Chagas Global View

Impact

Approximately 8 million cases (1)
14,000 deaths (2)
667,000 DALYs (2) (3)
Chronic Chagas disease results in significant disability with great social and economic impact including unemployment and decreased earning ability. In Brazil alone, losses of over US$ 1.3 billion in wages and industrial productivity were due to workers with Chagas disease (4).

Geography

Endemic in 21 countries across Latin America, Chagas disease kills more people in the region each year than any other parasite-born disease, including malaria. Patient numbers are growing in non-endemic, developed countries (eg. Australia, Canada, Japan, Spain, and the United States), due to increased migration of Latin American immigrants unknowingly carrying the parasite in their blood.

Transmission

Caused by the kinetoplastid protozoan parasite Trypanosoma cruzi, Chagas disease is primarily transmitted by large, blood-sucking reduviid insects widely known as "the kissing bugs" in endemic countries. Other ways of transmission are blood transfusion, organ transplantation, as well as congenital and oral transmissions.

Symptoms

The disease has two clinical stages:
 Acute (in which 5% of children die)
- characterised by fever, malaise, facial oedema, generalised lymphadenopathy, and hepatosplenomegaly - often spontaneously resolves in four to six weeks
 Chronic disease has two phases:
- chronic asymptomatic "indeterminate" disease, during which patients can transmit the parasite to others while showing no signs of the disease, can last 10 years to life
- chronic symptomatic disease develops in 10% to 30% of infected patients and most often involves the heart or gastrointestinal tract.
Chagas disease is a leading cause of infectious cardiomyopathy worldwide.

Patient treatment needs

Improved treatment options are needed for all stages of Chagas infection:
 A paediatric strength which is affordable, age-adapted, safe, and efficacious would cure patients early on in the disease.
 A new drug for chronic disease that is safe, efficacious, and adapted to the field, and ideally would work in both stages of the disease.

Current Treatments

Current treatments can cure infected patients, but highest efficacy is seen early in infection

Current treatment options for patients with Chagas disease

Drugs

Associated problems

Nifurtimox & Benznidazole

- low effectiveness (10 - 20% of parasitological cure) in the chronic phase of the disease - limited effectiveness (60 - 80% of parasitological cure) in the acute phase of the disease - regional variations in efficacy due to naturally resistant T.cruzi strains - high number of side effect: digestive disturbances (epigastric and abdominal pain, nausea and vomiting, anorexia, weight loss) in the case of nifurtimox; and benznidazole can cause haematological disorders and hypersensitive dermatitis, often associated with lymphadenopathy - high rate of patient non-compliance due to drug side effects - long period of treatment (30-90 days), and dose-dependent toxicity - no paediatric strengths - contraindicated during pregnancy - need for monitoring under specialized medical supervision