Síntesis de evidencia: Guía para el diagnóstico y el tratamiento de la enfermedad de Chagas

Abstract

Introduction. Chagas disease or American trypanosomiasis is caused by the flagellate protozoan Trypanosoma cruzi, transmitted mainly by insect vectors (popularly known in the different areas of the Region of the Americas as “kissing bugs”, “pitos”, “chinches”, or “chirimachas” or “vinchuchas”). The parasite is transmitted via the placenta and in transfusions, and less frequently, orally or during organ transplantation. Because it was necessary to strengthen the implementation of public policies and the management of clinical conditions, given the diagnostic and therapeutic difficulties that this systemic parasitosis presents, the Pan American Health Organization (PAHO) developed guidance for the management of American trypanosomiasis. Objectives. Synthesize the recommendations included in the Guide for Diagnosis and Treatment of Chagas Disease, published (in Spanish only) by the Pan American Health Organization in 2018, in order to present the proper diagnostic methods and treatment for Chagas disease and to address aspects of its implementation. Methods. A summary was made of the guide and its recommendations. In addition, a systematic search was conducted in PubMed, Lilacs, Health Systems Evidence, Epistemonikos, and the gray literature for studies carried out in the Americas, in order to identify barriers, facilitators, and implementation strategies. Results. Ten recommendations are made. These are applicable to adult and pediatric patients with suspected Chagas disease, exposure to T. cruzi, or a confirmed diagnosis of acute, chronic, or congenital Chagas disease. Reports that addressed aspects of implementation were identified. Conclusions. The recommendations seek to provide strategies for the timely diagnosis and treatment of Chagas disease, as well as considerations for the implementation of such strategies.