see also: [[Trypanosomiasis]] > - major public health concern in Latin and South America > - Chagas disease is caused by the flagellate protozoan *Trypanosoma cruzi*. It is spread to humans and other mammals by the faeces of insects of the Triatominae subfamily (‘kissing bugs’). Additionally, it can be spread vertically or by the administration of blood products. > - Prevention focuses on vector control, including the improvement of housing conditions and the use of insecticides and mosquito nets. > - Blood products and organ donors in the Americas are screened for T. cruzi. - acute phase of the infection causes no or non-specific flu-like symptoms, but it can be fatal in children. - Swelling around the site of inoculation in the face or around the eye (*Romaña sign*) is well described. The infection becomes asymptomatic within approximately 2 months. - In the chronic phase, the parasites invade the myocardium and intestinal smooth muscle. The development of **cardiomyopathy** leads to congestive heart failure and arrhythmias and is fatal in 30% of patients. Dilation of the oesophagus and colon (10%) and neurological involvement may also occur. **diagnosis:** - direct visualization of the parasites in blood smears or by serological testing. **treatment:** - Benznidazole and nifurtimox are effective treatments if given soon after the infection occurs. - Treatment for chronic infections is difficult and side effects are common. - Supportive treatment for cardiac and gastrointestinal complications is important.