Talk:Chagas disease/Archive 1

older entries
Hello, contradiction in the main article : "Nevertheless, he at least believed falsely until 1925, that the main infection route is by the bite of the insect and not by the feces" ... actualy is seems that's it's mainly the bug!! Otherwise it would be good to push the details a bit more!

-- Again : "ore rarely, better constructed houses may harbor the insect vector, due to the use of rough materials for making roofs, such as bamboo and thatch"
 * -: I corrected: Nevertheless, he at least believed falsely until 1925, that the main infection route is by the bite of the insect - and not by its feces, as this was proposed by his colleague Emile Brumpt 1915 and assured by Silveira Dias 1932, Cardoso 1938 and Brumpt himself 1939. Good english now?

I would say due to the use of plaster or vinyl, difficult for a x millimeter black pest to hide on white plaster roof, but in bamboos!!!!!!!!!!!!! Let's be serious here !!! Could somody better knoledgable on that topic, make the necessary corrections!!


 * i dont understand this question.--

-

Hello, don't want to slap my own biases on what is a very nice wikipaedia entry but thought it worth mentioning that the answers to a lot of the questions raised here as well as a lot more detail on this disease and the organism that causes it are found in this recent book on the subject.

http://www.amazon.com/gp/product/1402073232/104-5157415-3057545

-

"solation of the agent by: a) inoculation into mice; b) culture in specialized media (e.g. NNN, LIT); and c) xenodiagnosis, where uninfected reduviidae bugs are fed on the patient's blood, and their gut contents examined for parasites 4 weeks later."

mistake?: i read in the german Dönges/Thieme it is only TWO weeks, it is 4 weeks with mice and guinea pig, only m.03/05

Some details
Hi. I liked the article, especially since I had not thought that we had such an extensive material on Chagas disease. I just have two points, one is a personal curiosity of mine, the second is really a suggestion that may be included in the article. 1) My question is (and maybe the article could be more emphatic about it): is there a cure for Chagas disease? I remember studying it at school, and books, if I recall correctly, used to say that it was incurable.  Maybe this has changed?  Or does it remain as a chronic disease, with the patient having to be treated for symptoms for the rest of his life? 2) About the recent outbreak in Santa Catarina, maybe the article could state that over 50 thousand people, spreading across 4 states (tourists that were visiting the Santa Catarina coast) are expected to get tested for the disease. But more importantly, maybe we should say something about this theory of the scientists over there: they say that deaths have occurred because the infection by the pathogen was much, much more accute than normal. Usually, the T.C. enters the host through the bite wound, when the person scratches the site (a detail that should be in the article also), and thus it does so in a very small quantity. In the case of the sugar cane infection, however, the "victims" ingested an unusually large quantity of the pathogen, which theoretically sped the cycle of the disease considerably, leading to death in some cases (which would not occur in such a short period since infection). I have not edited the article myself because I am not knowlegeable enough in this field to edit this type of work. I'd end up messing things up and misinforming the reader. But I tought that the suggestions were good. Regards, Redux 14:24, 26 Mar 2005 (UTC)


 * Hello, Redux, I wrote most of the article, including the news about the new type of infection. I studied medicine at the School of Medicine of Ribeirão Preto, Brazil, recognized as the center of excellence in research on Chagas disease, and Fritz Köberle, one of the most famous researchers on the etiology of Chagas disease. Responding to your questions: yes, the disease is incurable in the chronic phase, and it is debatable whether it can be cured in the acute phase. A vaccine was developed in Ribeirão Preto but it was found economically unfeasible. I will add the information about scratching, you are correct (note that I have added a picture about the chagoma), and regarding the new outbreak in Santa Catarina, I am waiting for more news to supplement it. The hypothesis about the higher severity due to oral ingestion you have commented is correct, but it is still a hypothesis. It could be a new strain, too. User:Rsabbatini.
 * Hi Rsabbatini. Thank you for your answers.  I had indeed noticed that you are the main contributor to this article.  I take this opportunity to congratulate you on it, it's quite good.  I've seen your latest additions, and they work very well at addressing the suggestions I had made.  Your answer has triggered another doubt in me though.  So, if I may abuse your good will:  so there actually is a working vaccine that nobody gets because it's too expensive??  That's a terrible thing, unless the vaccine wasn't effective, or maybe it was hazardous in some way?  Also, if I may ask (although I'm not sure wheather this would have a place in the article):  suppose you live in a risk area (for the insect vector), if you notice a wound that may be a chagoma, resist the urge to scratch and brush the area with alcohol (or maybe just wash it), would that be effective in preventing the pathogen from entering the body?  Or maybe as you clean the area (with alcohol or water) you might end up pushing the pathogen in just the same?  As you probably noticed, I'm Brazilian too, and I remember clearly studying Chagas disease at school and thinking what would I do if I ever saw a chagoma in my skin  (I was very young then, and I spent a month checking every mosquito bite before scratching, to make sure that it wasn't a chagoma.  I was scared by the notion of this incurable disease that could be transmited by an insect bite.  But of course, I don't live in a risk area for the Barbeiro).  Regards, Redux 02:11, 28 Mar 2005 (UTC)


 * Nice to know that you are a Brazilian, too. We are very few here. Theoretically you are right, if we refrain to scratch and desinfect the area the blood infection should not occur. However, this happens unconsciously at night, so, unless you don't sleep... The first week I slept at the Moradia dos Estudantes in the Medical School, we discovered a barbeiro. Most astonishing the dividing walls of the moradia were compressed sugar cane straw!!! (unbelievable, in the medical school were Chagas was so studied). I got in a panic and he had the barbeiro tested, but fortunately it was clean. The students protested and the straw bricks were layered over with mortar. But or a few months everyone slept with a mosquito net! Regarding the vaccine: 1) it did not protect 100% (only about 85%), and it could not be obtained in large animals, such as horses, which produce a large amount of antiserum. My professor, Dr. Becker, infected himself and his lab assistant, Helinho, with Chagas (very corageously or silly, it depends) after vaccination and it worked. Furthermore, spending money in prevention would be more useful, because vaccinating everybody was also found to be too difficult.


 * Unbelievable this story! Talk about irony!  But that makes me think that the Barbeiro appears to have a sore spot for sugar cane, which would be a hazardous substance unless closely controled by sanitation authorities.  Maybe this would be worth including in the article?  Although there's this new stuff coming from Pará, about a smaller-scale outbreak that has apparently been brought on by contaminated Açaí.  In the "Santa Catarina front", they are now saying that there's a possibility that a Barbeiro bug (the actual insect) might have been grinded along with the sugar cane (argh!).  I don't know if that would be worth including though.  Also, your story made me realize that the article is not all that clear in the fact that not all the vector insects carry the pathogen (as per the one you found in the school dorm, which was clean).  That may appear obvious, but many people tend to think that all of the vector bugs (such as the Barbeiro) carry the T.C. within then, which is not the case. Regards, Redux 13:47, 1 Apr 2005 (UTC)

RSabattini, is it possible, for the sake of completeness of this article, to provide a reference or a link on the paper that reports the oral infection trials held by Instituto Oswaldo Cruz?


 * I tried to find, but it seems that they stil remain unpublished. I got this second-hand from a science news source in Brazil. User:Rsabbatini 2 July 2005

RSabbatini: A quibble - I live in Florianópolis, SC, and here, we call sugarcane juice "caldo de cana". Just in case any vacationing gringos are reading this and want to know what to avoid!


