CHAGAS-DISEASE

Control programs to interrupt the transmission of Trypanosoma cruzi to humans still cover few endemic areas, and therefore Chagas' disease continues to be a public health problem. Immigrants with chronic Chagas' disease are detected in increasing numbers in the United States. The specificity and sensitivity of diagnostic tests have been improved greatly through the use of both the polymerase chain reaction and native and recombinant antigens, as well as the synthetic peptides derived from them. The role of different lymphocyte subpopulations and the possible participation of autoimmune mechanisms in the pathogenesis of the disease continue to be intensively investigated. The clinical denervation syndrome observed in Chagas' disease can be assessed by tests of heart rate variability. New experimental and clinical evidence supports the presence of abnormalities in the coronary microcirculation leading to myocardial hypoperfusion. Reactivation of the disease by cancer chemotherapy and in patients with AIDS poses new clinical challenges. Finally, antiarrhythmic drugs, ablation, and recent advances in the treatment of heart failure are under evaluation.