[Trypanosoma cruzi in French Guinea: review of accumulated data since 1940].

Between 1939 and 1994, nine cases of Chagas disease have been reported in French Guiana: seven in the acute phase including two that were fatal and two in the chronic phase with cardiac sequellae. A tenth case of transient parasitemia was described but the patient's clinical status was not mentioned. Screening by xenodiagnosis revealed one subclinical infection. Heart disease is a highly specific manifestation of Trypanosoma cruzi infection, this being consistent with the known presence of zymodeme 1 in the sylvatic reservoir and reduviid vectors. The low incidence of positive serology (0.7% in a group of 740 subjects in whom serum samples were tested by indirect immunofluorescence) indicates that the disease is not currently becoming endemic. The main animal reservoirs for infection are small land marsupials (Didelphis marsupialis being the most frequently infected) and edentata especially armadillos (Dasypus novemcinctus). A peridomestic cycle, implicating D. marsupialis and Philander oppossum, plant-eating marsupials, with Rhodnius pictipes as the vector is highly active. Further study is necessary to ascertain another mechanism involving R. prolixus as a vector in dwellings in urban areas. Outbreaks require careful epidemiologic surveillance. French Guiana should no longer be considered as an enzootic area but as an area of risk for sporadic Chagas disease with epidemiologic features similar to those of the disease in dense Amazon forest areas. Appropriate measures must be taken to screen and promptly manage Chagas disease in the population. Special care is needed for concurrent HIV-T. cruzi infection due to the severity of this combination. Preventive measures are also needed to preclude transfusional infection.