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{{Chagas disease}}
{{Chagas disease}}
{{CMG}}; {{AE}} {{RT}}; {{YD}}


{{CMG}}; {{AE}} {{RT}}
==Overview==
On physical examination, Chagas disease may manifest with fever, tachycardia, cardiac rhythm abnormalities, hepatosplenomegaly, and lymphadenopathy. Romaña's sign, a classical sign of Chagas disease, is characterized by eyelid sweilling at the site of parasitic entry. Other signs on physical examination are usually due to either cardiac or GI manifestations of the disease.
 
==Physical Examination==
===Vital signs===
*[[Fever]]
*[[Tachycardia]]
*[[Bradycardia]]
*[[Tachypnea]]
*[[Irregular pulse]]
 
===Skin===
*Insect bite wound
*Excoriations due to scratching at site of insect bite


==Overview==
===HEENT===
The most recognized marker of acute Chagas disease is called Romaña's sign, which includes swelling of the eyelids on the side of the face near the bite wound or where the bug feces were deposited or accidentally rubbed into the eye.
*Romaña's sign (swelling of the eyelids at the site of parasitic entry)
==Clinical manifestations==
[[Image:Chagoma.jpg|thumb|This child from Panama is suffering from Chagas' disease manifested as an acute infection with swelling of the right eye (Romaña's sign). Source: CDC.]]
[[Image:Chagoma.jpg|thumb|left|This child from Panama is suffering from Chagas' disease manifested as an acute infection with swelling of the right eye (Romaña's sign). Source: CDC.]]
*[[Lower extremity edema]]
The human [[disease]] occurs in two stages: the acute stage shortly after the [[infection]], and the chronic stage that may develop over 10 years.


In the acute phase, a local skin nodule called a ''chagoma'' can appear at the site of [[inoculation]]. When the inoculation site is the [[conjunctiva]]l mucous membranes, the patient may develop unilateral [[periorbital edema]], [[conjunctivitis]], and preauricular lymphadenitis. This constellation of symptoms is referred to as Romaña's sign. The acute phase is usually [[asymptomatic]], but may present symptoms of [[fever]], [[anorexia (symptom)|anorexia]], [[lymphadenopathy]], mild [[hepatosplenomegaly]], and [[myocarditis]]. The most recognized marker of acute Chagas disease is called Romaña's sign, which includes swelling of the eyelids on the side of the face near the bite wound or where the bug feces were deposited or accidentally rubbed into the eye. Even if symptoms develop during the acute phase, they usually fade away on their own within a few weeks or months. Although the symptoms resolve, the infection, if untreated, persists. Rarely, young children (<5%) die from severe inflammation/infection of the heart muscle (myocarditis) or brain ([[meningoencephalitis]]).
===Neck===
*Cervical [[lymphadenopathy]]
*[[Jugular venous distention]]


Some acute cases (10 to 20%) resolve over a period of 2 to 3 months into an asymptomatic chronic stage (called “chronic indeterminate”) during which few or no parasites are found in the blood. During this time, most people are unaware of their infection. Many people may remain asymptomatic for life and never develop Chagas-related symptoms. However, an estimated 30% of infected people will develop debilitating and sometimes life-threatening medical problems over the course of their lives.
===Cardiac===
Positive cardiac findings are due to development of Chagas cardiomyopathy
*S3 or S4 heart sounds
*[[Displaced point of maximal impulse]] (PMI)


The symptomatic chronic stage may not occur for years or even decades after initial infection. The disease affects the [[nervous system]], [[digestive system]] and [[heart]]. Chronic infections result in various neurological disorders, including [[dementia]], damage to the heart muscle ([[cardiomyopathy]], the most serious manifestation), and sometimes dilation of the [[digestive tract]] ([[megacolon]] and [[megaesophagus]]), as well as [[weight loss]]. [[Swallowing]] difficulties may be the first symptom of digestive disturbances and may lead to [[malnutrition]]. After several years of an asymptomatic period, 27% of those infected develop cardiac damage, 6% develop digestive damage, and 3% present peripheral nervous involvement. Left untreated, Chagas' disease can be fatal, in most cases due to the [[cardiomyopathy]] component.
To view a comprehensive list of physical exam signs of congestive heart failure, click [[Congestive heart failure physical examination|'''here''']]


In people who have suppressed immune systems (for example, due to AIDS or chemotherapy), Chagas disease can reactivate with parasites found in the circulating blood. This occurrence can potentially cause severe disease.
===Abdomen===
*[[Hepatosplenomegaly]]
*[[Abdominal tenderness]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]
[[Category:Gastroenterology]]
[[Category:Cardiology]]

Latest revision as of 20:53, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Yazan Daaboul, M.D.

Overview

On physical examination, Chagas disease may manifest with fever, tachycardia, cardiac rhythm abnormalities, hepatosplenomegaly, and lymphadenopathy. Romaña's sign, a classical sign of Chagas disease, is characterized by eyelid sweilling at the site of parasitic entry. Other signs on physical examination are usually due to either cardiac or GI manifestations of the disease.

Physical Examination

Vital signs

Skin

  • Insect bite wound
  • Excoriations due to scratching at site of insect bite

HEENT

  • Romaña's sign (swelling of the eyelids at the site of parasitic entry)
This child from Panama is suffering from Chagas' disease manifested as an acute infection with swelling of the right eye (Romaña's sign). Source: CDC.

Neck

Cardiac

Positive cardiac findings are due to development of Chagas cardiomyopathy

To view a comprehensive list of physical exam signs of congestive heart failure, click here

Abdomen

References

Template:WH Template:WS