 * Good suggestion. I produced too the article on garapa and will add this regional term. User:Rsabbatini 2 July 2005

—== ideas ==

I've done some editing of the article in the past day or so. It looks really good, but there are a few things that need to be fixed that I probably can't do on my own:
 * Sources: inline references (like footnotes) should be added for a lot of the claims, for instance "Chagas’ work is unique in the history of medicine..." I can set up the footnoting system if the author can identify sources for the various claims.  As an example, take a look at Myxobolus cerebralis, which I helped write.
 * *In the last paragraph of "epidemiology and geographical distribution," could we add more information about the insects' "domestic behavior?" Right now, it's a little unclear. This one is fixed now, but the others (especially the map) still need to be fixed. Dave (talk) July 7, 2005 18:21 (UTC)
 * Can someon update the map to reflect its range in the U.S.?
 * Clarify chagoma in the "clinical manifestations" section. I'm not sure how to interpret " A local lesion (so called chagoma (see picture), palpebral edema)."  Could it be rewritten to say "a local lesion, called a chagoma, forms due to palpebral edema?  I'm not sure I understand the relationship between lesions, edema, and chagoma.
 * The issue was a bit unclear. The way I've understood it, a chagoma is a nodule at the site of inoculation, while the palpebral edema seen in the picture is actually Romaña's sign, a swelling of the eyebrow after inoculation at the conjunctiva. Zyryab 22:22, 14 February 2006 (UTC)

I hope we can get this featured. I'm always very impressed when people can do something like this in a foreign language because I know I'd never be able to even come close.

Best of luck, Dave (talk) July 5, 2005 20:39 (UTC) /* ideas */ How about some photos of bites. I imagine a lot of people who check this site are paranoid about a suspicious bite (like me), and could do with some on the spot info as to how to differentiate between different bites. For instance I spent a few days in thatched huts in the Amazon in Bolivia, and a few days later noticed a mosquito bite sized hard lump on my head, within the hairline. It stung strongly and sporadically for a few dyas, but responded well to standard insect bite cream. Is now small but has developed violet colour. Should I be worried?

Leslie Beben chiming in - Chagas' cardiomyopathy probably represents a "gold standard" in appreciation of a singularly lethal swath of autonomic devastation cut through the myocardium (or esophagus, colon, etc. under vagal control) initially dealt to an unfortunate host by a common household insect. Chagas' cardiomyopathy likely represents cardiac autonomic insufficiency in a very specific form as the sinoatrial tree and spinal ganglia are usually spared. Chagas' helps us to see that there are two electrical supply systems to the heart. First order electrical control of the myocardium is governed by traditionally understood mechanisms of sinoatrial propagation. Second order control is derived from background autonomic control derived from the vagus nerve and spinal accessory nerves and ganglia. Chagas' shows an etiology specific dismantling of vagal/autonomic control that inevitably leads to geometric derangement and subsequently clinically observable diastolic dysfunction.

double see http://en.wikipedia.org/wiki/Chagas_disease#Alternative_infection_mechanism
Recent Outbreaks

In March, 2005, in Santa Catarina, Brazil, at least 19 people got the disease by ingesting sugar cane juice that was pressed together with some bugs. It was a very strange case and Brazilian Health Vigilance demonstrated a special interest to solve the origin of infection. At least 3, from the 19 accounted for, people died. Folha On-line news (in Portuguese)

Version 0.5 nomination failed
This article is considered to fall outside the scope of the Version 0.5 test release, since this version only includes a limited number of articles. It is now held ready for a later version such as Version 1.0 nomination. Walkerma 03:58, 5 June 2006 (UTC)

Just added the results from an article that came out this week about chagas in NEJM. Sorry about the untabled version... Just learned how to do tables as well.Jfmarchini 00:48, 29 August 2006 (UTC)

Pneumocystis & Schizotrypanum
I added in links to Chagas' discovery of Pneumocystis and its complicating factor in the description of Schizotrypanum as an independent genus based upon two mixed life-cycles. I also added a link to the the original validating description of Trypanosoma cruzi earlier than the description of Schizotrypanum cruzi. These details are explained in the reference by Redhead, Cushion, Frenkel & Stringer 2006. Chagas actually illustrated Pneumocystis in the latter 1909 paper on Schizotrypanum. He differentiated both pathogens in 1912. Heliocybe 13:24, 3 April 2007 (UTC)

Image
Can someone please fix the broken image in the article? -- Permafrost 01:19, 12 June 2007 (UTC)
 * Strange. It was deleted locally as being available on Commons, but now the file is gone from Commons (only the image description page is left). Fvasconcellos (t·c) 01:40, 12 June 2007 (UTC)

Which image was this? I can't see any missing. TimVickers 02:42, 12 June 2007 (UTC)
 * See Wikipedia:Administrators' noticeboard#Image undeletion. It's been restored. Fvasconcellos (t·c) 09:22, 12 June 2007 (UTC)

Name
I think the name is "Chagas' disease" rather than "Chagas disease". I've added the apostrophe to the text, hope I haven't missed any. Tim Vickers 17:53, 11 July 2007 (UTC)
 * Apostrophe now seems to have vanished. As far as I can tell both forms get wide usage. Is there some official source? Stumps (talk) 07:22, 19 January 2009 (UTC)
 * Both CDC (link) and WHO omit the apostrophe (link). So I agree that we should follow that usage. Tim Vickers (talk) 15:35, 19 January 2009 (UTC)

Life cycle Image
Can some one re-draw this CDC image pls? It looks too big and odd yet barely readable--Countincr ( T@lk ) 00:26, 12 July 2007 (UTC)

Blood transfusion and monitoring
JAMA last week has come up with a strategy how to monitor people who have been found to be Chagas serology positive in screening of blood donations. JFW | T@lk  06:45, 20 November 2007 (UTC)

Nice background
See this for some nice historical background. --Una Smith (talk) 05:20, 13 September 2008 (UTC)

Chagas Cardiomyopathy
Chagas cardiomyopathy appears to be an expedient pathophysiology model of accelerated onset nonischemic diastolic heart failure. Electrocardiographic evidence of Chagas is widely appreciated. Electrocradiographic tracings appear to show that the sinoatrial and Purkinge trees are incrementally spared from the parasympathetic cardiac decline imparted by this common South American household parasite. The socioeconomic burden of Chagas' disease is especially heavy in Central America. Eradication of the Riduvid Bug as a public health measure should be considered a policy matter akin to prior polio policy. Concise, encyclopedic definition of the issue may benefit research in a common area of great concern to all. .--lbeben 02:08, 14 January 2009 (UTC)

External review comments
The following comments from external reviewer BSW-RMH are early fruit of the new joint Wikipedia talk:WikiProject Medicine/Google Project. Thank you for your efforts, BSW-RMH. LeadSongDog come howl  13:11, 11 May 2010 (UTC)

Introductory section
Hello Chagas article writers and editors, This article is both comprehensive and well-written. I hope that I can offer some useful suggestions to enhance it further. I think the Introductory material would benefit from additional citations and clarification. Specific suggestions are as follows:

First paragraph: Add the following updated references
 * (article reference 1 updated) "DPDx – Trypanosomiasis, American. Fact Sheet". Centers for Disease Control (CDC). http://www.dpd.cdc.gov/dpdx/HTML/TrypanosomiasisAmerican.htm. Retrieved 2010-05-09.
 * (article reference 2 updated) Kirchhoff LV (17 December 2009). Chagas Disease (American Trypanosomiasis). eMedicine. Retrieved on 11 September 2008.

Second paragraph: WE 5HUNNA 5OE This section would benefit from an updated clarified summary of the usual disease progression and treatment incorporating some of the following proposed changes: The symptoms of Chagas disease vary over the course of an infection. In the early, acute stage, symptoms are mild and usually produce no more than local swelling at the site of infection. After 4-8 weeks, infected individuals enter the chronic phase Chagas disease that is asymptomatic for 60-80% of individuals. The initial acute phase is responsive to antiparasitic treatments, with 60-90% cure rates. These antiparasitic treatments also appear to delay or prevent the development of disease symptoms during the chronic phase of the disease, but 20-40% of infected individuals will eventually develop life-threatening heart and digestive system disorders. The currently available antiparasitic treatments for Chagas disease are benznidazole and nifurtimox, which can cause temporary side effects in many patients including skin disorders, brain toxicity, and digestive system irritation.
 * Bern C, Montgomery SP, Herwaldt BL, Rassi A Jr, Marin-Neto JA, Dantas RO, et al. Evaluation and treatment of Chagas disease in the United States: A systematic review. JAMA. 2007;298(18):2171-81.
 * Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402.

