Talk:Chagas disease

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External review comments

The following comments from external reviewer BSW-RMH are early fruit of the new joint Wikipedia talk:WikiProject Medicine/Google Project. Thank you for your efforts, BSW-RMH. LeadSongDog come howl 13:11, 11 May 2010 (UTC)

Introductory section

Hello Chagas article writers and editors, This article is both comprehensive and well-written. I hope that I can offer some useful suggestions to enhance it further. I think the Introductory material would benefit from additional citations and clarification. Specific suggestions are as follows:

First paragraph: Add the following updated references

• (article reference 1 updated) "DPDx – Trypanosomiasis, American. Fact Sheet". Centers for Disease Control (CDC). http://www.dpd.cdc.gov/dpdx/HTML/TrypanosomiasisAmerican.htm. Retrieved 2010-05-09.
• (article reference 2 updated) Kirchhoff LV (17 December 2009). Chagas Disease (American Trypanosomiasis). eMedicine. Retrieved on 11 September 2008.

Second paragraph: WE 5HUNNA 5OE This section would benefit from an updated clarified summary of the usual disease progression and treatment incorporating some of the following proposed changes: The symptoms of Chagas disease vary over the course of an infection. In the early, acute stage, symptoms are mild and usually produce no more than local swelling at the site of infection. After 4-8 weeks, infected individuals enter the chronic phase Chagas disease that is asymptomatic for 60-80% of individuals. The initial acute phase is responsive to antiparasitic treatments, with 60-90% cure rates. These antiparasitic treatments also appear to delay or prevent the development of disease symptoms during the chronic phase of the disease, but 20-40% of infected individuals will eventually develop life-threatening heart and digestive system disorders. The currently available antiparasitic treatments for Chagas disease are benznidazole and nifurtimox, which can cause temporary side effects in many patients including skin disorders, brain toxicity, and digestive system irritation.

• Bern C, Montgomery SP, Herwaldt BL, Rassi A Jr, Marin-Neto JA, Dantas RO, et al. Evaluation and treatment of Chagas disease in the United States: A systematic review. JAMA. 2007;298(18):2171-81. PMID 18000201
• Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402. PMID 20399979

Third paragraph: Clarification is needed for this statement: “Chagas disease occurs exclusively in the Americas…” While this disease is contracted primarily in the Americas, it occurs in many countries, particularly in Europe, primarily due to travel to and immigration from endemic areas in the Americas.

• Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402. PMID 20399979

BSW-RMH (talk) 19:44, 10 May 2010 (UTC)BSW-RMH

 Done--DO11.10 (talk) 15:49, 13 May 2010 (UTC)

Sign and symptoms

The statistics in this section could use some clarification.

This statistic is inaccurate:

"In about 10% of infections, the symptoms do not completely resolve and result in a so-called chronic latent or indeterminate asymptomatic phase of the disease."

Actually, 90% of acute disease cases eventually resolve and then enter a latent phase. The remaining 10% progress directly to a symptomatic clinical form of chronic Chagas disease. The 90% that resolve during the acute phase will then enter a chronic phase. Of individuals with chronic Chagas disease, 60-80% will never develop symptoms (called indeterminate chronic Chagas disease), while the remaining 20-40% will develop life-threatening heart and/or digestive disorders during their lifetime(called determinate chronic Chagas disease).

• Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402. PMID 20399979
• Bern C, Montgomery SP, Herwaldt BL, Rassi A Jr, Marin-Neto JA, Dantas RO, et al. Evaluation and treatment of Chagas disease in the United States: A systematic review. JAMA. 2007;298(18):2171-81. PMID 18000201

Also: "If left untreated, Chagas disease can be fatal, in most cases due to heart muscle damage."

I recommend revising to read: Even if with treatment...

BSW-RMH (talk) 20:19, 10 May 2010 (UTC)BSW-RMH

 Done--DO11.10 (talk) 15:49, 13 May 2010 (UTC)

Prevention

The paragraph of this section regarding blood transfusion as a mode of Chagas transmission requires updating.

5 HUNNA 5HUNNA WE 5HUNNA 5OE 5PS Blood transfusion was formerly the second most common mode of trasmission for Chagas disease, but the development and implementation of blood bank screening tests has dramatically reduced this risk in the last decade. Blood donations undergo Chagas screening in all the endemic Latin American countries and is expanding in countries, such as Spain and the United States, that have significant or growing populations of immigrants from endemic areas (1,2). In Spain, donors are evaluated with a questionaire to identify individuals at risk of Chagas exposure for screening tests (2). The US FDA has approved two Chagas tests including one recently approved in April of 2010, and has published guidelines that recommends testing of all donated blood and tissue products (2,3). While these tests are not required in U.S., it is estimated that 75-90% of the blood supply is currently tested for Chagas, including all units collected by the American Red Cross which accounts for 40% of the U.S. blood supply (3,4). The Chagas Biovigilance Network reports incidents of Chagas positive blood products during screening with FDA-approved (2007)tests in the United States (5)

