Clinical Presentation

Acute infection can lead to recovery, death or chronic infection
* Babies can be infected by breast milk from infected mothers
* Generally there are 3 stages: acute, inderterminate and chronic
* Only about 1% of people develop symptoms in the acute stage
* Indeterminate stage begins 8-10 weeks after infection (asymptomatic)
* In the chronic stage, the most serious symptoms develop 10-20 years after infection
* Most people do not have symptoms until the chronic stage (10-20 years after infection)

Symptoms (Older children and adults):

* most acute and chronic phases are asymptomatic but symptoms can include:
* malaise
* chills
* fever
* muscle pain
* exhaustion
* gland enlargement
* small red spots on chest that go away in 10 days
* lymph nodes swell within 3 days of infection (become hard and tender)
* Chagoma lesion (an erythematous hardened area) develops where the parasite penetrated the skin (usually the face) and lasts for several months
* more chagomas may develop on other parts of the body
* edema all over body
* Romana’s sign: edema on the upper and lower eyelid and conjunctivitis
* ocuglandular syndrome (ocular, facial, cheek and neck edema)
* Chronic: cardiac problems, enlargement of digestive tract and heart, swallowing problems, severe constipation

Romana's sign (left)

Chagoma (middle)

Swollen lymph node (right)

Infants and kids:

* Most serious symptoms seen in children under the age of 5 because the CNS can be affected
* fever
* lymphadenitis
* hepatosplenomegaly
* meningoencephalitis
* tachycardia
* arrhythmias
* cardiac failure
* less common symptoms: megacolon, constipation, fecal impaction, volvulus


Markell and Voge's Medical Parasitology, pages 136-139