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  • Review Article
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Cardiac involvement in Chagas disease and African trypanosomiasis

Nature Reviews Cardiology volume 21, pages 865–879 (2024)Cite this article

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Abstract

Trypanosomiases are diseases caused by various species of protozoan parasite in the genus Trypanosoma, each presenting with distinct clinical manifestations and prognoses. Infections can affect multiple organs, with Trypanosoma cruzi predominantly affecting the heart and digestive system, leading to American trypanosomiasis or Chagas disease, and Trypanosoma brucei primarily causing a disease of the central nervous system known as human African trypanosomiasis or sleeping sickness. In this Review, we discuss the effects of these infections on the heart, with particular emphasis on Chagas disease, which continues to be a leading cause of cardiomyopathy in Latin America. The epidemiology of Chagas disease has changed substantially since 1990 owing to the emigration of over 30 million Latin American citizens, primarily to Europe and the USA. This movement of people has led to the global dissemination of individuals infected with T. cruzi. Therefore, cardiologists worldwide must familiarize themselves with Chagas disease and the severe, chronic manifestation — Chagas cardiomyopathy — because of the expanded prevalence of this disease beyond traditional endemic regions.

Key points

  • American trypanosomiasis, also known as Chagas disease (ChD), and human African trypanosomiasis (HAT), also known as sleeping sickness, are distinct diseases caused by different species of parasitic trypanosomes and with unique clinical manifestations.

  • The clinical presentation of ChD depends on the severity of organ involvement, particularly the heart, whereas the presentation of HAT varies according to the subspecies of parasite and disease stage.

  • In ChD, trypanosomes invade myocardial cells, resulting in progression to Chagas cardiomyopathy (CCM); in HAT, trypanosomes do not invade myocardial cells.

  • The pathogenesis of CCM is influenced by parasite persistence, triggering dysregulation of the immune response.

  • ChD can be diagnosed by serological tests; CCM is recognized by clinical presentation or the appearance of typical electrocardiographic changes.

  • Antitrypanosomal medications are more effective for HAT than for ChD or CCM, for which therapeutic options are limited, highlighting a crucial need for novel therapies.

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Fig. 1: The natural history of Chagas disease and Chagas cardiomyopathy.
Fig. 2: The proposed pathogenesis of Chagas cardiomyopathy.
Fig. 3: Classification of chronic Chagas disease.

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Acknowledgements

The authors are funded by NIAID TMRC-grant number U01 AI168383/AI. E.C.S., M.C.P.N. and A.L.P.R. are recipients of National Council for Scientific and Technological Development (CNPq) scholarship. A.L.P.R. is supported in part by FAPEMIG (Minas Gerais State Foundation for Research Support), CIIA-S (Innovation Center on Artificial Intelligence for Health) and IATS (National Institute of Science and Technology for Health Technology Assessment).

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Authors and Affiliations

  1. Department of Pathology, Instituto de Medicina Tropical da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil

    Ester Cerdeira Sabino

  2. Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    Maria Carmo P. Nunes & Antonio Luiz P. Ribeiro

  3. Swiss Tropical and Public Health Institute, Allschwil, Switzerland

    Johannes Blum

  4. University of Basel, Basel, Switzerland

    Johannes Blum

  5. International Health Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain

    Israel Molina

  6. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain

    Israel Molina

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Sabino, E.C., Nunes, M.C.P., Blum, J. et al. Cardiac involvement in Chagas disease and African trypanosomiasis. Nat Rev Cardiol 21, 865–879 (2024). https://doi.org/10.1038/s41569-024-01057-3

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