Chagas Disease: Past, Present, and Future

  • Héctor Freilij
Part of the Birkhäuser Advances in Infectious Diseases book series (BAID)


In this chapter we present an introduction to diverse aspects of Chagas disease. It is especially targeted to members of the health system in need for a deeper insight on the disease.

Chagas disease is a silent, silenced, and very complex disease. Silent because it may take 20 years since the parasite ingresses the organism until the subject develops a pathology. Silenced, because governments have managed to keep it without a common denominator. It is highly associated to poverty. It is included within the so-termed neglected tropical diseases by the WHO, given the little concern it represents to health officers from many countries and the pharmaceutical industries.

It is caused by the protozoan Trypanosoma cruzi, which has a wild life cycle, with over 100 animal species involved, and a human cycle. Its vector is a triatomine hematophagous insect, varying according to the geographic area. The parasite is transmitted through the vector feces. It is the most important endemic disease in the Americas, but due to Latin American population migratory movements, it has reached different countries in several continents. It affects approximately eight million people.

About 30% of the infected subjects develop cardiac disease with severe consequences and mortality. It also produces digestive disease, with a smaller load of morbidity.

We produced this chapter as a review of the history of the disease, and we describe a panoramic view of the infection ways, points relevant to diagnosis, treatment, phases of the disease, criteria of cure, and new research.


Trypanosoma cruzi Epidemiology Historical aspects Diagnosis Anti-parasitic treatment Phases of disease Criteria of cure New research 


  1. 1.
    Hotez PJ, Bottazzi ME, Franco-Paredes C, Ault SK, Rosrs Periago M. The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis. 2008;2:e300.CrossRefGoogle Scholar
  2. 2.
    World Health Organization. Sustaining the drive to overcome the global impact of neglected tropical diseases: second WHO report on neglected diseases. Geneva: WHO Press; 2013.Google Scholar
  3. 3.
    Lescure FX, Le Loup G, Freilij H, Develoux M, Paris L, Brutus L, et al. Chagas disease: changes in knowledge and management. Lancet Infect Dis. 2010;10(8):556–70.CrossRefGoogle Scholar
  4. 4.
    Rassi A Jr, Rassi A, Marcondes de Rezende J. American trypanosomiasis (Chagas disease). Infect Dis Clin North Am. 2012;26:275–91.CrossRefGoogle Scholar
  5. 5.
    Dias JSP, Machado EMM, Borges EC, et al. Doenca de Chagas em Lassance MG. Revaliacao clinic-epidemiologica 90 anos apos a descoberta de Carlos Chagas. Rev Soc Bras Med Trop. 2002;35:167–76.CrossRefGoogle Scholar
  6. 6.
    Prata A. Clinical and epidemiological aspects of Chagas disease. Lancet Infect Dis. 2000;1:92–100.CrossRefGoogle Scholar
  7. 7.
    Felman AM, Mac Namara D. Myocarditis. N Engl J Med. 2000;343:1388–98.CrossRefGoogle Scholar
  8. 8.
    Carlier Y, Torrico F, Sosa-Estani S, Russomando G, Luquetti A, Freilij H, et al. Congenital Chagas disease: recommendations for diagnosis, treatment and control of newborns, siblings and pregnant women. PLoS Negl Trop Dis. 2011;5:e1250.CrossRefGoogle Scholar
  9. 9.
    Freilij H, Altcheh J. Congenital Chagas’ disease. Diagnostic and clinical aspects. Clin Infect Dis. 1995;21:551–5.CrossRefGoogle Scholar
  10. 10.
    Segura EL, Sosa Estani S, Esquivel ML, Gómez A, Salomon OD. Control of the transmission of Trypanosoma cruzi in Argentina 1999. Medicina. 1999;59(Suppl 2):91–6.PubMedGoogle Scholar
  11. 11.
    Torrico F, Alonso-Vega C, Suarez E, Rodríguez P, Torrico MC, Dramaix M, et al. Endemic level of congenital Trypanosoma cruzi infection in the areas of maternal residence and the development of congenital Chagas disease in Bolivia. Rev Soc Bras Med Trop. 2005;38(Suppl 2):17–20.PubMedGoogle Scholar
  12. 12.
    Sánchez Negrette O, Mora MC, Basombrío MA. High prevalence of congenital Trypanosoma cruzi infection and family clustering in Salta, Argentina. Pediatrics. 2005;115(6):e668–72.CrossRefGoogle Scholar
  13. 13.
