ENFERMEDAD DE CHAGAS: DINÂMICA EPIDEMIOLÓGICA CONTEMPORÂNEA Y DESAFÍOS DIAGNÓSTICOS Y TERAPÊUTICOS.
Resumen
Objetivo: Revisar los desafíos contemporáneos de la enfermedad de Chagas, centrándose en los cambios en su distribución geográfica, las barreras diagnósticas y la búsqueda de terapias más efectivas. Metodología: Se realizó una revisión narrativa de carácter descriptivo y analítico, en las bases de datos PubMed, SciELO, LILACS e Web of Science, utilizando los descriptores "Enfermedad de Chagas", "Cardiomiopatía de Chagas" y "Enfermedades Negligenciadas". Se seleccionaron artículos originales, revisiones y directrices en español, portugués e inglés, con ènfasis em la producción de los últimos 10 años.Revisión de la literatura: Los resultados indicanque la enfermedad causada por el protozoo Trypanosoma cruzi, es considerada una enfermedad desatendida e que afecta poblaciones vulnerables y recibe inversión limitada para su control. Aunque históricamente asociada con la transmisión vectorial en áreas rurales de Latinoamérica, se observo um cambio en su perfil epidemiológico, notablemente la transmisión oral en la región amazónica y la expansión a áreas no endémicas debido a la migración. Los impactos sociales y económicos son significativos en la población afectada, mientras que las estrategias de mitigación siguen siendo insuficientes, lo que resalta la necesidad de avances en la investigación, especialmente en el desarrollo de pruebas diagnósticas más precisas y medicamentos más efectivos con menor toxicidad. Consideraciones finales: A pesar de los avances en el conocimiento de la enfermedad, persisten lagunas en la epidemiología, el diagnóstico y el tratamiento. El estudio destaca la necesidad de garantizar el acceso a un diagnóstico oportuno y un tratamiento eficaz para prevenir la progresión a formas graves y debilitantes.
Biografía del autor/a
Médica pediatra com habilitação em cardiologia. É professora assistente do curso de medicina da Universidade do Estado do Pará.
Médica dermatologista e doutora em agentes Infecciosos e parasitários da Amazônia, professora adjunto da Universidade do Estado do Pará.
Médico, cirurgião cardíaco, médico assistente da Fundação Pública Hospital de Clínicas Gaspar Viana, Belém-PA.
Biólogo, mestrando em Gestão em Serviços de Saúde da Fundação Santa Casa de Misericórdia do Pará, coordenador estadual do Programa de Doença de Chagas da Secretaria de Estado de Saúde Pública do Estado do Pará.
Referencias
1. ABRAS, A. et al. Worldwide control and management of Chagas disease in a new era of globalization: a close look at congenital Trypanosoma cruzi infection. Clinical Microbiology Reviews, v. 35, n. 2, p. e0015221, 2022. DOI: https://doi.org/10.1128/cmr.00152-21
2. ALEVI, K. et al. Trends in taxonomy of Chagas disease vectors (Hemiptera, Reduviidae, Triatominae): from Linnaean to integrative taxonomy. Pathogens, v. 10, n. 12, p. 1627, 2021. DOI: https://doi.org/10.3390/pathogens10121627
3. ÁLVAREZ-HERNÁNDEZ, D. et al. A systematic review of historical and current trends in Chagas disease. Therapeutic Advances in Infectious Disease, v. 8, p. 204993612110337, 2021. DOI: https://doi.org/10.1177/20499361211033715
4. AVILA-PIRES, F. A note on the discovery of Chagas' disease. Memórias do Instituto Oswaldo Cruz, v. 117, p. e210372, 2022. DOI: https://doi.org/10.1590/0074-02760210372chgsb
5. BEATTY, N. L. et al. Oral Chagas disease in Colombia—confirmed and suspected routes of transmission. Tropical Medicine and Infectious Disease, v. 9, n. 1, p. 14, 2024. DOI: https://doi.org/10.3390/tropicalmed9010014
6. BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde. Panorama da doença de Chagas no Brasil. Boletim Epidemiológico, v. 50, n. 36, 2019.
7. BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Boletim Epidemiológico: Doença de Chagas: panorama da transmissão e desafios da vigilância no Brasil. Brasília, DF: Ministério da Saúde, 2024.
