Chronic Chagas' Disease

After a period of many years or decades, and probably after repeated infections with the trypanosomes, the systemic changes of the chronic stage may develop. These occur commonly in the esophagus, rectosigmoid colon and heart, and less often in the central nervous system (CNS). CNS involvement may be the late result of the acute phase or due to reactivation (eg, in the immunosuppressed).

Gastrointestinal Tract

Brasil suggested that the name "aperistalsis" be applied to chronic Chagas' disease to denote the pathophysiologic disturbances of motor incoordination and defective esophageal and colonic motility, together with disturbed or absent peristalsis without propulsive efficiency. Koberle and others demonstrated that the quantitative and qualitative reduction in the number of ganglia throughout the entire gastrointestinal tract, especially in the colon and esophagus, causes aperistalsis and atony, which in turn result in dilatation of these hollow viscera. The complement fixation and hemagglutination tests are positive in 95% and the immunofluorescence test is 100% positive in this group. The age range is from 2 to 75 years with an average of 33 years. Although there is deficiency of ganglion cells throughout the gastrointestinal tract in chronic Chagas' disease, radiographically and clinically the esophagus and rectosigmoid colon show by far the greatest distention, probably because they are subjected to greater mechanical pressure. The gallbladder, bronchi, ureters, and bladder may rarely be dilated.