    Biancardi MA, Torres N, Pepe C, Altcheh J, Freilij H. Seroprevalencia de la enfermedad de Chagas en 17 parajes del “Monte Impenetrable” de la Provincia del Chaco. Medicina. 2003;63:125. ISSN 1669-9106.PubMedGoogle Scholar
  14. 14.
    Chuit R, Subias E, Perez AC, Paulone I, Wisnivesky-Colli C, Segura EL. Usefulness of serology for the evaluation of Trypanosome cruzi transmission in endemic areas of Chagas’ Disease. Rev Soc Brazil Trop Med. 1989;22(3):119–29. ISSN: 0037-8682-1989.CrossRefGoogle Scholar
  15. 15.
    Viotti R, Vigliano C. Etiological treatment of chronic Chagas disease: neglected evidence-base medicine. Expert Rev Anti Infect Ther. 2007;5:717–26.CrossRefGoogle Scholar
  16. 16.
    Strasen J, Williams T, Ertl G, et al. Epidemiology of Chagas disease in Europe: many calculations, little knowledge. Clin Res Cardiol. 2014;103:1–10.CrossRefGoogle Scholar
  17. 17.
    Schmunis GA, Yadon ZE. Chagas disease: a Latin American health problem becoming a world health problem. Acta Trop. 2010;115:14–21.CrossRefGoogle Scholar
  18. 18.
    Hotez PJ, Dumonteil E, Betancourt Cravioto M, Borrazi ME, Tapia-Conyer R, et al. An unfolding tragedy of Chagas disease in North America. PLoS Negl Trop Dis. 2013;7:e2300.CrossRefGoogle Scholar
  19. 19.
    Guerri-Guttenberg RA, Ciannameo A, Di Girolamo C, Milei JJ. [Chagas disease: an emerging public health problem in Italy?]. Infez Med 2009;17:5–13. In Italian.Google Scholar
  20. 20.
    Chin-Hong PV, Schwartz BS, Bern C, et al. Screening and treatment of Chagas disease in organ transplant recipients in the United States: recommendations from the Chagas in Transplant Working Group. Am J Transplant. 2011;11:672–80.CrossRefGoogle Scholar
  21. 21.
    Bisio M, Altcheh J, Lattner J, Moscatelli G, Fink V, Burgos JM, et al. Benznidazole treatment of chagasic encephalitis in pregnant woman with AIDS. Emerg Infect Dis. 2013;19(9):1490–2. Scholar
  22. 22.
    Soriano-Arandes A, Angheben A, Serre-Delcor N, Treviño-Maruri B, Gómez I, Prat J, Jackson Y. Control and management of congenital Chagas disease in Europe and other non-endemic countries: current policies and practices. Trop Med Int Health. 2016;21(5):590–6. Scholar
  23. 23.
    Coura JR, Abad-Franch F, Aguillera X, Dias JCP, Gil H, Junqueira ACV, et al. The initiative for the control of Chagas disease in the Americas and in non-endemic countries. Rev Soc Bras Med Trop. 2009;42(Suppl. 2):106–10.Google Scholar
  24. 24.
    Bisio M, Seidenstein E, Burgos JM, Ballering B, Risso M, Marcelo Moreau M, et al. Urbanization of congenital transmission of Trypanosoma cruzi: prospective polymerase chain reaction study in pregnancy. Trans R Soc Trop Med Hyg. 2011;105(10):543–9. Scholar
  25. 25.
    Alarcón de Noya B, Díaz-Bello Z, Colmenares C, Ruiz-Guevara R, Mauriello L, Muñoz-Calderón A, Noya O. Update on oral Chagas disease outbreaks in Venezuela: epidemiological, clinical and diagnostic approaches. Mem Inst Oswaldo Cruz. 2015;110(3):377–86.CrossRefGoogle Scholar
  26. 26.
    Shikanai-Yasuda MA, Carvalho NB. Oral transmission of Chagas disease. Clin Infect Dis. 2012;54:845–52.CrossRefGoogle Scholar
  27. 27.
    Castro E. Chagas’ disease: lessons from routine donation testing. Transfus Med. 2009;19(1):16–23. Scholar
  28. 28.
    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;298:2171–81.CrossRefGoogle Scholar
  29. 29.
    Carrilero B, Murcia L, Martinez-Lage L, Segovia M. Side effects of benznidazole treatment in a cohort of patients with Chagas disease in non-endemic country. Rev Esp Quimioter. 2011;24:123–6.PubMedGoogle Scholar
  30. 30.
