La malattia di Chagas detta anche Tripanosomiasi americana è una malattia infettiva causata da un parassita (Trypanosoma cruzi) di cui l’ospite intermedio è una cimice, il più spesso Pantrongylus megistus. La trasmissione avviene per puntura dell’insetto o per contatto della congiuntiva delle mucose o della pelle screpolata con le deiezioni dell’insetto; esistono forme congenite e forme acquisite per trasfusione di sangue  proveniente da donatori infetti, trapianto di organi o, più comunemente, per ingestione di cibo crudo o bevande contaminati.
EpidemiologiaÂ
La malattia di Chagas è una zoonosi diffusa in Messico e in tutti i paesi dell’America centrale e meridionale. Secondo le stime più recenti i pazienti con infezione cronica da Trypanosoma cruzi sono circa 8 milioni e la malattia provoca circa 14.000 morti ogni anno. Il serbatoio naturale selvatico del microrganismo è rappresentato da armadilli, procioni, opossum, ratti del legno. La trasmissione naturale avviene ad opera di cimici triatomine ematofaghe della famiglia Reduviidae. che eliminano i microorganismi con le feci durante il proprio pasto ematico. Penetrati attraverso le mucose (bocca, naso, occhi) o dalla minima lesione di continuo prodotta dal rostro dell’insetto, i tripomastigoti vengono captati dalle cellule macrofagiche perdenti il flagello e trasformandosi in amastigoti.
Sintomi della malattia di Chagas
La fase acuta, più frequente nei bambini, si presenta con sintomi aspecifici (febbre, anoressia, astenia, epatosplenomegalia, e con la comparsa di una lesione cutanea (chagoma) nel sito di inoculo del parassita entro una settimana dalla sua inoculazione. Nel caso in cui la porta d’ingresso sia la congiuntiva, si osserva edemapalpebrale e perioculare (segno di  Romaña) associato al linfoadenopatia.Dopo 1-2 settimane di incubazione, si ha la fase di invasione ematica con febbre ed eruzione orticarioide dopo 4 settimane. La tripanosomiasi può allora evolvere sia verso la forma acuta sia verso la forma cronica con localizzazioni diverse.Forma acuta
Si osserva soprattutto nel bambino; si manifesta con febbre, ascite, e epatosplenomegalia e talvolta linfoadenopatia generalizzata. La morte può avvenire per encefalomeningite o per miocardite acuta.
Cardiaca: aritmie, lesioni del sistema di conduzione atrioventricolare con blocco di branca destro o blocco atrioventricolare.
Mal de engasco: megaesofago e megacolon per lesioni dei plessi nervosi della muscolatura degli organi cavi.
Diagnosi
La diagnosi definitiva della malattia acuta richiede la dimostrazione diretta dei tripomastigoti su sangue. Più recentemente è stato proposto l’impiego di tecniche di biologia molecolare che sarebbero più sensibili. Nei nati da madri con infezione cronica è necessario effettuare alla nascita l’esame del sangue e, se negativo, vanno ricercati gli anticorpi specifici (IgG) a distanza di 6-9 mesi.
Microscopia ottica di strisci di sangue (goccia spessa o striscio sottile) o di tessuto (malattia acuta di Chagas)
Test sierologico di screening confermato da un secondo test
Test basati sulla reazione a catena della polimerasi.
Terapia
I farmaci disponibili non sono molto efficaci.
Gli unici farmaci efficaci sono: Benznidazolo, Nifurtimox, che richiedono un ciclo di terapia di 60 giorni (il primo) e di 90-120 giorni (il secondo). Entrambi sono gravati da importanti effetti collaterali.
ProfilassiÂ
Lotta contro i vettori, informazione della popolazione sulle modalità di trasmissione della malattia. Nelle zone endemiche ricerca dell’infezione nei donatori di sangue.
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