El mundo celebra este 14 de abril, el Día Mundial de la Enfermedad de Chagas. Uno de los objetivos de la celebración es dar visibilidad a las personas que tienen la enfermedad de Chagas y sensibilizar a la sociedad sobre esa enfermedad y los recursos necesarios para prevenirla, controlarla o eliminarla.
La enfermedad lleva el nombre de Carlos Ribeiro Justiniano Chagas, médico e investigador brasileño que la descubrió en 1909. En mayo de 2019, en cumplimiento de la decisión de la 72.ª Asamblea Mundial de la Salud, se estableció el Día Mundial de la Enfermedad de Chagas para su celebración el 14 de abril (día de 1909 en que Carlos Chagas diagnosticó el primer caso humano de la enfermedad, una niña de dos años llamada Berenice).
La enfermedad de Chagas, también llamada tripanosomiasis americana, es una enfermedad potencialmente mortal causada por el parásito protozoo Trypanosoma cruzi (T. cruzi). Es una afección parasitaria, sistémica, crónica, transmitida por vectores, con una firme vinculación con aspectos socio-económico-culturales deficitarios, considerándola una «enfermedad silenciosa y silenciada», no solo por su lenta evolución clínica, frecuentemente asintomática, sino también porque afecta principalmente a poblaciones pobres sin peso político ni acceso a atención de salud.
Se calcula que en el mundo hay entre 6 y 7 millones de personas infectadas por Trypanosoma cruzi, el parásito causante de la enfermedad de Chagas. La enfermedad de Chagas se encuentra sobre todo en zonas endémicas de 21 países de América Latina, aunque las migraciones de personas infectadas pueden llevarla a países no endémicos de América y el Mundo.
El principal mecanismo de transmisión es vectorial, por hemípteros (chinches), de la Subfamilia Triatominae (con alimentación hematófaga). Infectan personas expuestas a su picadura, al depositar sus heces infectadas en heridas de la piel o sobre mucosas. Otras modalidades de transmisión son transfusional, congénita, trasplantes de órganos u oral.
Se estima que en la Región, cerca de 100 millones de personas están en riesgo de infectarse, unos 6 millones infectadas, con 30.000 nuevos casos anuales por todas las formas de transmisión, motivando 12.000 muertes anuales.
Sin tratamiento, la enfermedad de Chagas puede provocar alteraciones cardíacas y digestivas y ser mortal.
Signos y síntomas
La enfermedad de Chagas tiene dos fases. Inicialmente, la fase aguda dura unos dos meses después de contraerse la infección. Durante esa fase aguda circulan por el torrente sanguíneo una gran cantidad de parásitos, pero en la mayoría de los casos no hay síntomas o estos son leves y no específicos. En menos del 50% de las personas picadas por un triatomino, un signo inicial característico puede ser una lesión cutánea o una hinchazón amoratada de un párpado. Además, esas personas pueden presentar fiebre, dolor de cabeza, agrandamiento de ganglios linfáticos, palidez, dolores musculares, dificultad para respirar, hinchazón y dolor abdominal o torácico.
Durante la fase crónica, los parásitos permanecen ocultos principalmente en el músculo cardíaco y digestivo. Hasta un 30% de los pacientes sufren trastornos cardíacos y hasta un 10% presentan alteraciones digestivas (típicamente, agrandamiento del esófago o del colon), neurológicas o mixtas. Con el paso de los años, la infección puede causar muerte súbita por arritmias cardíacas o insuficiencia cardíaca progresiva como consecuencia de la destrucción del músculo cardíaco y sus inervaciones.
Tratamiento
La enfermedad de Chagas puede tratarse con benznidazol, y también con nifurtimox, que matan al parásito. Ambos medicamentos son eficaces casi al 100% para curar la enfermedad si se administran al comienzo de la infección en la etapa aguda, incluso en los casos de transmisión congénita. Sin embargo, su eficacia disminuye a medida que transcurre el tiempo de la infección, y las reacciones adversas son más frecuentes en edades avanzadas.
El benznidazol y el nifurtimox no deben administrarse a las embarazadas ni a las personas con insuficiencia renal o hepática. El nifurtimox también está contraindicado en personas con antecedentes de trastornos neurológicos o psiquiátricos.
Control y prevención
Los objetivos de control consisten en eliminar la transmisión y lograr que la población infectada y enferma tenga acceso temprano a la asistencia sanitaria.
No hay vacuna contra la enfermedad de Chagas. El control vectorial ha sido el método más útil para prevenir la enfermedad de Chagas en América Latina. El cribado de la sangre es necesario para prevenir la infección por transfusiones sanguíneas y el trasplante de órganos y para aumentar la detección y el cuidado de la población afectada.
Según la zona geográfica, la OMS recomienda los siguientes métodos de prevención y control:
- rociamiento de las casas y sus alrededores con insecticidas de acción residual;
- mejora de las viviendas y su limpieza para prevenir la infestación por el vector;
- medidas preventivas personales, como el empleo de mosquiteros;
- buenas prácticas higiénicas en la preparación, el transporte, el almacenamiento y el consumo de los alimentos;
- cribado de la sangre donada;
- pruebas de cribado en órganos, tejidos o células donados y en los receptores de estos;
- acceso al diagnóstico y el tratamiento para las personas en las que esté indicado o recomendado el tratamiento antiparasitario, especialmente los niños y las mujeres en edad fecunda antes del embarazo; y
- cribado de los recién nacidos y otros hijos de madres infectadas que no hayan recibido antes tratamiento antiparasitario para diagnosticarlos y tratarlos precozmente.
Se ha calculado que el costo de atender médicamente a pacientes con formas cardíacas, digestivas, neurológicas o mixtas crónicas de la enfermedad es más de un 80% superior al costo de fumigar con insecticida residual para controlar los vectores y prevenir la infección.
Datos clave
- El Chagas es casi 100% curable si se trata en sus etapas iniciales con los medicamentos: Benznidazol y Nifurtimox.
- La enfermedad de Chagas es endémica en 21 países de las Américas y afecta a un estimado de 6 millones de personas.
- En las Américas, se registran 30.000 nuevos casos cada año, 12.000 muertes en promedio y 8.000 recién nacidos se infectan durante la gestación.
Actualmente, unos 70 millones de personas en las Américas viven en áreas expuestas al Chagas y están en riesgo de contraer la enfermedad.
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