Chronic CD may lead to gastrointestinal complications, specifically within the upper GI tract, such as chest pain, abdominal pain and nausea. All three of these symptoms have been associated with Covid-19 infections. However, the prim	ary digestive symptoms of Covid-19 and T. Cruzi infections include constipation. Upper and lower GI symptoms are present in 3-11% of patients infected with SARS-CoV-2 and are associated with high ACE2 expression in the digestive tract. Digestive symptoms may be indicative of a SARS-CoV-2 infection resulting in multi-organ failure or CD progression. 

Tulane University

CD is primarily transmitted through vectors, specifically triatomines or kissing bugs. However, infected blood transfusions or organ donations, contamination of food and drink as well as vertical transmission can persist. Infection is characterized by three phases: 
- incubation period lasting between 15-40 days
- acute phase of disease 
- indeterminate phase of disease characterized by no observable symptoms
- chronic phase of disease characterized by extensive organ damage to the cardiovascular and gastrointestinal systems. Chronic CD may lead to sudden death caused by stroke, brady-or-tachy arrhythmias and congestive heart failure. 


Pathogenesis & Clinical Manifestation of Chagas Disease

Zaidel, E. J., Forsyth, C. J., Novick, G., Marcus, R., Ribeiro, A., Pinazo, M. J., Morillo, C. A., Echeverría, L. E., Shikanai-Yasuda, M. A., Buekens, P., Perel, P., Meymandi, S. K., Ralston, K., Pinto, F., & Sosa-Estani, S. (2020). COVID-19: Implications for People with Chagas Disease. Global heart, 15(1), 69. https://doi.org/10.5334/gh.891

Covid-19: Implications for People with Chagas Disease

Patients with indeterminate Chagas Disease (CD) require constant surveillance and care, which has been impeded by the Covid-19 pandemic. Chronic indeterminate CD requires annual cardiac tests as approximately 30-40% of patients develop cardiac or GI complications. Patients may need antiparasitic treatment to disrupt congenital transmission. The course of treatment includes two months of patient monitoring and lab testing to scan for potential side effects. These routine appointments have been hindered by the Covid-19 pandemic due to the risk of SARS-CoV-2 infection in healthcare settings. Additionally, medical personnel and resources have been dedicated to combating the Covid-19 pandemic, contributing to the disparities in treatment for patients with indeterminate CD. Patients with chronic indeterminate CD may develop arrhythmias or cardiovascular issues associated with CCC when an acute infection triggers a cytokine storm. 

Implications for Chronic Indeterminate CD

Implications for Gastrointestinal CD

Coronaviruses may produce neurological disorders indicated by analyses of SARS and MERS. A review of the literature published before April 2020 has shown that various neurological disorders, such as encephalitis, demyelination and neuropathy are associated with SARS-CoV-2. Covid-19 could lead to chagasic neuropathy, which is observed in the chronic phase of CD. 

Implications for Neurological Chagas Disease (CD)

Chronic infections of Chagas Disease can lead to persistent tissue inflammation around the heart leading to myocardial fibrosis and cardiac remodeling. Cardiac inflammation is mainly attributed to parasitic load, immune response, fibrosis, dysautonomia and microvascular changes. Although the inflammatory response is required to control parasitic proliferation, the secretion of Th1 cytokines may lead to the destruction of the cardiac tissue. SARS-CoV-2, which binds to the ACE2 receptor, elicits the production of type 2 pneumocytes, macrophages, perivascular pericytes and cardiomyocytes. Additionally, infections lead to cytokine storms, producing cytokines and chemokines associated with an inflammatory response similar to those elicited in chronic chagas cardiomyopathy. Myocarditic cases have been associated with infection of SARS-CoV-2 and are considered to be related to viral injury and the host immune response. One of the clinical manifestations of Covid-19 is thrombotic disease caused by excessive inflammation, platelet production, endothelial dysfunction and stasis. 

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