8. BRENIÈRE, S. et al. Over six thousand Trypanosoma cruzi strains classified into discrete typing units (DTUs): attempt at an inventory. PLOS Neglected Tropical Diseases, v. 10, n. 8, p. e0004792, 2016. DOI: https://doi.org/10.1371/journal.pntd.0004792
9. BRUNETO, E. et al. Case-fatality from orally-transmitted acute Chagas disease: a systematic review and meta-analysis. Clinical Infectious Diseases, v. 72, n. 6, p. 1084–1092, 2021. DOI: https://doi.org/10.1093/cid/ciaa1148
10. BUSSELMAN, R.; HAMER, S. Chagas disease ecology in the United States: recent advances in understanding Trypanosoma cruzi transmission among triatomines, wildlife, and domestic animals and a quantitative synthesis of vector-host interactions. Annual Review of Animal Biosciences, v. 10, p. 325–348, 2022. DOI: https://doi.org/10.1146/annurev-animal-013120-043949
11. CHANCEY, R. et al. Congenital Chagas disease. Pediatrics in Review, v. 44, n. 4, p. 213–221, 2023. DOI: https://doi.org/10.1542/pir.2022-005857
12. CLARK, E.; BERN, C. Chagas disease in the immunocompromised host. Current Opinion in Infectious Diseases, v. 37, n. 5, p. 333–341, 2024. DOI: https://doi.org/10.1097/QCO.0000000000001035
13. DE SOUSA PEREIRA, H. et al. Chagas disease in urban and peri-urban environment in the Amazon: sentinel hosts, vectors, and the environment. Acta Tropica, v. 217, p. 105858, 2021. DOI: https://doi.org/10.1016/j.actatropica.2021.105858
14. ECHAVARRÍA, N. et al. Chagas disease: chronic Chagas cardiomyopathy. Current Problems in Cardiology, v. 46, n. 3, p. 100507, 2021. DOI: https://doi.org/10.1016/j.cpcardiol.2019.100507
15. FRANCO-PAREDES, C. et al. A deadly feast: elucidating the burden of orally acquired acute Chagas disease in Latin America – public health and travel medicine importance. Travel Medicine and Infectious Disease, v. 36, p. 101565, 2020. DOI: https://doi.org/10.1016/j.tmaid.2020.101565
16. GIANCOLA, M. et al. Chagas disease in the non-endemic area of Rome, Italy: ten years of experience and a brief overview. Infectious Disease Reports, v. 16, n. 4, p. 650–663, 2024. DOI: https://doi.org/10.3390/idr16040050
17. HARADA, Y. et al. The current status of neglected tropical diseases in Japan: a scoping review. PLOS Neglected Tropical Diseases, v. 18, n. 1, p. e0011854, 2024. DOI: https://doi.org/10.1371/journal.pntd.0011854
18. HOCHBERG, N.; MONTGOMERY, S. Chagas disease. Annals of Internal Medicine, v. 176, n. 2, p. ITC17–ITC32, 2023. DOI: https://doi.org/10.7326/AITC202302210
19. HUDSON, F. et al. Acute Chagas disease manifesting as orbital cellulitis. Emerging Infectious Diseases, v. 27, n. 11, p. 2937–2939, 2021. DOI: https://doi.org/10.3201/eid2711.203698
20. IGLESIAS RODRÍGUEZ, I. et al. Analysis of the Chagas disease situation in Japan: a cross-sectional study and cost-effectiveness analysis of a Chagas disease screening program. The Lancet Regional Health – Western Pacific, v. 31, p. 100574, 2023. DOI: https://doi.org/10.1016/j.lanwpc.2022.100574
