) Chagas disease in Latin America (endemic zones)

(2) Chagas disease world map - DALY - WHO2004

(3) Chagas disease world map-DALYs per million persons-WHO2012

(4) Red is endemic countries where spread is through vectors; yellow is endemic countries where spread is occasionally through vectors; blue is non-endemic countries where spread is through blood transfusions

This map still matches this one by the CDC https://www.cdc.gov/parasites/cme/chagas/lesson_1/5.html I will reach out to PAHO about the possibility of getting this under an open license https://www.paho.org/en/node/49722

Doc James (talk · contribs · email) 02:44, 26 April 2020 (UTC)

How about a map like this from NEJM in 2015? [12] Fairly easy to make. Doc James (talk · contribs · email) 02:53, 26 April 2020 (UTC)

I like this one and have asked for release under an open license aswell.[13]

Our image is also very much supported by this [14] Doc James (talk · contribs · email) 02:56, 26 April 2020 (UTC)

Thanks for finding a source for the current map - now we can say what time frame it represents, at least. It would be great if we could get one of the more recent map under a free license. Thanks for doing the legwork. SpicyMilkBoy (talk) 03:03, 26 April 2020 (UTC)

Okay will upload these.[15] and added the 4th one Doc James (talk · contribs · email) 02:59, 26 April 2020 (UTC)

I prefer the NEJM map though. Doc James (talk · contribs · email) 03:07, 26 April 2020 (UTC)

SpicyMilkBoy had posted 2016 DALYs data above. If that data is map-ified for the world, it looks like this (also displayed at right).

2016 WHO GBD DALY's lost for Chagas by country

I picked the colors fairly arbitrarily and colored by order of magnitude of total DALYs lost (i.e. I didn't adjust for the population sizes). I uploaded it as an SVG, so it's editable if someone is interested in a different color scheme or finer gradations. For a "zoomed" version of, e.g. just the Western Hemisphere, you can just screenshot the part of the map you like (or I can remove the other half of the planet). That said, I'm happy with the maps available! Thanks DocJames for all the work finding these maps! Ajpolino (talk) 19:47, 27 April 2020 (UTC)

Ajpolino awesome work, thanks so much! I'll add it to the article. SpicyMilkBoy (talk) 21:34, 27 April 2020 (UTC)

References

Copyvio check

Regarding this impressive edit by José Eymard H. Pittella, I am concerned if the paraphrasing is too close. SandyGeorgia (Talk) 21:59, 4 April 2020 (UTC)

For now, I have commented out the text but left it in the article;[16] if others feel there is no other way to paraphrase the text in our words, they can uncomment it, but it also needs some attention to wikilinking, jargon, etc. SandyGeorgia (Talk) 22:02, 4 April 2020 (UTC)

• Source:

• Many patients present a pseudotumoral form (cerebral chagoma), characterized by the presence of single or multiple necrotic-hemorrhagic nodular lesions, usually located in the white matter of the cerebral lobes and, less frequently, in the brainstem and cerebellum

• Text:

• Many patients have the pseudotumoral form (brain ‘chagoma’), characterized by the presence of single or multiple necrotic-hemorrhagic nodular lesions, usually located in the white matter of the cerebral lobes and, in some cases, in the brain stem and cerebellum.

• Source:

• The classic manifestations are those of acute meningoencephalitis, with fever, headache, meningism, convulsions, altered mental state, vomiting, and focal neurological deficits.

• Text:

• The clinical manifestations of CNS involvement in reactivated Chagas disease are characterized by fever, headache, vomiting, seizures, and focal neurological signs.

• Source:

• Since the 1980s, with the beginning of the use of immunosuppressants and of organ transplants, as well as with the emergence of HIV, clinical conditions appeared for the reactivation of the pre-existing chronic infection caused by T. cruzi, with severe repercussions, especially in the CNS.

• Text:

• The use of corticosteroids, immunosuppressors and cytostatic agents, the progress in organ transplantation, and in particular the emergence of AIDS in 1981 have set conditions for infection reactivation in chronic chagasic patients.

Yes, I believe they're new here and the author of the textbook chapter, so I assume the very close paraphrasing is inadvertent (though still a problem of course). I've left a message at their talk page. I'll get a chance to work on this article again in the next few days, and will try to add some info on HIV+ Chagas reactivation (if someone doesn't beat me to it). Thanks for checking that. Sorry for the slow pace here! Ajpolino (talk) 22:31, 4 April 2020 (UTC)

Slow and steady wins the race! SandyGeorgia (Talk) 22:33, 4 April 2020 (UTC)

When you all get to this, please remember that this text is still in the article, but hidden by commenting it out with inline comments. SandyGeorgia (Talk) 10:53, 9 April 2020 (UTC)

Text

Linked triatomine bug and changed to singular rather than plural. Also added the common name "kissing bug" in brackets as that will be far more recognizable.

Change fetus to baby as can happen during the birth process and the resulting child is what is infected. Doc James (talk · contribs · email) 20:42, 19 April 2020 (UTC)

I'm not sure whether my thoughts are in the right place here! Instead of '… %-age of people …' I would rather choose '… of cases or infected people …'. Thanks for letting me share. Lodidol (talk) 12:24, 28 November 2020 (UTC)

Hi Lodidol, your thoughts are welcome here. Pardon my thickness, but could you please quote the text you'd like changed? I'm not sure I understand your suggestion. Thanks! Ajpolino (talk) 19:36, 28 November 2020 (UTC)