Chagas Disease

What is Chagas Disease?

Chagas disease, also called American trypanosomiasis, is a potentially life-threatening infection caused by the parasite Trypanosoma cruzi. It is found mainly in Central and South America and is spread when contaminated bug feces enter a bite wound or mucous membrane, and it can also pass from mother to baby, through blood transfusion, through organ transplant or through contaminated food or drink.^[1]

Chagas disease is increasingly recognized in the United States. An estimated 240,000 to 350,000 people in the country are infected, mostly immigrants from endemic regions.^[2]

Common symptoms

The acute phase lasts about two months and often causes mild symptoms or none. Fever, swelling at the bite site and swelling of one eyelid (Romana's sign) can occur.^[1]

In the chronic phase, which develops in about 30% of infected people, the heart and digestive tract can be affected.^{[1, 2]}

• Heart rhythm problems, an enlarged heart and heart failure
• An enlarged esophagus (trouble swallowing) or enlarged colon (severe constipation)^[1]
• Lower quality of life than in healthy people, especially with heart or digestive symptoms^[3]

Causes and risk factors

The cause is infection with T. cruzi. People at risk include those who lived in areas where the disease is endemic, those who lived in homes built of natural materials in Latin America, those with a history of kissing bug bites, and family members of someone diagnosed.^[4] Locally acquired cases have also been found in the United States.^[4]

How it is diagnosed and treated conventionally

Early infection is diagnosed by finding the parasite in blood, and chronic infection by blood tests for antibodies.^[1] Newly diagnosed patients usually have an examination and an electrocardiogram, with further heart or digestive testing if symptoms suggest involvement.^[5]

Treatment of the infection itself is limited to benznidazole and nifurtimox, which work best early. Their role in people who already have heart disease is not settled.^{[1, 4]} A Cochrane review found insufficient evidence that these drugs help late-stage symptomatic disease, and benznidazole caused more adverse effects than placebo.^[6] Chronic Chagas heart disease is managed with the medical therapy used for other heart muscle disease, and some people need pacemakers, defibrillators or surgery.^{[1, 7]}

Why Chagas Disease calls for a whole-person approach

Chagas disease is a long-term infection that can affect several organ systems and a person's emotional life at once. Medical teams treat the parasite and the organ complications, and many people also live with fatigue, worry, constipation or reduced well-being that need attention too.

This is the area where supportive care may have a role, always after the disease is under specialist management.

Inflammation and oxidative stress

Researchers believe that oxidative stress and inflammation driven by the infection contribute to tissue damage as the disease progresses.^{[8, 9]} This is an active research area, and it does not mean any supplement or herb treats the disease.

The heart

Chronic Chagas heart disease involves inflammation of the heart muscle, scarring and a high tendency to dangerous rhythm problems.^[7] This is why cardiology care is central and why symptoms such as fainting or palpitations always need medical review.

Digestive symptoms

Some people develop an enlarged esophagus or colon, which causes swallowing trouble or constipation.^[1] Symptom support for constipation has been studied in other conditions, not in Chagas disease.

Quality of life and emotional health

Quality of life is lower in people with Chagas disease, and the disease is associated with poverty and stigma.^[3] Exercise training and pharmaceutical care have been linked to better quality of life in people with Chagas heart disease.^[3]

Acupuncture as supportive care in Chagas Disease

What the research shows

A PubMed search found no clinical trials of acupuncture for Chagas disease, so there is no evidence that it affects the infection, the heart disease or the digestive complications of this condition.

Studies in related conditions give only an indirect picture. A review of seven randomized trials of acupuncture in heart failure, mostly with methodological flaws, reported improvements in exercise capacity and quality of life in chronic heart failure but judged the overall effectiveness inconclusive.^[10] An umbrella review of integrative medicine for chronic heart failure concluded that evidence for acupuncture was low to very low certainty and limited to a marker of heart strain.^[11] These findings come from heart failure of other causes and may not apply to Chagas heart disease.

For symptoms, a meta-analysis of 16 studies of acupuncture for chronic fatigue syndrome found better response than sham acupuncture, but the studies were mostly of low quality and no firm conclusion was possible.^[12] A meta-analysis of 11 trials found that acupuncture, usually combined with conventional care, improved bowel movements and constipation-related quality of life in Parkinson's disease, with the authors calling for higher-quality trials.^[13]

How acupuncture may work

How acupuncture might act on fatigue or bowel symptoms is not established. In chronic heart failure studies from other causes, acupuncture was associated with changes in heart rate variability, a measure linked to the autonomic nervous system, but this does not show a mechanism.^[10] No study has examined these questions in Chagas disease.

What treatment involves

Treatment uses fine, sterile, single-use needles, typically left in place for about 20 to 40 minutes, with a short course of visits and reassessment. Needle placement and treatment goals are adjusted to be supportive and conservative.