    Perez-Ayala A, Perez-Molina JA, Norman F, et al. Chagas disease in Latin American migrants: a Spanish challenge. Clin Microbiol Infect. 2011;17:1108–13.CrossRefGoogle Scholar
  31. 31.
    Leiby D, Nguyen ML, Proctor MC, Rebecca L, Townsend RL, Stramer SL. Frequency of Trypanosoma cruzi parasitemia among infected blood donors with a potential association between parasite lineage and transfusion transmission. Transfusion. 2017;57:1426–32. Scholar
  32. 32.
    Benjamin RJ, Stramer SL, Leiby DA, et al. Trypanosoma cruzi infection in North America and Spain: evidence in support of transfusion transmission. Transfusion. 2012;52:1913–21.CrossRefGoogle Scholar
  33. 33.
    Guerri-Guttenberg RA, Grana DR, Ambrosio G, Milei J. Chagas cardiomyopathy: Europe is not spared. Eur Heart J. 2008;29:2587–91.CrossRefGoogle Scholar
  34. 34.
    Jackson Y, Getaz L, Wolff H, Mauris A, Tardini A, Sztajzel J, et al. Prevalence, clinical staging and risk for blood-borne transmission of Chagas disease among Latin American migrants in Geneva, Switzerland. PLoS Negl Trop Dis. 2010;4(2):e592. Scholar
  35. 35.
    Kessler DA, Shi PA, Avecilla ST, Shaz BH. Results of lookback for Chagas disease since the inception of donor screening at New York Blood Center. Transfusion. 2013;53:1083–7.CrossRefGoogle Scholar
  36. 36.
    Basile L, Jansa JM, Carlier Y, Salamanca DD, Angheben A, Bartoloni A, et al. Chagas disease in European countries: the challenge of a surveillance system. Euro Surveill. 2011;16(37):pii: 19968.Google Scholar
  37. 37.
    Taquini AC, Lozada BB, Furman B. Cardiopatía chagásica crónica. Medicina. 1952;12:123–48.PubMedGoogle Scholar
  38. 38.
    Benchimol AB. Doenca de Chagas nos grandes centros urbanos. In: Annais do Congreso International sóbre a doenca de Chagas, Vol I, Rio de Janeiro, 1961, 189-203.Google Scholar
  39. 39.
    Romaña C. Acerca de un síntoma inicial de valor para el diagnóstico de forma aguda de la enfermedad de Chagas. MEPRA. 1935;22:16–28.Google Scholar
  40. 40.
    Chagas C. Nova Trypanosomiase humana. Estudos sobre a morfolojia e o ciclo evolutivodo Schizotrypanun cruzi, agente etiologicode nova entidade mórbida do homem. Mem Inst Oswaldo Cruz. 1909;1:159–218.CrossRefGoogle Scholar
  41. 41.
    Sá MR. The history of tropical medicine in Brazil: the discovery of Trypanosoma cruzi by Chagas and the German school of protozoology. Parasitologia. 2005;47:309–17.Google Scholar
  42. 42.
    Mazza S. La enfermedad de Chagas en la República Argentina. Mem Inst Oswaldo Cruz. 1949;47:273–88.CrossRefGoogle Scholar
  43. 43.
    Neiva A, Lent H. Triatomideos do Chile. Mem Inst Oswaldo Cruz. 1943;1:43–75.CrossRefGoogle Scholar
  44. 44.
    Araujo A, Jansen AM, Reinhard K, Ferreira LF. Paleoparasitology of Chagas disease: a review. Mem Inst Oswaldo Cruz. 2009;104(Suppl I):9–16.CrossRefGoogle Scholar
  45. 45.
    Aufderheide AC, Salo LW, Madden M, Streitz J, Ghul F, et al. A 9000 year record of Chagas disease. Proc Natl Acad Sci U S A. 2004;101(7):2034–9.CrossRefGoogle Scholar
  46. 46.
    Deane MP, Lenzi HL, Jansen A. Trypanosoma cruzi: vertebrate and invertebrate cycles in the same mammal host, the opossum Didelphis marsupialis. Mem Inst Oswaldo Cruz. 1984;79:513–5.CrossRefGoogle Scholar
  47. 47.
    Lenzi HL, Jansen AM, Deane MP. The recent discovery of what might be a primordial escape mechanism for Trypanosoma cruzi. Mem Inst Oswaldo Cruz. 1984;79:13–8.CrossRefGoogle Scholar
  48. 48.
