Develoux M, Lescure F-X, Le Loup G, Pialoux G
Service de parasitologie, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France.
Rev Med Interne. 2009 Aug;30(8):686-95. doi: 10.1016/j.revmed.2008.11.010. Epub 2009 Feb 6.
Chagas disease (human American trypanosomiasis) is a zoonose caused by the protozoan Trypanosoma cruzi. Vectors are Triatoma spp. insects. T. cruzi can also be transmitted by blood transfusion, organ transplantation, and transplacentally. Infection is generally acquired during infancy. The acute infection is rarely symptomatic and is followed by a chronic phase. Chronic infected people are asymptomatic (indeterminate stage) and may remain at this stage for the rest of their lives. About a third of infected people will develop a chronic Chagas disease which affects the heart and the digestive tract. Morbidity and mortality of chronic Chagas cardiomyopathy (CCC) are high. Specific treatment of asymptomatic infected individual could reduce the risk of progression to CCC. With control initiatives case incidence declined in most endemic countries. American trypanosomiasis has become an emerging imported disease in North America and Europe because of the migration of population originating from endemic zones. They are only two available drugs for specific treatment of Chagas disease: benznidazole and nifurtimox. Both have frequent side effects and variable efficacy according the phase of the disease. There is an urgent need for new treatments and better serological tests. Policies must be developed to avoid the risk of transmission trough blood transfusion and transplantation in developed countries.
恰加斯病（美洲锥虫病）是一种由原生动物克氏锥虫引起的人畜共患病。传播媒介为锥蝽属昆虫。克氏锥虫也可通过输血、器官移植和母婴传播。感染通常在婴儿期获得。急性感染很少有症状，随后进入慢性期。慢性感染者无症状（不确定阶段），可能终生处于此阶段。约三分之一的感染者会发展为影响心脏和消化道的慢性恰加斯病。慢性恰加斯心肌病（CCC）的发病率和死亡率很高。对无症状感染者进行特异性治疗可降低发展为CCC的风险。随着防控措施的实施，大多数流行国家的病例发病率有所下降。由于来自流行区的人口迁移，美洲锥虫病在北美和欧洲已成为一种新出现的输入性疾病。目前仅有两种药物可用于恰加斯病的特异性治疗：苯硝唑和硝呋莫司。两者都有常见的副作用，且疗效因疾病阶段而异。迫切需要新的治疗方法和更好的血清学检测方法。必须制定政策以避免在发达国家通过输血和移植传播的风险。