Third paragraph: Clarification is needed for this statement: “Chagas disease occurs exclusively in the Americas…” While this disease is contracted primarily in the Americas, it occurs in many countries, particularly in Europe, primarily due to travel to and immigration from endemic areas in the Americas.
 * Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402.

BSW-RMH (talk) 19:44, 10 May 2010 (UTC)BSW-RMH


 * ✅--DO11.10 (talk) 15:49, 13 May 2010 (UTC)

Sign and symptoms
The statistics in this section could use some clarification.

This statistic is inaccurate:

"In about 10% of infections, the symptoms do not completely resolve and result in a so-called chronic latent or indeterminate asymptomatic phase of the disease."

Actually, 90% of acute disease cases eventually resolve and then enter a latent phase. The remaining 10% progress directly to a symptomatic clinical form of chronic Chagas disease. The 90% that resolve during the acute phase will then enter a chronic phase. Of individuals with chronic Chagas disease, 60-80% will never develop symptoms (called indeterminate chronic Chagas disease), while the remaining 20-40% will develop life-threatening heart and/or digestive disorders during their lifetime(called determinate chronic Chagas disease).
 * Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402.
 * Bern C, Montgomery SP, Herwaldt BL, Rassi A Jr, Marin-Neto JA, Dantas RO, et al. Evaluation and treatment of Chagas disease in the United States: A systematic review. JAMA. 2007;298(18):2171-81.

Also: "If left untreated, Chagas disease can be fatal, in most cases due to heart muscle damage."

I recommend revising to read: Even if with treatment...

BSW-RMH (talk) 20:19, 10 May 2010 (UTC)BSW-RMH


 * ✅--DO11.10 (talk) 15:49, 13 May 2010 (UTC)

Prevention
The paragraph of this section regarding blood transfusion as a mode of Chagas transmission requires updating.

5 HUNNA 5HUNNA WE 5HUNNA 5OE 5PS Blood transfusion was formerly the second most common mode of trasmission for Chagas disease, but the development and implementation of blood bank screening tests has dramatically reduced this risk in the last decade. Blood donations undergo Chagas screening in all the endemic Latin American countries and is expanding in countries, such as Spain and the United States, that have significant or growing populations of immigrants from endemic areas (1,2). In Spain, donors are evaluated with a questionaire to identify individuals at risk of Chagas exposure for screening tests (2). The US FDA has approved two Chagas tests including one recently approved in April of 2010, and has published guidelines that recommends testing of all donated blood and tissue products (2,3). While these tests are not required in U.S., it is estimated that 75-90% of the blood supply is currently tested for Chagas, including all units collected by the American Red Cross which accounts for 40% of the U.S. blood supply (3,4). The Chagas Biovigilance Network reports incidents of Chagas positive blood products during screening with FDA-approved (2007)tests in the United States (5)

1. Castro E. Chagas' disease: lessons from routine donation testing. Transfus Med. 2009;19(1):16-23.

2. Gascon J, Bernb C, Pinazoa MJ. Chagas disease in Spain, the United States and other non-endemic countries. Acta Tropica. 2010.

3. FDA NEWS RELEASE, April 30, 2010, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm210429.htm

4. American Red Cross Infectious Disease Testing, http://www.redcrossblood.org/hospitals/infectious-disease-testing

5. Chagas Biovigilance Network, http://www.aabb.org/programs/biovigilance/Pages/chagas.aspx

I recommend removing the outdated information on gentian violet, which has not been in practice since the 1980s and is therefore obsolete:

"In the past, donated blood was mixed with 0.25 g/L of gentian violet, which kills T. cruzi parasites.[21] The antifungal agent amphotericin B has been proposed as a second-line treatment, but the high cost and relatively high toxicity of the drug have limited its use.[22]"

BSW-RMH (talk) 21:29, 10 May 2010 (UTC)BSW-RMH


 * ✅--DO11.10 (talk) 15:49, 13 May 2010 (UTC)

Management
Posaconazole

The information associated with trymanostatic versus trypanocidal activity in the Randomized Trial of Posaconazole and Benznidazole for Chronic Chagas' Disease article seems too specific for a tertiary source article. Sorry dude. Lime0life (talk) 00:59, 15 May 2014 (UTC)


 * Yes we need to use secondary sources per WP:MEDRS Doc James  (talk · contribs · email) (if I write on your page reply on mine) 07:08, 15 May 2014 (UTC)

This section also could use some updating.

The information regarding incomplete removal of parasites discussed in this section was published in 2000. Since this time, several reviews of newer studies have been published showing that disease is parasitological cure occurs in about 60-85% of adults and more than 90% of infants treated in the first year of acute phase Chagas disease. Children (age 6 to 12-years) with chronic disease have a cure rate of about 60% with benznidazole. While the rate of cure declines the longer an adult has been infected with Changas, treatment with benznidazole has been shown to slow the onset of heart disease in adults with chronic Chagas infections.

See *Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402.

BSW-RMH (talk) 21:48, 10 May 2010 (UTC)BSW-RMH


 * ✅--DO11.10 (talk) 18:19, 13 May 2010 (UTC)

Epidemiology
Updated epidemiological statistics and references:

Chagas disease affects 8-10 million people living in endemic Latin American countries, with and additional 300,000-400,00 living in non-edemic countries including Spain and the United States. An estimated 41,200 new cases occur annually in endemic countries, while 20,000 deaths are attributed to Chagas disease each year. US physicians are treating more patients with Chagasic disease every year. Fortunately the Riduvid Bug has not moved to North America; the patients are here but the vector is not. Like Polio and Smallpox, policy is evolving on how to eradicate the Riduvid Bug.


 * Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388-402.


 * (article reference 2 updated) Kirchhoff LV (17 December 2009). Chagas Disease (American Trypanosomiasis). eMedicine. Retrieved on 11 September 2008.
 * ✅--DO11.10 (talk) 18:19, 13 May 2010 (UTC)

suggested revision

of "With increased population movements, however, the possibility of transmission by blood transfusion has become more substantial in the United States.[37] Approximately 500,000 infected people live in the United States, which is likely the result of immigration from Latin American countries.[38]"

Transmission blood and tissue products are now actively screened in the U.S., thus addressing and minimizing this risk. Also, the current figure is 300,000 infected individuals in the U.S. (see above references)
 * ✅--DO11.10 (talk) 18:19, 13 May 2010 (UTC)

DALY figure

This figure appears to be compiled using data from 2002. The 2004 statistics are noe available on the WHO website and can be used to update this figure.

BSW-RMH (talk) 22:32, 10 May 2010 (UTC)BSW-RMH

✗ Not done yet Any editor should feel free to do some or all of these items! WhatamIdoing (talk) 18:16, 13 May 2010 (UTC)
 * I left a note on (the image repository) Commons for Lokal Profil, the editor who created the DALY figure. It looks like s/he is pretty busy, but perhaps he'll be able to update it.  WhatamIdoing (talk) 18:34, 13 May 2010 (UTC)
 * Lokal and I worked on a few hundred of these maps. I am sure we have the 2004 data done just that it has not been updated.  Doc James  (talk · contribs · email) 18:36, 13 May 2010 (UTC)
 * ✅! WhatamIdoing (talk) 02:24, 19 May 2010 (UTC)

Re-check
It's amazing how fast you incorporated all the recommendations :) I added a few very minor edits to the wording in the intro, changed a reference, fixed a few numbers. You can check these edits in the history. The article looks great! Very impressive work, everyone. If there was a status higher than FA, I'd recommend this article for it.

BSW-RMH (talk) 14:50, 20 May 2010 (UTC)

Drug investigations
I suspect this bit could benefit from: It's a recent research review. LeadSongDog come howl!  19:52, 13 May 2010 (UTC)

Stink bugs
Can anyone add a cite that states positively that stink bugs (halyomorpha halys) cannot transmit Chagas? 173.79.8.75 (talk) 14:44, 1 June 2012 (UTC)
 * Is there some particular reason for thinking they (out of all the insects extant) might? While both insects are part of suborder (Heteroptera), they are of different infraorders (Pentatomoidea vs Cimicomorpha). LeadSongDog come howl!  15:43, 1 June 2012 (UTC)

Pathophysiology
Just cross checking with my pathology textbook here, and it seems like a lot of the GI problems arise from destruction of the myenteric plexus. Maybe this ought to be made a little more explicit? On that note, pathophysiology in general seems a little thin (there's just that one, not incredibly specific paragraph.)

