In 2019, the 72nd World Health Assembly established April 14 as World Chagas Disease Day.
The title of this column is justified because this terrible disease is part of the group of so-called neglected diseases, along with malaria, leishmaniasis, dengue, leprosy, tuberculosis, typhoid, cholera, leptospirosis and infectious diarrhea. About three thousand people die every day in the world, victims of these problems, which belong to this sad category because they affect mostly the poorest populations, where precarious housing, poor hygiene conditions and little access to health care predominate.
Chagas disease, for example, is classified by the WHO (World Health Organization) as endemic in 21 countries on the American continent and it is estimated that more than 70% of those infected are unaware of having the problem, due to lack of opportunity for diagnosis. Due to globalization, it has become a disease also present in Europe, Asia and the USA. In the US, it is estimated that there are about 100,000 immigrants infected with the disease in the US.
According to the WHO, Chagas has appeared in developed countries because blood banks are not prepared to detect the disease in material used for transfusion and organ donation.
According to the WHO, the disease affects 9 million people worldwide and is already considered a global problem. The number of registered cases was higher in 1990, when it reached 18 million. The reduction was the result of efforts undertaken by several countries, which shows that it is indeed possible to control and eradicate the problem.
Chagas is considered one of the diseases with the greatest global impact, with an estimated incidence of 30,000 new cases per year, 14,000 deaths and 8,000 newborns infected during pregnancy.
In Brazil, it is estimated that there are more than 1 million people infected – about only 200 per year have the diagnosis. This is because the most affected population has little access to medical care and also because the symptoms considered to be of the acute phase are quite nonspecific, such as headache and fever, which is very regrettable, since the chance of cure in this phase is of 100%. Hence the importance of epidemiological data such as the patient’s origin from an endemic area and contact with the transmitting insect, the barber.
From there, the chronic phase sets in, which can take years to manifest, but is characterized by complications, especially in the heart and/or intestines, where healing is no longer possible.
According to some estimates, about 6,000 people die annually in Brazil due to the chronic complications of the disease. In our country, the state of Pará is responsible for 81% of cases resulting from oral transmission in the North region, with higher proportions of cases occurring after the açaí and bacaba harvest (a fruit rich in oil, with moisturizing and emollient properties), due to the consumption of foods derived from these fruits contaminated by the feces of the insect.
The disease was baptized with that name when it was discovered in 1909 by the Brazilian public health specialist Carlos Ribeiro Justiniano das Chagas (born in the Minas Gerais municipality of Oliveira, in 1879) who, at the time, was fighting malaria in the interior of his state. Fiocruz and the municipal government of Lassance (the discovery city of Minas Gerais) recently reopened the Carlos Chagas Memorial.
By an unfortunate coincidence, if we look up the meaning of the word “Chaga” in the dictionary, we will find it as a feminine noun with open lesions on the body, usually caused by wound; wound that festers. Word described numerous times by the Holy Bible as a sign of Jesus’ physical suffering.
Even without the open wound, in the case of the disease that bears this name, it is always related to the enormous suffering of the bearer.
The cause of the disease is the protozoan Trypanosoma cruzi –named after Carlos Chagas to honor the scientist Oswaldo Cruz–, who uses the insect known as the barber as a host.
Where does the disease come from? How do people get infected?
Since its discovery, the disease has been linked to poverty, mainly due to the fact that the transmitting insect is more present in more precarious homes, made of wattle and daub. Also straw, used as raw material in precarious housing in rural areas and in food baskets, creates an environment conducive to the proliferation of the barber, the transmitter of Chagas disease.
There are several ways of transmitting the disease. The so-called vector transmission, through the bite and defecation on the wound of the barber bug, infected with the trypanosoma crossed. Either the contamination occurs through the ingestion of food contaminated with the protozoan or through the pregnant woman to the fetus or through breast milk (at any stage of the disease). It is estimated that more than one million women of childbearing age may be infected in endemic regions without knowing it, at the risk of transmitting the infection to their newborns. Transmission by contaminated blood transfusion or laboratory accidents is still possible.
Given the current conditions of humanity with wars, pandemics and the prevalence of lack of love, producing more and more scourges and scourges, the WHO estimates that there are 75 million people in the world at risk of contracting the disease today.
The pride of having been discovered by a Brazilian is greatly overshadowed by the fact that our country is the one with the highest concentration of cases of the disease in the world. Neglected diseases, which always come from poverty and neglect, should affect us all because, as Martin Luther King said:
“As long as there is poverty in the world, no man can be totally rich even if he has a billion dollars. All life is interconnected, we are caught in an inevitable web of reciprocity, strung together in a single thread.fate, which directly affects one, indirectly affects all”.