    Galvão C, Carvalho RU, Rocha DS, Juberg J. A check-list of the current valid species of the subfamily Triatominae Jeannel, 1919 (Hemiptera, Reduviidae) and their geographical distribution, with nomenclatural and taxonomic notes. Zootaxa. 2003;2002:1–36.CrossRefGoogle Scholar
  49. 49.
    Stevens JR, Noyes HA, Dover GA, Gibson WG. The ancient and divergent origins of the human pathogenis trypanosomes, Trypanosoma brucei and Trypanosoma. cruzi. Parasitology. 1999;116:107–16.CrossRefGoogle Scholar
  50. 50.
    El Sayed NM, Myler PJ, Bartholomeu DC, Nilsson D, Aggarwal G, Tran NA. The genome sequence of Trypanosoma cruzi, etiologic agent of Chagas disease. Science. 2005;309(5733):409–15.CrossRefGoogle Scholar
  51. 51.
    Zingales B, Andrade S, Briones R, Campbell D, Chiari E, Fernandes O, et al. A new consensus for Trypanosoma cruzi intrespecific nomenclature: second revision meeting recommends TcI to TcVI. Mem Inst Oswaldo Cruz. 2009;1047:1051–4.CrossRefGoogle Scholar
  52. 52.
    Araujo Perla F, Almeida Adriana B, Pimentel Carlos F, Silva Adriano R, Alessandro S, Valente Sebastião A, et al. Sexual transmission of American trypanosomiasis in humans: a new potential pandemic route for Chagas parasites. Mem Inst Oswaldo Cruz. 2017;112(6):437–46.CrossRefGoogle Scholar
  53. 53.
    Gürtler RE. Sustainability of vector control strategies in the Gran Chaco Region: current challenges and possible approaches. Mem Inst Oswaldo Cruz. 2009;104(Suppl I):52–9.CrossRefGoogle Scholar
  54. 54.
    Estimación cuantitativa de la enfermedad de Chagas en las Américas. OPS/HDM/CD/425-06. OPS/OMS.Google Scholar
  55. 55.
    Gurtler RE, Yadon ZE. Eco-bio-social research on community-based approaches for Chagas disease vector control in Latin America. Trans R Soc Trop Med Hyg. 2015;109(2):91–8. Scholar
  56. 56.
    Henao-Martínez A, Colborn K, Parra-Hena G. Overcoming research barriers in Chagas disease—designing effective implementation science. Parasitol Res. 2017;116:35. Scholar
  57. 57.
    Sartor P, Colaianni I, Cardinal MV, Bua J, Freilij H, Gurtler RE. Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation. PLoS Negl Trop Dis. 2017;11:e0005336. Scholar
  58. 58.
    Germano MD, Picollo MI. Demographic effects of deltamethrin resistance in the Chagas disease vector Triatoma infestans. Med Vet Entomol. 2016;30(4):416–25. Scholar
  59. 59.
    Dao L. Otros casos de enfermedad de Chagas en el Estado de Guarico (Venezuela) Observación sobre enfermedad de Chagas congénita. Rev Policlin Caracas. 1949;17:17–32.Google Scholar
  60. 60.
    Rueda K, Trujillo JE, Carranza JC, Vallejo GA. Transmisión oral de Trypanosoma cruzi: una nueva situación epidemiológica de la enfermedad de Chagas en Colombia y otros países suramericanos. Rev Biomédica. 2014;34(4):631.Google Scholar
  61. 61.
    Alarcón de Noya B, Díaz-Bello Z, Colmenares C, Ruiz R, Noya O, Zavala-Jaspe R, et al. Large urban outbreak of orally acquired acute Chagas disease at a school in Caracas, Venezuela. J Infect Dis. 2010;201:1308–15. Scholar
  62. 62.
    Hernandez-Becerril N, Mejia AM, Ballinas-Verdugo MA, et al. Blood transfusion and iatrogenic risks in Mexico City. Anti-Trypanosoma cruzi seroprevalence in 43,048 blood donors, evaluation of parasitemia, and electrocardiogram findings in seropositive. Mem Inst Oswaldo Cruz. 2005;100:111–6.CrossRefGoogle Scholar
  63. 63.
    Schmunis GA, Cruz JR. Safety of the blood supply in Latin America. Clin Microbiol Rev. 2005;18:12–29.CrossRefGoogle Scholar
  64. 64.
    Schmunis GA. Trypanosoma cruzi, the etiologic agent of Chagas’ disease: status in the blood supply in endemic and nonendemic countries. Transfusion. 1991;31:547–57.CrossRefGoogle Scholar
  65. 65.