"very rare" in the U.S.?
Not so.

An Unfolding Tragedy of Chagas Disease in North America. PLoS Neglected Tropical Diseases, 2013; 7 (10): e2300 DOI: 10.1371/journal.pntd.0002300 — Preceding unsigned comment added by 68.40.56.234 (talk) 23:09, 2 November 2013 (UTC)

Transmission
The sentence - "Other modes of transmission include organ transplantation, through breast milk,[14] and by accidental laboratory exposure. " Is there a good reason to have "and by accidental laboratory exposure"? Wouldn't this be true for almost any disease, or is there something special about Chagas Disease that it needs to be pointed out. — Preceding unsigned comment added by Martyvis (talk • contribs) 01:39, 12 August 2014 (UTC)

There are numerous interesting new findings in a Scientific American article discussing both the transmission patterns and the frequency of the disease. — Preceding unsigned comment added by 96.22.72.73 (talk) 22:22, 13 December 2014 (UTC)

New ref
Have a look at: José Rodrigues Coura; José Borges-Pereira. ''Rev. Soc. Bras. Med. Trop.'' vol.45 no.3 Uberaba May/June 2012 "Chagas disease. What is known and what should be improved: a systemic review" [Doença de Chagas. O que é conhecido e o que deve ser melhorado: uma visão sistêmica] It looks to be a very useful overview. LeadSongDog come howl!  17:06, 3 December 2014 (UTC)

External links modified
Hello fellow Wikipedians,

I have just added archive links to 1 one external link on Chagas disease. Please take a moment to review my edit. If necessary, add after the link to keep me from modifying it. Alternatively, you can add to keep me off the page altogether. I made the following changes:
 * Added archive https://web.archive.org/20090922232932/http://www.who.int:80/tdrold/publications/tdrnews/news65/chagas.htm to http://www.who.int/tdrold/publications/tdrnews/news65/chagas.htm

When you have finished reviewing my changes, please set the checked parameter below to true to let others know.

Cheers. —cyberbot II  Talk to my owner :Online 21:19, 25 August 2015 (UTC)

Primary source
A randomized controlled trial of benznidazole for chronic Chagas cardiomyopathy found it did not reduce clinical deterioration through 5 years of follow-up. Although people treated with benznidazole converted to negative Trypanosoma test results (PCR) by the end of treatment more commonly (66.2%) than people in the placebo group (33.5%), this difference disappeared over time and was 46.7% and 33.1%, respectively, at 5 years or more, and the rates of PCR conversion did not correspond with clinical outcome. The test conversion varied according to geographic region being the highest in Argentina and Bolivia 2.79 (95% CI, 1.99 to 3.92) at 5 or more years, followed by Brazil (odds ratio 1.87 (95% CI, 1.33 to 2.63) at 5 or more years; and in Colombia and El Salvador, the odds ratio was 0.96 (95% CI, 0.63 to 1.45) at 5 or more years.

This is undue weight being given to a primary source. We should try to use secondary sources per WP:MEDRS. Or at least shorten this. CIs are not appropriate for a general encyclopedia. Doc James (talk · contribs · email) 05:19, 11 September 2015 (UTC)


 * Agree. The wording reads almost like a copyvio from an abstract and is not suitable for a general readership. Matthew Ferguson (talk) 06:34, 11 September 2015 (UTC)
 * I agree as well--Ozzie10aaaa (talk) 10:31, 11 September 2015 (UTC)
 * There are numerous primary sources misused all over the wikiproject medicine pages and you guys get bent out of shape because of this decent and recent one, carefully used?
 * Pardon me, but this is too funny, and the obvious heel clacking consent of all guys with the boss too. It appears that none of you even knows about the disease and what the trial means. the edit is totally not undue and its no copy vio.
 * alter the text,take out the CI's if you please but just deleting it, you are shooting yourself in the foot. And for jiminy's sake ping me when you talk to me.--Wuerzele (talk) 19:17, 11 September 2015 (UTC)
 * User:Wuerzele I tried to trim some of it and you reverted . It is better if you use secondary sources though. There are lots for this disease. Doc James  (talk · contribs · email) 05:17, 13 September 2015 (UTC)

Review
Of Chagasic heart disease 10.1016/j.amjmed.2015.04.036 JFW &#124; T@lk  22:57, 24 October 2015 (UTC)

Bedbugs in US linked to Chagas
"Upto 300,000 immigrants in US infected." Scientific American 12/2014. http://www.scientificamerican.com/article/bed-bugs-kissing-bugs-linked-to-deadly-chagas-disease-in-u-s/ 74.60.161.158 (talk) 15:37, 8 June 2015 (UTC)
 * Wow. Did you actually read that SA article you cited? "Much more worrisome, he says, is the possibility that bed bugs may also feed on rodents in homes, which may act as a reservoir species for T. cruzi. Whether that happens or could happen is also currently unknown." No indication of bedbugs passing Chagas among humans. LeadSongDog come howl!  21:02, 8 June 2015 (UTC)
 * While need some time. Could be mention under research I guess but probably a little early yet. Doc James  (talk · contribs · email) 21:06, 8 June 2015 (UTC)

anything on this, or should I archive it? Sandy Georgia (Talk)  03:08, 16 March 2020 (UTC)
 * I haven't looked into this yet, sorry. Have been busy over the past couple of days. I'll get to it. SpicyMilkBoy (talk) 03:32, 16 March 2020 (UTC)
 * Belated reply: I've read several recent reviews on Chagas disease in the US and I have not seen bedbugs mentioned. SpicyMilkBoy (talk) 10:41, 9 April 2020 (UTC)
 * Thanks! Will archive this section in a few weeks then, Sandy Georgia  (Talk)  10:47, 9 April 2020 (UTC)

Text
"Oral transmission has become one of the most important modes of transmission in Brazil. Between 2000 and 2011, 1252 cases of acute Chagas disease were reported, and of these, 70% were attributed to oral transmission ."

This http://dx.doi.org/10.1590/s0037-86822008000300014 is a primary source that discusses a few cases of oral transmission

This url http://dx.doi.org/10.3395/vd.v2i4.358 does not work. This link https://pdfs.semanticscholar.org/ea84/ae0a9d053e6837b94c7245697939e154eab4.pdf works. But the source is not great. Doc James (talk · contribs · email) 10:28, 26 August 2019 (UTC)
 * This is a good ref https://www.ncbi.nlm.nih.gov/pubmed/31006555 Doc James  (talk · contribs · email) 10:34, 26 August 2019 (UTC)

Has this been dealt with? I don’t see mention of the ‘’extent’’ of oral transmission in the article— just that it can happen. Sandy Georgia (Talk)  10:51, 9 April 2020 (UTC)
 * I had added that it is an important mode of transmission in the Amazon basin and Venezuela, but it looks like it got lost somewhere along the way. I'll restore it. SpicyMilkBoy (talk) 11:11, 9 April 2020 (UTC)
 * Mea culpa, I snipped it out with the intention to discuss the extent of oral transmission in the epidemiology section, but I seem to have lost it along the way. Thanks for catching that. Ajpolino (talk) 17:41, 10 April 2020 (UTC)
 * You two are awesome. Sandy Georgia  (Talk)  17:47, 10 April 2020 (UTC)

