Chagas Disease in Argentina

Improving Information and Finding Cures

Chagas is an infectious disease caused by single-cell parasites, which are transmitted to humans via kissing bugs. Both adults and children can get infected but often show no symptoms for a long time. The lethal transmission of the infection from mothers to their unborn children can be described as largely unknown. Healthcare experts in Argentina explain this risk and prescribe the right cure for adults and children.

Dr. Jaime Altcheh, pediatric doctor and head of the department for parasitology and Chagas disease in his office at the Ricardo Gutierrez Pediatric Hospital in Buenos Aires, Argentina.

 

“We believe Chagas is a children’s disease,” Dr. Jaime Altcheh says, formulating an altogether radical theory about one of the greatest scourges afflicting Latin America. The pediatrician and head of the department for parasitology and Chagas disease is sitting in his office in the pediatric hospital Ricardo Gutierrez in Buenos Aires, Argentina. In fact the room is no larger than a tiny glass-walled cubicle, crammed with patients’ records, specialist literature and, of course, a computer, above which is hanging a slogan: “Anyone can change everything”.


Dr. Altcheh, a man in his mid-50s, would never utter such a revolutionary idea flippantly: After all, he has spent most of his professional life researching Chagas disease, which, according to the World Health Organization (WHO) estimates, poses a lethal threat to some six to seven million infected people[1] worldwide. But against this backdrop, his rationale is precise: “An infected adult is a child that went untreated. Most infections are caused in childhood.”

 

Dr. Ledesma Patiño has spent over 45 years combating Chagas disease but is still overwhelmed when talking about the tragic fortunes of those who are infected.

 

Dr. Ledesma Patiño, director of the regional Chagas center in Santiago del Estero, capital of the eponymous province since 2005, corroborates the views of his colleague Altcheh. This region, in the far north of Argentina, is one of the six provinces with the highest risk of infection by the disease.[2] “Children are the most threatened group in our population,” he declares, summing up his experience. “Our center has so far compiled 27,000 patients’ files. 3,500 of them concern acute cases of Chagas, 83 percent of these younger than nine.”

 

Number of cases worldwide:
Approximately 
6-7 million,

primarily in Latin America

(WHO)

 

Dr. Claudia Domínguez, a specialist for prenatal infections, works in a public clinic, the Luis Carlos Lagomaggiore Hospital, in Mendoza, Argentina, one of the six regions worst affected by Chagas disease.

 

“Anyone can get Chagas disease,” Dr. Claudia Domínguez, specialist for prenatal infections, observes dispassionately. The vivacious, dedicated doctor works in a public clinic, the Luis Carlos Lagomaggiore Hospital in Mendoza at the foot of the snow-capped Andes Mountains. The same-named province in central Western Argentina is, like Santiago del Estero, one of the six regions in the country worst affected by Chagas disease. “People living in the endemic areas run a much higher risk of infection from a vector bite than elsewhere,” Dr. Domínguez continues. “However,” she adds with urgency, “most children under fifteen have already contracted the disease from their mothers during pregnancy.”

 

 

Chagas disease (caused by Trypanosoma cruzi parasites) has its main spread in the Americas and Europe. Central and South America are particularly affected.

 

Pregnancy as a Risk

Dr. Adelina Riarte, director of the department of clinical pathology and treatment at the National Institute for Parasitology in Buenos Aires, confirms this observation: “Transfer from mother to child has become the second most important mode of transmission of Chagas disease,” she says, then goes one step further: “It’s now assumed that this is precisely how Chagas will persist over the next fifty years.”

 

This is why Dr. Domínguez, with the sleeves of her doctor’s white coat rolled up as if about to launch into work, repeatedly and with the utmost vehemence demands: “One of the key pillars in the fight to eradicate the disease is examining pregnant women and monitoring their children. And it has to be done 100 percent, irrespective of the different social classes or income groups. Because the younger the patient, the better their chances of recovery.” 

The examination and monitoring of all pregnant women and their children as well as testing blood samples and blood donations are key pillars in the fight to eradicate the disease.

 

On her way to a house call, the doctor points out that her patient, Sabrina Lojam, lives in an urban area in the center of Mendoza. Since the vector generally does not occur in this area, Lojam was completely bowled over by her Chagas diagnosis, especially as she had no symptoms. “I didn’t know how I got the infection,” the 29-year-old mother says, still shocked. “With my first daughter, I wasn’t aware I could infect her. I only learned about it when my son fell ill. Doctor Domínguez phoned to tell me I had tested positive for Chagas. So we had to examine the baby too. That’s when I first found out I can pass on the disease during pregnancy.”

