In our country, Chagas Disease vectorial transmisión (insects) has been extensively studied. However, oral transmission has been described since 1921. Tripanosoma cruzi can resist gastric pH, penetrate the mucosae and induce immune response.
On December 2007, we had an acute outbreak of Acute Chagas Disease, transmitted by oral route. 250 persons were affected in Caracas, 11 hospitalized in our Department of Pediatrics: 73% males, 27% females. The more evident symptoms were: fever 9/11pts (81%), bipalpebral edema 6/11pts (54%), chest pain 5/11pts(45%), effort dysnea 1/11pts(9%). 90% of the patients had clinical cardiovascular evaluation, echocardiogram and Holter ECG. Acute Myocarditis was evident in 1/11(9%), pericardial effusion 9/11(18%), supraventricular arrhythmias 5/11(45%).
Diagnosis was made by a positive ELISA test in 81% of patients, and in 18% by parasitologic tests. Acute Phase Reactants, CK, CKMB and transaminases determination were made on admisión and as follow-up. Patients were dismissed only after normalization of C- Reactive protein of their erithrocyte sedimentation rate.
45% of the patients were treated with nifurtimox, 54% with beznidazole. Secondary effects detected: epigastralgia 3/11(27%), maculo-papular rash 2/11(18%), visual allucinations 1/11(9%), thrombocytopenia 1/11(9%).
Acute Chagas Disease by oral transmisión is a reality. It has been proved by experimental, clinical and epidemiological data. Its true incidence is probably underestimated, specially in urban population. It is important to inform properly to the Medical Community and all the population about this transmission mechanism. Appropiate strategies about food manipulation, Access to specific treatment and promote research programs are necessary.