FAR needed


This article passed FAC in 2005, and doesn't appear to have been significantly updated since about 2010. There are numerous dated statements throughout the article (far too many to list), and a review listed above that has not been incorporated. Other newer reviews are: The article is quite badly outdated. Also, with the current Crisis in Venezuela, new effects there might be mentioned. Sandy Georgia (Talk)  01:48, 23 January 2020 (UTC)
 * "CD is the most common fatal infection in Central and South America affecting, in endemic countries, about eight million people and causing the death of approximately 50,000 individuals each year (WHO, 2018)."
 * Sandy Georgia (Talk)  22:53, 10 March 2020 (UTC)
 * "CD is the most common fatal infection in Central and South America affecting, in endemic countries, about eight million people and causing the death of approximately 50,000 individuals each year (WHO, 2018)."
 * Sandy Georgia (Talk)  22:53, 10 March 2020 (UTC)
 * "CD is the most common fatal infection in Central and South America affecting, in endemic countries, about eight million people and causing the death of approximately 50,000 individuals each year (WHO, 2018)."
 * Sandy Georgia (Talk)  22:53, 10 March 2020 (UTC)
 * "CD is the most common fatal infection in Central and South America affecting, in endemic countries, about eight million people and causing the death of approximately 50,000 individuals each year (WHO, 2018)."
 * Sandy Georgia (Talk)  22:53, 10 March 2020 (UTC)
 * User:SandyGeorgia I completely agree, though updates disappear / are censored/ discouraged because of our medical WP leader, Doc James, as for example | here . He inserts the term unusual even though facts have been emerging that state otherwise. He has even attributed statements to completely different sources as here, disappearing the original ref.
 * A problem with the 4 refs you suggested is, some are already 4 yrs old. all except one ( Current trends in the pharmacological management of Chagas disease) are behind paywalls. we need good publicly viewable refs (and they regularly get removed by Doc James too, if you check). The other open access "Update on Chagas disease in Venezuela during the period 2003–2018" unfortunately is a review of self selected samples, so it is unclear what prevalence it reflects. -But by all means you should take a stab at working your references into the article! --Wuerzele (talk) 16:41, 25 February 2020 (UTC)
 * Yikes! Saw your post at WT:MED, this may be the worst article with the FA star I've seen yet. I should have time and sources to start working on the article this week. I'm unfamiliar with the bureaucratic trappings of FAR, so let me know if there's something I should post there. If the others who commented there are interested in helping, the more the merrier. Thanks for bringing this up, SandyGeorgia! I was just looking for a new chore. Happy editing! Ajpolino (talk) 17:35, 7 March 2020 (UTC)
 * Hi, ; glad to see someone jump in! First, the process, then the changes needed.Here are the Featured article standards. A medical featured article has the additional need to use the most current WP:MEDRS-compliant sources.  FAR measures the article against that list of standards, so when working to retain the star, it is important to maintain a professional level of prose, consistent citations, conformance with WP:MOS, WP:LEAD, etc.  If you are not up on MOS or citation formatting, please don't worry about that, as I am able to go through and fix that sort of stuff once sources and text settle down.  FAR is divided into three stages, all very deliberate and prodding, with the goal of restoring articles to featured status rather than removing the star.  The first stage is to notify the article talk page.  If that gets no results, the FAR (review) is opened, with two weeks to identify issues, and maybe fix them without a FARC (removal candidate).  Unfortunately, Chagas has already progressed to the FARC phase, so we need to get moving.  Fortunately, as long as progress is being made, the Coords give time.  But there needs to be steady progress demonstrated. One of the FAR Coords,  is a medical editor, and knows the amount of work that we need to do here.  Work is discussed on this page, with only periodic updates to the FAR so the FAR coordinators know we're on it. Next, what needs to be done. There are numerous very old sources in the article, and some of the content is demonstrably outdated.  But it is good to add newer citations on accurate text even if the text hasn't changed (so that five years from now, we're not looking at 20-year-old sources!)  So, next is to identify the latest and highest quality secondary broad journal reviews (I added several above), and use them to thoroughly update the article.  Textbooks are typically too outdated, although sometimes helpful, and there is rarely the need to use a primary source in a broad overview medical condition.  If you are able to help on all of that, I can be watchlisting to make sure we keep consistent citations, MOS compliance, etc.  It is always wise to leave updating the lead to last; once the body of the article is settled, things can be summarized to the lead. If you are on board, I will indicate on the FAR that we are holding for improvements. There is too much work for me to do undertake alone, but if you are able to do most of the updating, I can help with other process issues. And towards the end, we might pull in other editors to review overall. Sandy Georgia  (Talk)  20:44, 7 March 2020 (UTC)
 * I'm interested in helping with this as well. Full disclosure: I have never worked on featured content before and I am fairly inexperienced in general. But I've been watching the WP:MED talk page and I've been very concerned about the issues with medical FAs that have been raised there. This one has some obvious problems ("as of 1993"?!) and addressing some of them seems simple enough. As a start, here are a few recent reviews that weren't linked above:


 * Chagas disease - 2018 review in the Lancet
 * Pathology and Pathogenesis of Chagas Heart Disease - 2019 review in Annual Review of Pathology
 * Chagas Disease Diagnostic Applications: Present Knowledge and Future Steps - 2017 review in Advances in Parasitology
 * Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region 2019 review in Lancet Infectious Diseases
 * I see you found it! Sandy Georgia  (Talk)  22:50, 10 March 2020 (UTC)
 * Screening for Trypanosoma cruzi infection in immigrants and refugees: Systematic review and recommendations from the Spanish Society of Infectious Diseases and Clinical Microbiology 2019 review in Eurosurveillance
 * Most recent version of the Global Burden of Disease study (2017) - 2015 version is currently cited
 * and two practice guidelines on Chagas and solid organ transplantation (2018 and 2019)
 * Chagas Disease: A Clinical Approach - this looks like a pretty comprehensive text on the subject, from 2019
 * I will read through the FARC instructions and take a look at the article over the next few days. SpicyMilkBoy (talk) 17:36, 9 March 2020 (UTC)
 * Thanks for jumping in ; I am glad the negative comments at WT:MED did not discourage you. I have not kept up with your edits, but will review all of them as I find time. I gave an overview of the FAR process in a post just above this one, so that should answer your questions.  With several people now willing to work on this article, the FAR is not in danger of being closed while progress is being made.  The most important thing needed is to update the article to the most recent, high quality secondary reviews, which I see you are doing.  Perhaps others will join in reviewing now:  . It is my impression that other than being out of date, the article is not in terrible shape, and this bronze star is saveable.  Sandy Georgia  (Talk)  15:13, 10 March 2020 (UTC)
 * might also want to jump in now. Sandy Georgia  (Talk)  15:15, 10 March 2020 (UTC)
 * don't worry about citation formatting; I can easily fix that, and am glad you are doing the real work. If anyone can locate the
 * and two practice guidelines on Chagas and solid organ transplantation (2018 and 2019)
 * Chagas Disease: A Clinical Approach - this looks like a pretty comprehensive text on the subject, from 2019
 * I will read through the FARC instructions and take a look at the article over the next few days. SpicyMilkBoy (talk) 17:36, 9 March 2020 (UTC)
 * Thanks for jumping in ; I am glad the negative comments at WT:MED did not discourage you. I have not kept up with your edits, but will review all of them as I find time. I gave an overview of the FAR process in a post just above this one, so that should answer your questions.  With several people now willing to work on this article, the FAR is not in danger of being closed while progress is being made.  The most important thing needed is to update the article to the most recent, high quality secondary reviews, which I see you are doing.  Perhaps others will join in reviewing now:  . It is my impression that other than being out of date, the article is not in terrible shape, and this bronze star is saveable.  Sandy Georgia  (Talk)  15:13, 10 March 2020 (UTC)
 * might also want to jump in now. Sandy Georgia  (Talk)  15:15, 10 March 2020 (UTC)
 * don't worry about citation formatting; I can easily fix that, and am glad you are doing the real work. If anyone can locate the
 * Thanks for jumping in ; I am glad the negative comments at WT:MED did not discourage you. I have not kept up with your edits, but will review all of them as I find time. I gave an overview of the FAR process in a post just above this one, so that should answer your questions.  With several people now willing to work on this article, the FAR is not in danger of being closed while progress is being made.  The most important thing needed is to update the article to the most recent, high quality secondary reviews, which I see you are doing.  Perhaps others will join in reviewing now:  . It is my impression that other than being out of date, the article is not in terrible shape, and this bronze star is saveable.  Sandy Georgia  (Talk)  15:13, 10 March 2020 (UTC)
 * might also want to jump in now. Sandy Georgia  (Talk)  15:15, 10 March 2020 (UTC)
 * don't worry about citation formatting; I can easily fix that, and am glad you are doing the real work. If anyone can locate the