 


The transmitting vector of Chagas disease is a nocturnal, blood-sucking bug named Triatoma infestans. In Argentina, it is more commonly known as “Vinchuca.”

Educating doctors and the public about treatment and possible cures is one of the big challenges in the fight against Chagas disease.

Also part of Argentina’s national Chagas program: Mobile medical teams who educate the rural population of the affected regions.

The mobile education teams visit about 1,800 rural schools, teaching schoolchildren about the infection, risks and consequences of Chagas disease, to share this information at home with their families.

 

It’s the same story with almost all the women with Chagas-infected children. No matter how much effort Argentina’s national Chagas program puts into educational campaigns through posters, flyers, TV and radio spots, the population overwhelmingly ignores, or turns a blind eye, to the disease. The lethal transmission of the infection from mothers to their unborn children can be described as largely unknown.

 

Lojam’s son has been treated for Chagas from birth. She began taking the same medicine because – despite the high risk – she had been hoping to have, and now has had, a healthy third child. Dr. Altcheh suggests a possible reason. In his experience, he relates, “we were able to prove that mothers who are in treatment transmit the infection less often than those who are not. This is why it has now become routine practice to treat children and their mothers at the same time.”

 

 

Providing Cures for Even the Smallest

There are basically two medicines available for this treatment. One is benznidazole, originally developed in the early 1970s by Hoffmann-LaRoche and now produced by the Argentinian company ELEA. The other is the substance nifurtimox, made by Bayer, which had already once been granted a license for treating Chagas disease in 1967. Production was halted in 1997 due to insufficient demand, but it resumed again in 2000 in consultation with WHO.

 

Dr. Maria-Luisa Rodriguez is Global Program Head with Pharmaceuticals at Bayer in Wuppertal, Germany, and global director of the development program for treating Chagas disease with nifurtimox.

 

Dr. Maria-Luisa Rodriguez, Bayer’s global director of the development project for treating Chagas-infected children with nifurtimox, explains how this decision came about: “Pharmaceutical companies are frequently criticized for focusing solely on diseases that occur in more developed countries. At Bayer, we face this criticism and say, we will do our part.“ Thus, since 2000, Bayer has been supporting WHO with donated medicines, which since 2012 have amounted to one million tablets a year. But, as yet, there is no suitable pediatric formulation of nifurtimox for children. Dr. María Serjan, pediatrician and neonatologist at Fernandez pediatric hospital in Buenos Aires, explains why this is so important: “For children, from newborns to those weighing around 40 kilos, the dose of the medicine is calculated per kilogram of body weight. With a tablet for adults, it is very difficult to properly adjust the dose to match the child’s weight. Especially, when it comes to neonates, who, in general, only weigh about three kilos.”

 

The Slow Course of Chagas disease

During the acute phase – immediately after the victim is bitten by a kissing bug, the vector of Chagas disease – only a third of victims suffer from symptoms such as fever, fatigue, swollen lymph glands and heart pain for several weeks. The majority of infected people do not notice anything. The following chronic phase is symptom-free and can last years or even decades. By the time Chagas disease symptoms are noticed again, some organs have already been irreversibly damaged by the parasite. Up to 30 percent of people affected develop chronic heart disease. Others suffer from an abnormal enlargement of the digestive organs. Many die of intestinal bleeding or suffer sudden cardiac death. The Drugs for Neglected Diseases initiative (DNDi) even estimates that 30-40 percent of patients suffer from some of these severe symptoms in the chronic phase.

 

For this reason, Bayer has been working to develop a new formulation of nifurtimox specifically tailored to children. It will contain just 30 milligrams of nifurtimox and will come as snap tablets, allowing it to be exactly halved. So, if required, the dose can be reduced to just 15 milligrams, the amount of the medicine that can be administered even to babies, especially neonates.

“The formulation we’ve developed is a tablet that dissolves quickly in water,” Dr. Rodriguez adds. “Which means it can also be administered to small babies. Solid formulations can only be taken by children that are already able to swallow tablets.”

 

“Our Responsibility to help”

Expert interview with Dr. Maria-Luisa Rodriguez

 

Inside the Nino Ricardo Gutierrez hospital in Buenos Aires, a wall is covered with the colorful handprints of small children. Written beneath these prints are the words “Por la esperanza de los chicos,” which translates as “For the hope of children.” All the specialists involved in the studies of the new children’s formulation of nifurtimox expect it to substantially boost this hope. Dr. Altcheh, who is delighted to have just discharged a fully-healed mother and her four Chagas-infected children, also sketches a highly optimistic view of the future: “By treating the children, we will stop getting adults with after-effects.”

 

 Chagas Disease – The Disease
Chagas Disease – The Children
Chagas Disease – The Vector 

 

 

[2] Programa Nacional de Chagas