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ABSTRACT
Introduction: Chagas disease is caused by the parasite Trypanosoma cruzi. Endemic in 21 American countries, there are ~7 million people infected, of which 14,000 die every year. Despite this burden, Chagas remains an orphan disease as it mainly affects poor communities with low economic and political power.
Areas covered: There are two drugs available to treat the infection, but both have safety and efficacy issues. Investment in new treatments and other control measures has been historically neglected. This trend is changing and there are novel perspectives to put an end to this senseless orphanage. Research and development agenda of new therapies, diagnostic tools and biomarkers have moved forward during the last decade; and patients associations have been active in promoting awareness of the disease all along. Besides, the WHO recently declared April 14th as the ‘World Chagas disease day’, which will increase the visibility of the disease and attract attention internationally.
Expert opinion: Efforts must focus on the prevention of new infections, but also in the management of the millions already chronically infected. This will require an integral approach where increasing the number of trained health workers and generalizing access to diagnosis and treatment will be fundamental.
Article highlights
Chagas is an infectious disease caused by the parasite Trypanosoma cruzi that is endemic in 21 American countries, where reside most of the ~7 million people infected.
It is mainly transmitted by vectors that proliferate in infra-housing settlements linking the disease to a poor socioeconomic status; and since the affected people are from low-income communities with no political voice Chagas disease treatment and control has been historically neglected.
There are two drugs to treat the infection: benznidazole and nifurtimox. These are very efficient against the acute stage, but since this is mostly asymptomatic it is not diagnosed. Treatment is provided at the chronic stage, and by then its efficacy is variable. In addition, both drugs entail long administration regimens that have frequent adverse effects associated.
Recent advances in more sensitive and specific diagnostics and point-of-care suited technologies, linked to a diversification of the drugs´ producers will contribute to generalize access to diagnosis and treatment in the near future. Moreover, Chagas disease is in the clinical trials arena, where alternative regimens of existing drugs as well as new drugs are being evaluated in the search of more efficacious and less toxic treatments.
Patients´ associations have greatly contributed to increase disease awareness and empower those affected by it. Sensitization must continue at all levels to ensure funding for research and development, and to invest in the training of health professionals in order to integrate Chagas disease patients care in the health systems from endemic and non-endemic regions.
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Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.