Reactivation of Chagas-Mazza disease during treatment with infliximab

Chagas-Mazza disease is a zoonosis caused by Trypanosoma cruzi, a species of parasitic euglenoid protozoan.It affects 21 countries in the Americas, where 7 to 10 million people are infected, 8 out of 100,000 individuals/year, and it has a mortality rate of 12,000 individuals/year.The main routes of transmission are exposure to vectors (Triatoma infestans), transfusion (second in frequency), placental and oral transmission.Given increasing migration and organ and blood product donations, this disease has become global, affecting Europe and North America. 1Chagas disease presents three well -defined clinical phases.The acute phase develops after an incubation phase that lasts from 4 to 10 days.The acute stage can be asymptomatic or present with fever, macular or inflammatory lesions in the inoculation site (chagoma), edema, palpebral unilateral induration (Romaña's sign) or myocarditis.Of all infected people, only 1 to 2 % is diagnosed during this phase.The indeterminate chronic phase is characterized by the absence of symptoms and by standard laboratory test findings.Thirty percent of patients can remain in this phase during their entire life, while the remaining 70% evolve into the chronic or symptomatic phase, with heart or esophagus involvement.Reactivation may occur in immunosuppressed patients, especially in those patients that present an alteration of cell mediated immunity.It can be asymptomatic or manifest with neurologic, cardiac or cutaneous changes. 2 PCR technique amplifies in vivo fragments of the parasite's DNA.In immunosuppressed patients, PCR test is useful for the diagnosis and control of the disease, given the fact that ELISA serology can be negative in some patients.It also allows to make early diag-