1. Castro E. Chagas' disease: lessons from routine donation testing. Transfus Med. 2009;19(1):16-23. PMID 19302451

2. Gascon J, Bernb C, Pinazoa MJ. Chagas disease in Spain, the United States and other non-endemic countries. Acta Tropica. 2010. PMID 19646412

3. FDA NEWS RELEASE, April 30, 2010, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm210429.htm

4. American Red Cross Infectious Disease Testing, http://www.redcrossblood.org/hospitals/infectious-disease-testing

5. Chagas Biovigilance Network, http://www.aabb.org/programs/biovigilance/Pages/chagas.aspx

I recommend removing the outdated information on gentian violet, which has not been in practice since the 1980s and is therefore obsolete:

"In the past, donated blood was mixed with 0.25 g/L of gentian violet, which kills T. cruzi parasites.[21] The antifungal agent amphotericin B has been proposed as a second-line treatment, but the high cost and relatively high toxicity of the drug have limited its use.[22]"

BSW-RMH (talk) 21:29, 10 May 2010 (UTC)BSW-RMH

 Done--DO11.10 (talk) 15:49, 13 May 2010 (UTC)

Management

Posaconazole

The information kasehose associated with trymanostatic versus trypanocidal activity in the Randomized Trial of Posaconazole and Benznidazole for Chronic Chagas' Disease article seems too specific for a tertiary source article. Sorry dude. Lime0life (talk) 00:59, 15 May 2014 (UTC)

Yes we need to use secondary sources per WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:08, 15 May 2014 (UTC)

This section also could use some updating.

The information regarding incomplete removal of parasites discussed in this section was published in 2000. Since this time, several reviews of newer studies have been published showing that disease is parasitological cure occurs in about 60-85% of adults and more than 90% of infants treated in the first year of acute phase Chagas disease. Children (age 6 to 12-years) with chronic disease have a cure rate of about 60% with benznidazole. While the rate of cure declines the longer an adult has been infected with Changas, treatment with benznidazole has been shown to slow the onset of heart disease in adults with chronic Chagas infections.

See *Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402. PMID 20399979

BSW-RMH (talk) 21:48, 10 May 2010 (UTC)BSW-RMH

 Done--DO11.10 (talk) 18:19, 13 May 2010 (UTC)

Epidemiology

Updated epidemiological statistics and references:

Chagas disease affects 8-10 million people living in endemic Latin American countries, with and additional 300,000-400,00 living in non-edemic countries including Spain and the United States. An estimated 41,200 new cases occur annually in endemic countries, while 20,000 deaths are attributed to Chagas disease each year. US physicians are treating more patients with Chagasic disease every year. Fortunately the Riduvid Bug has not moved to North America; the patients are here but the vector is not. Like Polio and Smallpox, policy is evolving on how to eradicate the Riduvid Bug.

• Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402. PMID 20399979

• (article reference 2 updated) Kirchhoff LV (17 December 2009). Chagas Disease (American Trypanosomiasis). eMedicine. Retrieved on 11 September 2008.

 Done--DO11.10 (talk) 18:19, 13 May 2010 (UTC)

suggested revision

of "With increased population movements, however, the possibility of transmission by blood transfusion has become more substantial in the United States.[37] Approximately 500,000 infected people live in the United States, which is likely the result of immigration from Latin American countries.[38]"

Transmission blood and tissue products are now actively screened in the U.S., thus addressing and minimizing this risk. Also, the current figure is 300,000 infected individuals in the U.S. (see above references)

 Done--DO11.10 (talk) 18:19, 13 May 2010 (UTC)

DALY figure

This figure appears to be compiled using data from 2002. The 2004 statistics are noe available on the WHO website and can be used to update this figure.

BSW-RMH (talk) 22:32, 10 May 2010 (UTC)BSW-RMH

✗ Not done yet Any editor should feel free to do some or all of these items! WhatamIdoing (talk) 18:16, 13 May 2010 (UTC)

I left a note on (the image repository) Commons for Lokal Profil, the editor who created the DALY figure. It looks like s/he is pretty busy, but perhaps he'll be able to update it. WhatamIdoing (talk) 18:34, 13 May 2010 (UTC)

Lokal and I worked on a few hundred of these maps. I am sure we have the 2004 data done just that it has not been updated. Doc James (talk · contribs · email) 18:36, 13 May 2010 (UTC)

 Done! WhatamIdoing (talk) 02:24, 19 May 2010 (UTC)

References

the following references require updating

recommended replacements follow the reference number:

20. http://www.aabb.org/resources/publications/bulletins/Pages/ab06-08.aspx

29. Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402. PMID 20399979, and/or (article reference 2 updated) Kirchhoff LV (17 December 2009). Chagas Disease (American Trypanosomiasis). eMedicine. Retrieved on 11 September 2008.

