Epidemia de chagas agudo adquirido por vía oral en una escuela de Caracas: Descripción del caso índice

SUMMARY: Introduction: Chagas disease (ChD) is usually transmitted to man by cutaneous penetration of parasites contained in the feces of haematofagous vectors known as "kissing bugs or chipos". However, other transmission mechanisms may occur. Herein, we report the first diagnosed case of an epidemic outbreak of acute oral transmitted ChD occurred in December 2007 in a school of Caracas. Clinical case: A 9 year old schoolgirl, coming from Caracas, was hospitalized with daily fever 39-40°C and chills of three weeks duration, sickness, vomitting, astenia, mialgias, cervical adenopathies, hepatomegaly, facial and inferior members edema. The laboratory tests showed lymphomonocytosis, negative serologies for mononucleosis and dengue. In the blood smear done to rule out malaria, tripomastigote of Trypanosoma cruzi was found. ELISA-IgM, ELISA-IgG, indirect hemaglutination, polymerase chain reaction, culture and mice inoculation were all positive for ChD. Few days after, similar cases were detected and it was carried out the epidemiological link that allowed the recognition of an urban outbreak of ChD of oral transmission. The patient evolved satisfactorily after being treated with nifurtimox. Discussion: In the oral form of transmission of the ChD, signs of entrance do not exist, the clinical manifestations as high and prolonged fever and edema are common to other pathologies. In patients with fever of unknown origin, blood smear as well as search for specific IgM and IgG for ChD should be included as part of the diagnosis. Conclusion: The first case is described in detailed form, considered index case of the outbreak of acute Chagas acquired by food ingestion in a school of Chacao's county in Caracas.