Introduction
A parasitic infectious disease (previously endemic to Latin America) caused by Trypanosoma cruzi (thus known as American trypanosomiasis) is commonly seen in South America, Central America and Mexico where the Triatomine bug is abundantly seen. Currently this disease has spread to other continents due to urbanization and population movements.
Causes of Chagas disease
It is a protozoan parasitic infection by T.cruzi and Triatomine bug/kissing bugs are being the blood sucking vector of transmission, defecate or urinate over the face or other body parts of humans and make them susceptible for infection. Kissing bugs usually dwell in the walls, roof cracks etc in both rural and semi-urban areas. They become active during night time for feeding on animal blood including humans leaving the contaminated urine/ faeces around the bitten skin surface. The parasite enters the body through the bite or any other wounds/ scars. The bug can expel the parasite through their faeces or urine into the food articles or beverages and thus it is also a food born disease. Other routes of transmission include blood/blood product transfusion, vertical transmission (mother to foetus), organ transplantation and laboratory accidents. In countries other than America, the parasite often spread through non-vectoral routes. After entering the host body, the parasite, multiplies.
Chagas disease develops through in 2 phases, initial acute phase and chronic phase. The acute phase usually lasts for about 2 months following infection with no or mild and vague symptoms. It often begins with symptoms like fever, headache, muscle pain, chest or abdominal pain and breathing difficulties. The first observable sign is a purplish swelling or lesion over single eyelid. Other signs like pallor, enlarged lymph nodes etc may also be associated. Eventually, the parasites may invade internal organs such as heart, digestive muscles etc and result in cardiac disorders, neurological or even mixed symptoms, leading to sudden death by cardiac arrythmia or progressive heart failure.
Travelling to the endemic areas, poor sanitation, living in unhygienic and crowded rural places of Central America and blood transfusion/organ transplantation from an infected person increase the risk. A person with Chagas disease is at risk of Covid-19 infection.
Treatment of Chagas disease
Treatment is aimed at destroying the parasite in acute phase. Benznidazole and nifurtimox are given in early chronic cases, immunosuppressed individuals and women of reproductive age (to prevent vertical transmission). Even in asymptomatic cases, the medicines are given to arrest the progression of disease. Specific management is needed for associated digestive, cardiac or neurological ailments. Benznidazole and Nifurtimox are contraindicated for pregnant women and persons with liver or kidney failure; and Nifurtimox for the one with neurological or psychiatric disorders.
Complications of Chagas disease
Untreated Chagas disease results in heart failure, Megaoesophagus (enlargement of Oesophagus) and megacolon (enlargement of colon).
Preventive measures of Chagas disease
As there is no vaccine for controlling Chagas disease, the best available method is to break the chain of transmission along with early detection and care. Vector control measures (eg: spraying residual insecticides in house-holds and other human-residences), screening of blood prior to transfusion and organ transplantation, maintaining hygienic conditions while cooking/transporting/storing and having food, screening for new-borns and children of mothers who never received anti-parasitic treatment earlier, improving IEC (Information, Education and Counselling) and access to early diagnosis and management are necessary. The people living in endemic areas are instructed to use insecticide-treated bed nets, insecticidal creams and repellents. Avoid sleeping in a mud, thatch or adobe house.
Ayurvedic Concept of Chagas disease
There is no single term in Ayurveda to explain Chaga’s disease but understanding three Ayurvedic concepts will help us treat the condition in a successful way. The disease exposes itself as Krimi (parasitic invasion), Keeda visha(insect poisoning) and Jwara(fever) explained in Ayurveda. Ayurveda explains fever in many ways. Jwara is the term mentioned to denote high bodily temperature but jwara is explained according to the associated ailments with each of its type and kind. Jwara can either be Nija (due to causes within the body, like another disease) or Aagantu (due to external causes like a microbe infestation). The disease is also classified according to various ways of its clinical manifestation. Chagas disease an infectious disease by an external factor and it can be understood as Aagantu jwara (fever due to an external cause) in Ayurveda. According to the cause & clinical manifestation, the disease can be also understood as Krimi(parasitic infection) as it is caused by the parasite known as Trypanosoma cruzi or Keeda visha(insect bite) as the disease develops after a bug bite.
Ayurvedic Nidana of Chagas disease
Bite by Keeda leading to keeda visha (insect poisoning)
Ayurvedic treatment for Chagas disease
Management of Chagas disease with Ayurveda can be done according to the clinical manifestation. The approach will be different in acute and chronic cases, considering the signs & symptoms. The age of the patient also matters as the severity may be high in young & old patients and patients with compromised immunity. The herbal formulations should also be used with caution in such patients, to avoid further adverse responses.
The first measure to be taken in Chaga’s disease is to make sure the patient is no longer exposed to the bug (and thereby the parasite). We can not get rid of the symptoms if the cycle of infection continues.
In acute cases, external measures like herbal fumigation and herbal warm water baths in Ayurvedic decoctions and using herbs with bug repellent properties help in this process. Herbal powder namely Aparajita dhoopachoornam is used successfully for herbal fumigation within the house. This helps to remove the possible fungus growth and other microbes in the air. Herbal washes include decoctions or water boiled with herbs like Triphala and Nalpamara. Keeping nee leaves near the bed or other areas suspected for infection is also beneficial to avoid the bug bites and to reduce the skin rashes after the bite.
An infected person should be undergone mild purgation considering his physical strength. After purgation, herbal formulations to nullify the toxic effects by the parasite can be administered. Herbal washes and baths can also be continued till needed.
In chronic cases, where cardiac and neurologic problems have developed, Ayurvedic treatment will be person-specific and according to the pathogenesis in each case.
Herbal Preparations for Chagas disease
Amritottaram kashayam
Vilwadi gulika
Gorochanadi gulika
Lodhradi choornam
Triphala choornam
Nalpamara churnam
Diet Yoga and Pranayama
Diet that helps reduce infection is advised in Chagas disease. Though the disease incidence is due to an external factor, the later stages and pathogenesis can be controlled by the food intake and daily routine. Avoid items that cause Vidaaha like curd, black gram, sesame etc as food, if not prescribed otherwise. Always eat warm and fresh food, avoid old stale and re-heated food items.
Yoga and pranayama when done under proper guidance hep improve the circulatory system, thereby improving the body’s defence system. Vajrasan, Padmasana and Nadeesuddhi pranayama can help improve digestion absorption and assimilation, thereby helping the body clean and free from toxins.
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
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Dr. Rajesh Nair, Ayurveda Medicine, India
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