40. broken link

BSW-RMH (talk) 03:35, 11 May 2010 (UTC)BSW-RMH

I have fixed the dead link at #40 (which is #39 in the current version). The numbers here seem to line up with this version. WhatamIdoing (talk) 17:59, 13 May 2010 (UTC)

 Done- both "20" and "29" were removed during implementation of reviewer comments.--DO11.10 (talk) 22:14, 18 May 2010 (UTC)

External Links

the following links require updating

2010 Image of Chagas by Tufts University does not point to the indicated images

Drugs for negelected diseases initiative, I would suggest linking specifically to the Chagas page, http://www.dndi.org/diseases/chagas.html

BSW-RMH (talk) 03:39, 11 May 2010 (UTC)BSW-RMH

I've  Done these two little tasks. I hope that another editor will happen along to put a few more of your suggestions into place. Many thanks for the comprehensive review! WhatamIdoing (talk) 02:40, 12 May 2010 (UTC)

Re-check

It's amazing how fast you incorporated all the recommendations :) I added a few very minor edits to the wording in the intro, changed a reference, fixed a few numbers. You can check these edits in the history.

The article looks great! Very impressive work, everyone. If there was a status higher than FA, I'd recommend this article for it.

BSW-RMH (talk) 14:50, 20 May 2010 (UTC)

Drug investigations

I suspect this bit could benefit from:

• Menna-Barreto RF, Salomão K, Dantas AP, Santa-Rita RM, Soares MJ, Barbosa HS, de Castro SL (2009 Feb). "Different cell death pathways induced by drugs in Trypanosoma cruzi: an ultrastructural study". Micron. 40 (2): 157–68. PMID 18849169. {{cite journal}}: Check date values in: |date= (help)CS1 maint: multiple names: authors list (link)

It's a recent research review. LeadSongDog come howl! 19:52, 13 May 2010 (UTC)

Stink bugs

Can anyone add a cite that states positively that stink bugs (halyomorpha halys) cannot transmit Chagas? 173.79.8.75 (talk) 14:44, 1 June 2012 (UTC)

Is there some particular reason for thinking they (out of all the insects extant) might? While both insects are part of suborder (Heteroptera), they are of different infraorders (Pentatomoidea vs Cimicomorpha). LeadSongDog come howl! 15:43, 1 June 2012 (UTC)

Pathophysiology

Just cross checking with my pathology textbook here, and it seems like a lot of the GI problems arise from destruction of the myenteric plexus. Maybe this ought to be made a little more explicit? On that note, pathophysiology in general seems a little thin (there's just that one, not incredibly specific paragraph.)

"very rare" in the U.S.?

Not so.

An Unfolding Tragedy of Chagas Disease in North America. PLoS Neglected Tropical Diseases, 2013; 7 (10): e2300 DOI: 10.1371/journal.pntd.0002300 — Preceding unsigned comment added by 68.40.56.234 (talk) 23:09, 2 November 2013 (UTC)

Transmission

The sentence - "Other modes of transmission include organ transplantation, through breast milk,[14] and by accidental laboratory exposure. " Is there a good reason to have "and by accidental laboratory exposure"? Wouldn't this be true for almost any disease, or is there something special about Chagas Disease that it needs to be pointed out. — Preceding unsigned comment added by Martyvis (talk • contribs) 01:39, 12 August 2014 (UTC)

There are numerous interesting new findings in a Scientific American article [1] discussing both the transmission patterns and the frequency of the disease. — Preceding unsigned comment added by 96.22.72.73 (talk) 22:22, 13 December 2014 (UTC)

New ref

Have a look at: José Rodrigues Coura; José Borges-Pereira. Rev. Soc. Bras. Med. Trop. vol.45 no.3 Uberaba May/June 2012 "Chagas disease. What is known and what should be improved: a systemic review" [Doença de Chagas. O que é conhecido e o que deve ser melhorado: uma visão sistêmica] PMID 22760123 doi:10.1590/S0037-86822012000300002 It looks to be a very useful overview. LeadSongDog come howl! 17:06, 3 December 2014 (UTC)

Bedbugs in US linked to Chagas

"Upto 300,000 immigrants in US infected." Scientific American 12/2014 . http://www.scientificamerican.com/article/bed-bugs-kissing-bugs-linked-to-deadly-chagas-disease-in-u-s/ 74.60.161.158 (talk) 15:37, 8 June 2015 (UTC)