Lancet report mentioned in this news article, it is important to look into the WHO data in depth, since it is unlikely that Venezuela is accurately reporting to them. This might be the Lancet article referenced. If there is a contradiction with the Lancet article, we might mention it. With the largest-ever crisis in the western hemisphere, with food and medicine weaponized, these diseases will resurge, and cross borders because of the emigration crisis. (see Crisis in Venezuela) Somewhere we should mention that it is called "mal de Chagas" throughout Latin America-- the article now mentions only Brazil. I don't know why we have the Spanish names of the bugs in the lead; is it not sufficient to have that info somewhere in the body? It affects more than 150 animals, but we have no section on Animals (see WP:MEDMOS). Sandy Georgia (Talk)  22:29, 10 March 2020 (UTC)
 * SpicyMilkBoy, I see you found the Venezuelan Lancet review above. I added all the cite journal templates for you (above), to save you one step in the process.  Sandy Georgia  (Talk)  22:50, 10 March 2020 (UTC)


 * Vague, throw-away sentence in the lead, what does this add? "These areas have also seen an increase in the years up to 2014."  Sandy Georgia  (Talk)  22:40, 10 March 2020 (UTC)
 * Many thanks for your help, . What's the protocol fir when sources disagree? For example, the 2017 GBD report puts the global prevalence at 6.2 million, while the 2019 WHO report says 8 million; GBD says 7,900 deaths per year, WHO says 10,000, and one of the sources above says 50,000 (!) I put "6 to 8 million" in the lead based on the WHO and GBD sources but that seems a bit sloppy/WP:SYNTH. I am inclined to trust the GBD data more because they actually explain how they arrived at those numbers but it is a bit old. I removed that pointless sentence from the lead BTW.
 * A few things that I noticed are missing. 1) There's no alt text - I was under the impression that FAs are required to have this. I can write alt text for the some of the photos but I'm not sure how to describe the heart image or what to say for the Rhodinus prolixor photo besides "it's a bug". 2) No discussion of the effects of congenital Chagas disease, and the coverage of drug treatment in pregnant women is not very detailed compared to what is in the sources. 3) I may be biased as someone who stares at microscope slides all day but since this is supposed to be a comprehensive article there should probably be some description of the parasite morphology in the "Diagnosis" section. 4) No discussion of specific vectors outside of an unsourced image caption; the article only talks about triatomine bugs in general. SpicyMilkBoy (talk) 00:51, 11 March 2020 (UTC)
 * Theoretically, yes, FAs should have alt text. This is an older FA, though, and back then, no one was adding alt text.  For many years (around 2008 to 2010), FAC was careful about making sure FAs had alt text, but when the editor who was the main advocate for and best writer of alt text left Wikipedia, it stopped being enforced as much.  If you are able to add it, please do; I would not send an article to FAR over missing alt text alone, though.   On the things you see missing, it would not hurt to add that content. On the source data discrepancy, if you can't convince yourself that the newest is the most accurate, we can report both. I wouldn't advise fudging as the solution. Either we directly state in the text that A says B but C says D, or we can do that via a footnote.  As an example for how to footnote conflicting text, see the notes I added at Georges Gilles de la Tourette, where older sources say he was shot in the head, but newer sources say neck.)  I have not looked at either source or their methodology, but the serious health and immigration crisis (5 million people displaced, and immigration throughout South America) in Venezuela started in 2018, so I would wonder if the data has accounted for the explosion in infectious diseases there.  So glad you are taking this on!  Sandy Georgia  (Talk)  03:12, 11 March 2020 (UTC)


 * Thoughts on eMedicine as a source? This is currently cited quite a bit. They are peer reviewed and all, and I've used them before when I need a quick citation for obvious stuff, but I'm not sure if this is up to the FA standard or if we should be sticking to review papers and textbooks. SpicyMilkBoy (talk) 16:42, 15 March 2020 (UTC)
 * I think it is fine to use eMed sparingly for non-controversial information. Sandy Georgia  (Talk)  17:54, 15 March 2020 (UTC)
 * Thanks! I don't understand the inline comment you placed for this source - it is indeed a secondary review article. SpicyMilkBoy (talk) 03:32, 16 March 2020 (UTC)

Images
Not really a FAR issue - but Chagas' 1909 paper, accessible here, has some nice illustrations of T. cruzi by someone named "Castro Silva". If the illustrator died over 70 years ago, the illustrations would be public domain per c:COM:BRAZIL and we could use them in the article. If anyone has the time to track down this illustrator and figure out when he died, it would be appreciated - it's difficult for me as I don't speak Portuguese. Not a pressing issue of course, I just like the pretty pictures. SpicyMilkBoy (talk) 21:12, 12 March 2020 (UTC)
 * for Portuguese help and for image help.  Sandy Georgia  (Talk)  21:27, 12 March 2020 (UTC)
 * So I don't know if this issue has been solved yet somewhere else (just stumbled upon it), but the autor of the pictures is Manoel de Castro Silva (you can check pages 340 and 343 in this paper about illustrators in science) and he has died in 1934. RetiredDuke (talk) 17:00, 3 May 2020 (UTC)
 * I am nowhere when it comes to images :) Have always been afraid of them-- others will have to address that one. Sandy Georgia  (Talk)  17:13, 3 May 2020 (UTC)
 * Thank you so much, . That's 86 years ago, so we're good. For some reason the site isn't letting me download the PDF right now, but I'll add the images when I can access them. SpicyMilkBoy (talk) 17:16, 3 May 2020 (UTC)
 * You're welcome, glad I could help. RetiredDuke (talk) 20:37, 3 May 2020 (UTC)

Causes section under construction
Hi all, I'm working on adding a "Causes" section to cover why T. cruzi infection leads to disease. It's somewhat hard for me to predict my schedule this week (due to disruption of everything by coronavirus), so I may be working in fits and starts. Pardon my dust during the process, and feel free to edit the section as I go. I've left a couple of comments in the wiki-markup as calls for help and reminders to myself. If I can't find the answers, I'll remove them and rephrase sentences if necessary. It's great to see the work going into this article (especially from SpicyMilkBoy)! Thanks all! Ajpolino (talk) 18:58, 15 March 2020 (UTC)
 * Just putting this here so I don't lose it while I move things around: Ajpolino (talk) 04:22, 26 March 2020 (UTC)
 * Just a note to those watching the page, sorry for the trimming in Signs & symptoms - I'm going to move the heart pathology material to a brief section on pathogenesis, and the sudden death thing to an outcomes section. I'm certainly open to other suggestions if folks prefer the old way. Thanks! Ajpolino (talk) 04:55, 26 March 2020 (UTC)
 * Parking this here momentarily as well. I'll move on to the Causes section tomorrow: The clinical manifestations of Chagas disease are due to cell death in the target tissues that occurs during the infective cycle, by sequentially inducing an inflammatory response, cellular lesions, and fibrosis. For example, intracellular amastigotes destroy the intramural neurons of the autonomic nervous system in the intestine and heart, leading to megaintestine and heart aneurysms, respectively. If left untreated, Chagas disease can be fatal, in most cases due to heart muscle damage. (ref emed)
 * Sorry for the disruption! Ajpolino (talk) 05:25, 26 March 2020 (UTC)

CNS involvement?
Hi all, we currently have this sentence in Signs & symptoms: Isolated cases exhibit central nervous system involvement, including dementia, confusion, chronic encephalopathy and sensory and motor deficits. cited to this 2010 review in Neurological Research. I can't find mention of CNS involvement (outside of reactivation in HIV-positive folks) in the 2018 Lancet review the 2015 NEJM review, or the 2019 edition of the textbook Parasitic Diseases. Does anyone have further insight into this? Otherwise I'd probably feel more comfortable leaving it out for now. Ajpolino (talk) 17:04, 26 March 2020 (UTC)
 * Plenty of reviews for dementia, but I find no recent mention of the rest. Google scholar search limited to 2016 forward. Sandy Georgia  (Talk)  18:48, 26 March 2020 (UTC)
 * Um... One of us may have our wires crossed. When I click on that link it takes me to a search for "Huntington" and "dementia". If I switch the text to "Chagas" I don't get much. Ajpolino (talk) 19:39, 26 March 2020 (UTC)
 * Well, fiddlesticks. Doing too much at once, forgot which article I was on. Here you go:   Perhaps this one? Cerebral Trypanosomiasis in an Immunocompromised Patient: Case Report and Review of the Literature, M Kaushal, S Shabani, EJ Cochran, H Samra… - World neurosurgery, 2019 - Elsevier This literature review focuses on the CNS manifestations of Chagas disease (American trypanosomiasis … mild infection with few or no symptoms to a severe presentation of chagasic encephalitis.6 … neurologic signs.6, 51 Involvement of the CNS in chronic Chagas disease infection …  Sandy Georgia  (Talk)  19:44, 26 March 2020 (UTC)

Misc wording
Welcome back! I hope all is well. Question about this edit to restore "determinate Chagas disease". Where do you see symptomatic chronic disease referred to that way? I see "indeterminate" several places, but I can't recall seeing the opposite referred to as "determinate". When I CTRL+F on the cited source (the Lancet review) there's no use of "determinate" I can find. But maybe my eyes just glazed over it on other sources. Sorry for the flurry of activity. I hope everything is clear enough to follow. Ajpolino (talk) 17:53, 27 March 2020 (UTC)
 * thanks, everything's fine here, I've just been working a lot. I should have more time to work on the article next week. You're right that that isn't in the Lancet source - thanks for catching that. It's used here, so I added that as a source. Thanks for all your work, it looks great so far. SpicyMilkBoy (talk) 18:40, 27 March 2020 (UTC)

Query
Please ignore me if this commentary is premature, but is anyone able to deal with the sections needing Update, so we can have a look at whether the FARC can be closed? There is no hurry, but wondering if anyone is able to deal with those sections. Sandy Georgia (Talk)  19:31, 29 March 2020 (UTC)
 * Perhaps I don't understand your query? We're working on it as time permits; I can jump around to target the tags, but it looks like the whole article needed to be updated, not just the tagged sections, so Spicy and I are slogging our way through. Are you wondering if the sections can be updated? If so, I think the answer is yes, there seem to be plenty of recent sources for those marked sections. If instead, contrary to what you said above, there is some rush (e.g. I saw your concern here linked from WT:MED), then I'm happy to work on the tags first if that helps some other administrative process run more smoothly. Just let me know. Thanks for all your help and attention to this article so far! I hope all is well! Ajpolino (talk) 20:45, 29 March 2020 (UTC)
 * I want you to proceed in the way that is easiest for you, but keep in mind the following: the article does not have to be at a "perfect" place yet for the FAR to be closed.  As soon as you all feel it is close enough, I can start reviewing the little stuff, but for now, I don't want to get in your way.  If going in order is easiest on you, ignore my query :)  If updating the tagged sections with the idea that it might be possible to close the FAR sooner rather than later, that is another alternative. Do what you think best !  Sandy Georgia  (Talk)  20:54, 29 March 2020 (UTC)

History section
I was just trying to complete some of the citations in the History section, but I will hold off to see if better sources can be found. A number of the Spanish-language sources are so-so and can probably be replaced. If you all are unable to replace them with newer, better, English-language sources, please let me know as I speak fluent Spanish. I can check these sections out and upgrade the citations, but preferable would be to eliminate most of those sources. For example, the Argentine Federation of Cardiology no longer even owns the FAC.org website. Sandy Georgia (Talk)  22:36, 29 March 2020 (UTC)
 * , and  might do the job for a History rewrite to better sources. Sandy Georgia  (Talk)  00:31, 30 March 2020 (UTC)

Looking for a source
Does anyone have access to ? I'm not sure if it has anything worthwhile for the Epidemiology section here because I can't get past the abstract. Thanks! Ajpolino (talk) 23:54, 2 April 2020 (UTC)
 * Emailed you. SpicyMilkBoy (talk) 13:29, 8 April 2020 (UTC)
 * Excellent! Thank you; I'd never seen that Firefox Send feature before. That's nifty. Ajpolino (talk) 22:48, 8 April 2020 (UTC)

Odds & ends
Hi all, a couple small things I wanted to bring up here for opinions:
 * Does anyone know why is at the top of the page? It says , but I'm not sure why someone wanted to keep that bot away, or indeed if it's even still active.
 * There were many problems with it in the past ... can probably be removed now. Sandy Georgia  (Talk)  22:54, 12 April 2020 (UTC)


 * I removed the paragraph on Charles Darwin from the History section since it seems like he probably didn't have Chagas disease, and it's covered at length elsewhere. Happy to discuss if folks miss it.
 * I'm good with that, unless the case for him is as strong as the case for Samuel Johnson at Tourette syndrome, where his own writings and those of Boswell solidly document his TS. Sandy Georgia  (Talk)  22:54, 12 April 2020 (UTC)


 * This comment is at the top of the references section: . I assume that's dated and is from the good old days?
 * Holy moly, yes, the good old days-- can be removed. Sandy Georgia  (Talk)  22:54, 12 April 2020 (UTC)


 * Further reading - we have a section just to host a link to an editorial by Peter Hotez, et al. from 2012. It's a nice article, but I don't know how much it adds for readers. I'd favor chopping it, but don't feel strongly either way.
 * No strong opinion either. Sandy Georgia  (Talk)  22:54, 12 April 2020 (UTC)


 * The first external link is from Curlie which I'd never heard of. Is this a resource we typically link to? If not, it doesn't look all that useful and I'd be happy removing it.
 * Yes, typical, see WP:MEDMOS-- it helps keep out the cruft. Those seeking support can go to those links.  Sandy Georgia  (Talk)  22:54, 12 April 2020 (UTC)

Thanks all for all the work! I'm excited to see this article improving! Ajpolino (talk) 22:17, 12 April 2020 (UTC)
 * Removing the Charles Darwin stuff seems like a good call to me and I agree with you on the further reading section. Curlie is linked in a lot of medical articles (and other ones, apparently: see Special:WhatLinksHere/Template:Curlie). I personally find it odd that it's so widespread on Wikipedia - it seems like a relic of Web 1.0 to me and I've rarely found it useful. But there is certainly precedent for it. (There's some interesting discussion at Templates for discussion/Log/2019_May_6). I could take it or leave it when it comes to this article. SpicyMilkBoy (talk) 22:27, 12 April 2020 (UTC)

Best, Sandy Georgia (Talk)  22:57, 12 April 2020 (UTC)
 * There are also several inline comments that need to be reviewed ... you can find them by ctrl-f on <!--
 * If you are both satisfied with the text, I can ping in some very good prose people next.
 * Oops, sorry-- see you are not done yet, as there are still maintenance tags ... Sandy Georgia (Talk)  22:58, 12 April 2020 (UTC)
 * We're nearly there! I'm looking through the comments now, and Spicy seems to be cleaning up the research section. Ajpolino (talk) 23:00, 12 April 2020 (UTC)


 * Oh wait, I had one more question for you both, the History section currently ends in In Argentina, the disease is known as mal de Chagas-Mazza, in honor of Salvador Mazza. because I didn't know where else to put it. Has anyone come across other local names for Chagas? Thoughts on where to put that info? Ajpolino (talk) 23:07, 12 April 2020 (UTC)
 * I can look around in Spanish for other local names, but I have always and only heard mal de Chagas. The MEDMOS Classification section tends to be a dumping ground for nomenclature and terminology, but I see this article has no Classification section (should it?).  Otherwise, History works ... ping me please if I forget to come back on other names, as I'm kinda busy. Sandy Georgia  (Talk)  23:16, 12 April 2020 (UTC)
 * I see that Dengue fever, closest FA to this one, also lacks a Classification section, so probably the name is OK in History. Sandy Georgia  (Talk)  23:18, 12 April 2020 (UTC)
 * I integrated that sentence with the main paragraph, which talks about Salvador Mazza - it seems to fit more naturally there. SpicyMilkBoy (talk) 23:25, 12 April 2020 (UTC)

The text in the epidemiology section looks updated so I removed the tag. Remaining issues in that section:
 * I can't find a newer better map than our somewhat mysterious 2012 one. If anyone has data they like, I can draw up a new one.
 * , I was thinking that we could just colour in the 21 endemic countries. How does that sound to you? SpicyMilkBoy (talk) 21:17, 15 April 2020 (UTC)
 * Fix ping: . SpicyMilkBoy (talk) 21:18, 15 April 2020 (UTC)
 * Meh, since a map of endemic countries colored would just be all of Latin America (excepting Caribbean islands) colored a single color, I prefer the current map even if dated and mysterious. But it's really just a question of personal preference. If others prefer a more updated map of more certain provenance, I'm certainly not opposed to an endemic countries map. Thanks for fixing all the other image problems! Looks super! Ajpolino (talk) 00:44, 16 April 2020 (UTC)
 * Right, I didn't really think that through. There is a nice map based on 2014 data in the 2018 Lancet paper, but I think there might be copyright concerns with reproducing such a detailed map. The paper states the map is "Adapted from the Pan American World Health Organization Chagas disease control programme" but I haven't been able to find the data they're referring to on the PAHO site. There might be something here but I couldn't find anything at a glance. SpicyMilkBoy (talk) 01:07, 16 April 2020 (UTC)
 * I found the PAHO map. But again, I'm not sure if we are allowed to reproduce it. SpicyMilkBoy (talk) 01:25, 16 April 2020 (UTC)
 * WHO has 2016 data on Chagas disease burden estimates by country here. Someone on Commons used the 2012 version of this data to make a map: . Seems like it would take considerable work to convert the data into a map though. SpicyMilkBoy (talk) 01:40, 16 April 2020 (UTC)
 * just pinging to make sure you've seen this - any thoughts about this data? :) I've removed the old map for now per the feedback in the image review. SpicyMilkBoy (talk) 01:39, 26 April 2020 (UTC)


 * Has anyone seen newer data for cases per transmission path? I moved the sentence on congenital cases in 2010 to the bottom since it's somewhat out of place now, and would support removing it altogether.
 * I found this WHO report from 2015, which gives a figure of 8668 congenital infections per year. It's a primary source but it's where the 22.5% estimate from  comes from.  The issue is that this is actually an estimate of how many cases there were in 2010. :/ SpicyMilkBoy (talk) 21:43, 13 April 2020 (UTC)
 * Ok, I removed the sentence for now. Maybe there just aren't good recent estimates for infections by each mode of transmission :( Ajpolino (talk) 22:21, 13 April 2020 (UTC)

Good work all! Home stretch on the large-scale (re)building phase! Ajpolino (talk) 17:23, 13 April 2020 (UTC)
 * A couple of sentences are commented out just before the non-endemic countries subsection. I'm removing them now, and am looking to add another sentence on how T. cruzi infects other animals.

Noticed this while working on the lead: This isn't covered in the body. Should we add something about it to the Epidemiology section? SpicyMilkBoy (talk) 21:21, 13 April 2020 (UTC)
 * Most people with the disease are poor, and most do not realize they are infected.

Prose check
Pinging, the King of the Copyedit. Riggr, this article is at FAR, and was just entirely rewritten by the good folk above. It has already been TFA mainpage, so only needs a cursory review for FA-standard prose, if I could interest you in a quick run-through. Best, always, Sandy Georgia (Talk)  01:34, 14 April 2020 (UTC)

I looked at the lead, and made some edits. Taking them in order from first paragraph to last:
 * I found the first paragraph confusing because the percentages didn't match, so I removed two of the figures. I can see they are given lower down in the article, where they are more fully explained; so, I think they can be removed from the lead without great loss.
 * I moved the first description of the disease to the second paragraph (on diagnosis), since description and diagnosis are related. The paragraph begins "commonly spread to other mammals", so I've also moved the sentence "affects more than 150 other animals" to this paragraph.
 * In the last paragraph "...as of 2017. In 2017,..." appeared unnecessarily repetitive, so I merged the two sentences.
 * I did note that there is a repetition: 'It is spread mostly by insects known as Triatominae, or "kissing bugs" ... T. cruzi is commonly spread to humans and other mammals by the blood-sucking "kissing bugs" of the subfamily Triatominae.' Should these sentences be merged?

If these edits seem reasonable to editors more familiar with the topic area, I'll see if I can find time to look at other sections. DrKay (talk) 14:04, 19 April 2020 (UTC)
 * the edits look good to me. I agree with your last point and I've revised the second sentence to avoid repetition. Thanks for your work. SpicyMilkBoy (talk) 16:41, 19 April 2020 (UTC)

Image check
, are you interested in doublechecking the images here? This FAR is almost good to Keep, after a complete rewrite. Sandy Georgia (Talk)  01:34, 14 April 2020 (UTC)
 * File:Rhodnius_prolixus70-300.jpg: the source states the image is courtesy of Erwin Huebner; that isn't the same as saying Erwin releases it into the public domain
 * File:Chagas_disease._Awareness_%26_prevention_campaign_poster._French_Guiana_2008.JPG: seems unlikely that the uploader is the author of the poster - more likely it's just the photo
 * File:Distribution_of_Chagas'_disease.svg: this image is dated 2012 - is it still accurate?
 * File:Carlos_chagas_2.jpg needs an author date of death and a US PD tag. Nikkimaria (talk) 01:56, 14 April 2020 (UTC)
 * Oof, not good. I'll look into the Carlos Chagas pic and see what I can do to replace the Rhodnius prolixus and awareness poster images. SpicyMilkBoy (talk) 02:05, 14 April 2020 (UTC)
 * SMB, actually there's a nicer version of that Chagas pic on Commons File:Carlos Chagas.png. Zeiss claims to own it for some reason, and it was released under CC-BY-SA a few years ago. Will that work?Ajpolino (talk) 02:18, 14 April 2020 (UTC)
 * I did some googling and I believe this is about the J. Pinto who took that photo; I don't speak Portuguese but O serviço de fotografia do Instituto Oswaldo Cruz would seem to indicate that this is our guy. This source (which wouldn't be RS on wp, but maybe it's ok for commons purposes?) states he died in 1951, which means that according to Brazil's copyright rules, this image will not be public domain until next year. If Zeiss obtained the rights to the photo and released it under a Creative Commons license then it should be okay, but it's not clear from that Flickr page whether they actually own the rights or not. The Commons page says Images donated as part of a GLAM collaboration with Carl Zeiss Microscopy - please contact Andy Mabbett for details., are you able to clarify this? SpicyMilkBoy (talk) 03:23, 14 April 2020 (UTC)
 * I can confirm that the image was part of a set released by Carl Zeiss Microscopy as stated on Commons. Andy Mabbett ( Pigsonthewing ); Talk to Andy;Andy's edits 10:44, 14 April 2020 (UTC)
 * Ok, I've replaced the original image with that one. SpicyMilkBoy (talk) 21:14, 15 April 2020 (UTC)
 * Thanks! Pardon my ignorance here. A couple of questions:
 * The source of File:Rhodnius prolixus70-300.jpg is archived here from around the time of upload. Is the declaration on that page sufficient? If not, there are other (slightly lower quality) images of the bugs we can substitute, so no big deal.
 * I'd suggest not relying on that declaration, since it isn't crystal clear as to how it translates into a licensing statement. Alternatively I could ask Erwin. Nikkimaria (talk) 02:21, 14 April 2020 (UTC)
 * I've replaced it with a picture of Triatoma infestans for now. This one has an OTRS release so we should be good. SpicyMilkBoy (talk) 04:02, 14 April 2020 (UTC)
 * File:Chagas_disease._Awareness_%26_prevention_campaign_poster._French_Guiana_2008.JPG, almost certainly true, although the editor has been silent since 2008, so we can't follow-up. Am I to assume from the stamps at the bottom of the poster, that it's a work of the French government, and so Commons:