<unk>  (American trypanosomiasis) is an infectious<unk>  caused by the flagellate protozoan parasite, T. cruzi. The global incidence of<unk>  is estimated to be 5-8 million with global incidence of<unk>  of approxiamtely 100-400 per 100,000 individuals. The majority of cases are reported in South America, where<unk>  is considered the most common parasitic infection. The most common mode of transmission of<unk>  is vectorborne via exposure to feces/urine of infected triatomine (Riduvid) insects. The incubation period of T. cruzi is 1-2 weeks following transmission. The majority (90%-95%) of infected individuals remain asymptomatic in the acute phase following<unk>  infection. Nonetheless, patients typically remain chronically infected and demonstrate clinical manifestation several years/decades following infection. Approximately 1/3 of patients develop manifestations of the chronic<unk> , namely cardiac conduction system dysfunction, GI denervation with esophageal and/or colonic dysfunction (megaesophagus and megacolon). Acute<unk>  is often diagnosed by peripheral blood smear following the visual detection of T. cruzi parasite. In contrast, the diagnosis of chronic<unk>  is more difficult and requires serial serological or PCR testing. Benznidazole and nifurtimox are the only antimicrobial therapies with proven efficacy against T. cruzi infection. Neither drug is FDA-approved, but can be obtained under investigational protocol. Either benznidazole or nifurtimox may be used to manage congenital infection, acute infection, and chronic infection (only among young patients < 50-55 years) including those with early cardiomyopathy. Chronic<unk>  leads to congestive heart failure. These patients commonly have right bundle branch block and/or other arrhythmias. These hearts are dilated and hypertrophied, have areas of fibrosis especially in the apex, and often contain mural thrombi. The myocardium is infiltrated with lymphocytes and macrophages and there is interstitial edema and fibrosis. This inflammatory reaction is most severe around the area of the right bundle branch. Patients may also develop megaesophagus and/or megacolon.
Chagas disease
Loa loa filariasis
Cyclosporiasis
Isosporiasis
Cryptosporidiosis
Strongyloidiasis
Enterobiasis
Candida esophagitis