In prospective studies, about 9 in 100 patients had a minor reaction such as soreness or bleeding at a needle site, and serious events occurred in about 1 in 10,000 patients.^[14] Tell the practitioner first if you have a pacemaker or implanted defibrillator (relevant to electroacupuncture), take blood thinners, have a bleeding disorder, are pregnant or have an active infection.

Ayurvedic medicine as supportive care in Chagas Disease

The Ayurvedic view

Ayurveda has no classical name for Chagas disease, which was described in 1909. A practitioner would instead look at the person's overall constitution, digestion and symptoms, such as poor digestion or fatigue, and describe them in terms of the doshas and agni (digestive fire). These are traditional frameworks, not biomedical diagnoses.

Therapies that may be used

Care is individualized and traditionally includes:

• Diet and daily routine suited to the person's digestion and energy, coordinated with any heart-failure or swallowing advice from your physicians
• Gentle oil massage and relaxation practices for stress and sleep
• Herbs prescribed individually by a qualified practitioner

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and it is generally not suitable for people with advanced heart disease or heart failure. Strong cleansing or purgative treatments can be risky when heart rhythm problems or fluid balance are an issue.

What the research shows

No clinical studies of Ayurvedic treatment for Chagas disease were found. Researchers have studied curcumin, the main active compound of turmeric, but a systematic review of curcumin and resveratrol for Chagas disease found no clinical studies at all, only 9 animal reports.^[9] A review of antioxidants as add-on therapy noted possible reductions in markers of oxidative damage with some compounds including curcumin, but said more research was needed.^[8] Ayurvedic care therefore cannot be presented as a treatment for the infection or its complications.

Herbal medicine as supportive care in Chagas Disease

Herbs and formulas that have been studied

Laboratory and animal research on Chagas disease has looked at plant compounds such as curcumin and resveratrol, plus antioxidants such as vitamins C and E and melatonin.^{[8, 9]} In heart failure from other causes, researchers have studied Chinese herbal medicines, some of them given by injection in hospitals.^[11]

What the research shows

No clinical trials of herbal medicine for Chagas disease were found.^[9] In heart failure of other causes, a meta-analysis of 8 trials found that acupuncture combined with herbal medicine plus conventional care improved heart measurements and quality of life compared with conventional care alone, but the number of trials was small and acupuncture and herbs were studied together, so the effect of each cannot be separated.^[15] The umbrella review rated the evidence for Chinese herbal injections as low to very low certainty.^[11]

Safety and herb-drug interactions

Herbs can interact with heart and blood-thinning medicines. Case reports describe bleeding when warfarin was combined with herbs such as dan shen, dang gui, ginseng and Boswellia, and a literature review describes interactions with digoxin and with antidepressants.^{[16, 17]}

Antiparasitic drugs, heart medicines and herbs may all be processed by the liver, and herbal and dietary supplements are a recognized cause of liver injury.^[18] About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[19] Vitamin E, a common antioxidant supplement, may increase hospitalizations in heart failure.^[11] Please tell us about all medicines and supplements, and tell us if you are pregnant or breastfeeding.

Translating traditional medicine into modern biological language

This section is interpretation, not equivalence. Chinese medicine would describe a long-term illness with fatigue and palpitations as a pattern such as deficiency of qi or blood, and Ayurveda might describe weak digestion and depleted energy. Researchers who study the biology of Chagas disease measure different things: parasite persistence, chronic inflammation, oxidative stress and heart muscle scarring.^{[7, 8]}

Where traditional care overlaps with research is in symptoms, for example fatigue, stress and bowel function, which are studied with trials of acupuncture and mind-body practices in other conditions.^{[12, 20]} Mind-body interventions such as Tai Chi, yoga and relaxation showed small to moderate improvements in quality of life, anxiety and fatigue in a review of 24 heart failure trials.^[20]

How this care fits with your medical care

Chagas disease needs diagnosis and ongoing care from physicians, often an infectious disease specialist and a cardiologist. Complementary care is supportive only, does not treat the infection, and should never replace antiparasitic treatment, heart medicines, devices or surgery. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Please do not stop or change any prescribed medicine without your prescriber. Bring your diagnosis, recent test and ECG results, a full list of medicines and supplements, and the names of your treating doctors.

When to seek urgent medical care

Chagas disease can cause sudden heart rhythm problems and heart failure.^[7]

• Fainting or near-fainting, or a racing or irregular heartbeat
• Chest pain or sudden shortness of breath
• Swelling of the legs or abdomen, or rapid weight gain with breathlessness
• Stroke symptoms such as face drooping, weakness on one side or trouble speaking
• Inability to swallow, or severe abdominal pain and swelling with no bowel movements
• Fever with unexplained illness after known exposure, or in anyone who is immunosuppressed

If any of these occur, call 911 or go to the nearest emergency department.