Acute Chagas' disease in western Venezuela: A clinical, seroparasitologic,and epidemiologic study

A clinical, parasitologic, and serologic study carried out between 1988 and 1996 on 59 acute-phase patients in areas of western Venezuela where Chagas ' disease is endemic showed 19 symptomatic patterns or groups of symptoms a ppearing in combination with different frequencies. The symptomatic pattern with the highest frequency was that showing simultaneously fever, myalgia, headache, and Romana's sign, which was detected in 20% of the acute-phase patients. Asymptomatic individuals and patients with fever as the only sign of the disease made up 15% and 11.9% of the total acute cases, respectivel y. Statistical correlation analysis revealed that xenodiagnosis and hemocul ture were the most reliable and concordant of the five parasitologic method s used; these two methods also showed the highest proportions in detecting any clinical symptomatic pattern in acute-phase patients. A similar high re liability and concordance was obtained with a direct agglutination test, an indirect immunofluorescent antibody test, and an ELISA as serologic tests, which also showed a higher proportion of positive detection of clinical pa tterns than parasitologic methods (P < 0.001). It is recommended that indiv iduals coming from endemic areas showing mild and/or severe clinical manife stations should be suspected of being in contact or having been in contact with Trypanosoma cruzi, be referred for parasitologic and serologic evaluat ions to confirm the presumptive clinical diagnosis of acute Chagas' disease , and start specific treatment. The epidemiologic implications of the prese nt findings are discussed and the use of similar methodology to evaluate ot her areas where Chagas' disease is endemic is suggested.