21. JUSTIZ VAILLANT, A. et al. Transfusion transmitted disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2025.
22. KLOTZ, S. et al. Kissing bug intrusions into homes in the southwest United States. Insects, v. 12, n. 7, p. 654, 2021. DOI: https://doi.org/10.3390/insects12070654
23. LASCANO, F. et al. Review of pharmacological options for the treatment of Chagas disease. British Journal of Clinical Pharmacology, v. 88, n. 2, p. 383–402, 2021. DOI: https://doi.org/10.1111/bcp.14700
24. LOPEZ-ALBIZU, C. et al. Laboratory diagnosis of Trypanosoma cruzi infection: a narrative review. Frontiers in Parasitology, v. 2, p. 1138375, 2023. DOI: https://doi.org/10.3389/fpara.2023.1138375
25. MAGALHÃES, L. et al. Pathogen diversity, immunity, and the fate of infections: lessons learned from Trypanosoma cruzi human–host interactions. The Lancet Microbe, v. 3, n. 9, p. e711–e722, 2022. DOI: https://doi.org/10.1016/S2666-5247(21)00265-2
26. MEDEIROS, C. et al. Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil. Revista do Instituto de Medicina Tropical de São Paulo, v. 64, p. e5, 2022. DOI: https://doi.org/10.1590/s1678-9946202264005
27. MILLS, R. M. Chagas disease: epidemiology and barriers to treatment. The American Journal of Medicine, v. 133, n. 11, p. 1262–1265, 2020. DOI: https://doi.org/10.1016/j.amjmed.2020.05.022
28. NUNES DA COSTA, E. A. P.; VICTÓRIA, C.; FORTALEZA, C. M. C. B. Predictors of development of cardiac and digestive disorders among patients with indeterminate chronic Chagas disease. PLOS Neglected Tropical Diseases, v. 15, n. 8, p. e0009680, 2021. DOI: https://doi.org/10.1371/journal.pntd.0009680
29. PÉREZ-MAZLIAH, D. et al. Host-parasite dynamics in Chagas disease from systemic to hyper-local scales. Parasite Immunology, v. 43, n. 2, p. e12786, 2021. DOI: https://doi.org/10.1111/pim.12786
30. RAVAZI, A. et al. Climate and environmental changes and their potential effects on the dynamics of Chagas disease: hybridization in Rhodniini (Hemiptera, Triatominae). Insects, v. 14, n. 4, p. 378, 2023. DOI: https://doi.org/10.3390/insects14040378
31. REYES, C. et al. Chagas disease in northern Chile: detection of Trypanosoma cruzi in children, dogs and triatomine bugs. Acta Tropica, v. 235, p. 106631, 2022. DOI: https://doi.org/10.1016/j.actatropica.2022.106631
32. RIBEIRO, L. et al. The burden of Chagas disease in the contemporary world: the RAISE study. Global Heart, v. 19, n. 1, 2024. DOI: https://doi.org/10.5334/gh.1280
33. ROCA, C. et al. IgG subclasses and congenital transmission of Chagas disease. The American Journal of Tropical Medicine and Hygiene, v. 105, n. 5, p. 1187–1192, 2021. DOI: https://doi.org/10.4269/ajtmh.20-1524
34. ROBERTSON, L. et al. The importance of estimating the burden of disease from foodborne transmission of Trypanosoma cruzi. PLOS Neglected Tropical Diseases, v. 18, n. 2, p. e0011898, 2024. DOI: https://doi.org/10.1371/journal.pntd.0011898
35. SILVEIRA, A.; DIAS, J. O controle da transmissão vetorial. Revista da Sociedade Brasileira de Medicina Tropical, v. 44, n. 2, p. 52–63, 2011. DOI: https://doi.org/10.1590/S0037-86822011000800009
36. SOUSA, A. et al. Chagas disease. The Lancet, v. 403, n. 10422, p. 203–218, 2024. DOI: https://doi.org/10.1016/S0140-6736(23)01787-7
37. SMITH-DORIA, S. et al. Chronic Chagas disease in the Brazilian Amazon: serological survey, clinical follow-up, and associated risk factors. The American Journal of Tropical Medicine and Hygiene, v. 112, n. 6, p. 1220–1228, 2025. DOI: https://doi.org/10.4269/ajtmh.24-0549
38. SUÁREZ, C. et al. Diagnosis and clinical management of Chagas disease: an increasing challenge in non-endemic areas. Research and Reports in Tropical Medicine, v. 13, p. 25–40, 2022. DOI: https://doi.org/10.2147/RRTM.S278135
39. WORLD HEALTH ORGANIZATION (WHO). Chagas disease in Latin America: an epidemiological update based on 2010 estimates. Weekly Epidemiological Record, v. 90, n. 6, p. 33–43, 2015.
40. WORLD HEALTH ORGANIZATION (WHO). Chagas disease (also known as American trypanosomiasis): fact sheet. Geneva: WHO, 2025. Disponível em: https://www.who.int Acesso em: 19 jan. 2026.
41. WINTERS, R. et al. Chagas disease (American trypanosomiasis). Atualizado em: 27 mar. 2025. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2025. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK459272/ Acesso em: 19 jan. 2026.
