231.4 📌 章末速蚘

  • Chagas Disease: Trypanosoma cruzi, Latin America endemic
  • Vector: triatomine (“kissing”) bug; feces transmission (not bite)
  • Other transmission: transfusion, vertical, oral, transplant
  • Acute: Romaña sign (eye edema) + chagoma + mild systemic; 100% chronic without treatment
  • Chronic Indeterminate (~ 70%) — asymptomatic decades
  • Chronic Cardiomyopathy (30%): RBBB + LAFB → DCM + apical aneurysm → mural thrombus + stroke + sudden death
  • Chronic Digestive (10-20% Brazil/Southern Cone): megaesophagus + megacolon
  • Diagnosis:
    • Acute: smear + PCR + buffy coat
    • Chronic: 2 different serology assays required
  • Treatment: Benznidazole 60 days or Nifurtimox 90 days
  • Indications: all acute/recent/newborn/pediatric; shared decision 18-50; less benefit in advanced CM (BENEFIT trial)
  • Pre-immunosuppression / pre-transplant screening + treatment essential
  • Reactivation in HIV / transplant / immunosuppression → myocarditis + meningoencephalitis (severe)
  • Vector control + blood screening + maternal screening + newborn treatment = control measures
  • WHO 2030 elimination goal
  • 盧醫垫 hint: Latin American immigrant + cardiomyopathy / dysphagia / chronic constipation → consider Chagas + serology