    Cerisola JA, Rabinovich A, Alvarez M, Corletto CA, Prumeda J. [Chagas’ disease and blood transfusion]. Bol Oficina Sanit Panam 1972;73:203–221. In Spanish.Google Scholar
  66. 66.
    World Health Organization. WHO Consultation on International Biological Reference Preparations for Chagas Diagnostic Tests; Geneva. 2–3 July 2007. Accessed on 14 Feb 2015. Available at:
  67. 67.
    Schmunis GA. Epidemiology of Chagas disease in non-endemic countries: the role of international migration. Mem Inst Oswaldo Cruz. 2007;102(Suppl 1):75–85.CrossRefGoogle Scholar
  68. 68.
    Angheben A, Boix L, Buonfrate D, Gobbi F, Bisoffi Z, Pupella S, et al. Chagas disease and transfusion medicine: a perspective from non-endemic countries. Blood Transfus. 2015;13(4):540–50.PubMedPubMedCentralGoogle Scholar
  69. 69.
    Cordova E, Boschi A, Ambrosioni J, Cudos C, Corti M. Reactivation of Chagas disease with central nervous system involvement in HIV-infected patients in Argentina, 1992-2007. Int J Infect Dis. 2008;12(6):587–92. Scholar
  70. 70.
    Kun H, Moore A, Mascola L, Steurer F, Lawrence G, Kubak B, et al. Transmission of Trypanosoma cruzi by heart transplantation. Clin Infect Dis. 2009;48(11):1534–40.CrossRefGoogle Scholar
  71. 71.
    Cura CI, Lattes R, Nagel C, Gimenez MJ, Blanes M, Calabuig E, et al. Early molecular diagnosis of acute Chagas disease after transplantation with organs from Trypanosoma cruzi-infected donors. Am J Transplant. 2013;13(12):3253–61.CrossRefGoogle Scholar
  72. 72.
  73. 73.
  74. 74.
    Freilij H, Muller Gonzalez Cappa DM. Direct micromethod for diagnosis of acute and congenital Chagas disease. J Clin Mocrobiol. 1983;18:327–30.Google Scholar
  75. 75.
    Strout RG. A method for concentrating hemoflagellates. J Parasitol. 1962;48:100.CrossRefGoogle Scholar
  76. 76.
    Pitella JE. Central nervous system involvement in Chagas disease: a hundred-year-history. Trans R Soc Trop Med Hyg. 2009;103:973–8.CrossRefGoogle Scholar
  77. 77.
    Moure Z, Angheben A, Molina I, Gobbi F, Espasa M, Anselmi M, et al. Serodiscordance in chronic Chagas disease diagnosis: a real problem in non-endemic countries. Clin Microbiol Infect. 2016;22(9):788–92. Scholar
  78. 78.
    Rivero R, Bisio M, Velazquez EB, Esteva MI, Scollo K, Gonzalez NL, et al. Rapid detection of Trypanosoma cruzi by colorimetric loop-mediated isothermal amplification (LAMP): a potential novel tool for the detection of congenital Chagas infection. Diagn Microbiol Infect Dis. 2017;89(1):26–8.CrossRefGoogle Scholar
  79. 79.
    Schijman AG, Altcheh J, Burgos JM, Biancardi M, Bisio M, Levin MJ, et al. Aetiological treatment of congenital Chagas’ disease diagnosed and monitored by the polymerase chain reaction. J Antimicrob Chemother. 2003;52(3):441–9.CrossRefGoogle Scholar
  80. 80.
    Morillo CA, Waskin H, Sosa-Estani S, Del Carmen Bangher M, Cuneo C. Benznidazole and posaconazole in eliminating parasites in asymptomatic T. cruzi carriers: the STOP-CHAGAS trial. J Am Coll Cardiol. 2017;69(8):939–47. Scholar
  81. 81.
    Pinazo MJ, Thomas MC, Bua J, Perrone A, Schijman A, Viotti R, et al. Biological markers for evaluating therapeutic efficacy in Chagas disease, a systematic review. Expert Rev Anti Infect Ther. 2014;12(4):479–96.CrossRefGoogle Scholar
  82. 82.
    Viotti R, Vigliano C, Lococo B, Bertocchi G, Petti M, Alvarez MG, et al. Long-term cardiac outcomes of treating chronic Chagas disease with benznidazol versus no treatment: a nonrandomized trial. Ann Intern Med. 2006;144:724–34.CrossRefGoogle Scholar
  83. 83.
