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Parasitological and serological tests in the acute phase and reactivation

Vectorial transmission

  • 1. Clinical situation: Person with fever, of some days/weeks of evolution. Common causes of fever discarded. Not severely ill. Few nonspecific findings on examination. Sometimes a portal of entry (one eye, both eyelids) or skin.
  • 2. Epidemiology: Living or has been recently in endemic area for Chagas disease.
  • 3. Laboratory: Ask for fresh blood smear, looking for motile flagellates. Ask for Strout or microhematocrit technique.
  • 4. Action: If positive, the diagnosis is acute phase of Chagas disease, probably by vector contamination. Start treatment at once.

If negative and the clinical suspicion persists, try to collect further blood mainly during febrile peaks. If negative persist, ask for IgM antibodies, by IIF. If positive, decide with the clinician if the clinical picture, evolution and this result may justify etiological treatment.

Hints: Romana sign and other eventual portal of entry, will remain for several weeks. Conjunctivitis will disappear in few days. Differential diagnosis with visceral leishmaniasis should be made if negative parasitological results are obtained, mainly if the evolution of the patient is to a progressive worsening.

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