Epidemiology of Chagas disease in Ecuador. A brief review

Chagas disease is a complex public health problem that has been underestima ted in Ecuador. Here we review the relevant published information, and pres ent unpublished and new data that help to understand the current Chagas dis ease epidemiological situation and its evolution in the country. Three main characteristics have been identified: (i) persistence of Trypanosoma cruzi transmission in already known foci, (ii) a marked endemicity in some urban areas of Guayaquil, and (iii) the transformation of new Amazon foci into t ruly endemic areas. The situation in other suspect nr eas remains uncertain . Five Triatominae species have been implicated in the transmission of T. c ruzi to people in Ecuador (Triatoma dimidiata, Rhodnius ecuadoriensis, R. p ictipes, R. robustus and Panstrongylus geniculatus), but some others may al so play a role in some areas (P. rufotuberculatus, P. howardi, T. carrioni and P. chinai). Other Triatominae reported seem to have little or no epidem iological relevance (T. venosa, T. dispar, Eratyrus mucronatus, E. cuspidat us, P. lignarius and Cavernicola pilosa). High frequency of acute cases and severe chronic disease has been observed Although cardiomyopathy is more f requent, serious digestive disease is also present. It is estimated that ar ound 120,000-200,000 people may be infected. 2.2 to 3.8 million people are estimated to live under transmission risk conditions.