    Britto C, Cardoso MA, Vanni CM, Hasslocher A, Xaviert SS, Oelemann N, et al. Polymerase chain reaction detection of Trypanosoma cruzi in human blood samples as a tool for diagnosis and treatment evaluation. Parasitology. 1995;110(Pt 3):241–7.CrossRefGoogle Scholar
  84. 84.
    Altcheh J, Corral R, Biancardi MA, Freilij H. Anti-F2/3 antibodies as cure marker in children with congenital Trypanosoma cruzi infection. Medicina. 2003;63(1):37–40.PubMedPubMedCentralGoogle Scholar
  85. 85.
    Sales Junior PA, Molina I, Fonseca Murta SM, Sánchez-Montalvá A, Salvador F, Corrêa-Oliveira R, Carneiro CM. Experimental and clinical treatment of Chagas disease: a review. Am J Trop Med Hyg. 2017;97(5):1289–303. Scholar
  86. 86.
    Altcheh J, Moscatelli G, Mastrantonio G, Moroni S, Giglio N, Marson ME, et al. Population pharmacokinetic study of benznidazole in pediatric Chagas disease suggests efficacy despite lower plasma concentrations than in adults. PLoS Negl Trop Dis. 2014;8(5):e2907.CrossRefGoogle Scholar
  87. 87.
    Altcheh J, Moscatelli G, Moroni S, Garcia-Bournissen F, Freilij H. Adverse events after the use of benznidazole in infants and children with Chagas disease. Pediatrics. 2011;127(1):e212–8.CrossRefGoogle Scholar
  88. 88.
  89. 89.
    Rodrigues Silva R, Shrestha-Bajracharya D, Almeida-Leite CM, Leite R, Bahia MT, Talvani A. Short-term therapy with simvastatin reduces inflammatory mediators and heart inflammation during the acute phase of experimental Chagas disease. Mem Inst Oswaldo Cruz. 2012;107(4):513–21.CrossRefGoogle Scholar
  90. 90.
    Bianchi F, Cucunubá Z, Guhl F, González NL, Freilij H, Nicholls R, et al. Follow-up of an asymptomatic Chagas disease population of children after treatment with nifurtimox (Lampit) in a sylvatic endemic transmission area of Colombia. PLoS Negl Trop Dis. 2015;9(2):e0003465. Scholar
  91. 91.
    Yun O, Lima MA, Ellman T, Chambi W, Castillo S, Flevaud L, et al. Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Médecins Sans Frontières. PLoS Negl Trop Dis. 2009;3(7):e488. Scholar
  92. 92.
    Dreyer C, Armenti HA, Gurtler RE, Freilij H. Curso de educación a distancia, Chagas: del conocimiento a la acción. Fundación Bunge y Born. Available at:
  93. 93.
    Lenardón M, Orsini P, Chopita M, Ramos P, Da Cruz AP, Suárez Crivaro F, et al. Chagas in a non-endemicarea: first level health care. Lights and shadows. PEAH – Policies for Equitable Access to Health. Accessed on 29 Sep 2016. Available at:
  94. 94.
    Pinazo MJ, Lacima G, Elizalde JI, Posada EJ, Gimeno F, Aldasoro E, et al. Characterization of digestive involvement in patients with chronic T. cruzi infection in Barcelona, Spain. PLoS Negl Trop Dis. 2014;8(8):e3105. Scholar
  95. 95.
    Biter AB, Weltje S, Hudspeth EM, Seid CA, McAtee CP, Chen WH, et al. Characterization and stability of Trypanosoma cruzi 24-C4 (Tc24-C4), a candidate antigen for a therapeutic vaccine against Chagas disease. J Pharm Sci. 2018;107:1468. pii: S0022-3549(17)30884-5.CrossRefPubMedGoogle Scholar
  96. 96.
    Sanchez Alberti A, Bivona AE, Cerny N, Schulze K, Weißmann S, Ebensen T, et al. Engineered trivalent immunogen adjuvanted with a STING agonist confers protection against Trypanosoma cruzi infection. Vaccine. 2017;2:9. Scholar
  97. 97.
    Rial MS, Scalise ML, Arrúa EC, Esteva MI, Salomon CJ, Fichera LE. Elucidating the impact of low doses of nano-formulated benznidazole in acute experimental Chagasdisease. PLoS Negl Trop Dis. 2017;11(12):e0006119. Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Héctor Freilij
    • 1
  1. 1.Servicio de Parasitología y Enfermedad de ChagasHospital de Niños “Ricardo Gutiérrez”Buenos AiresArgentina

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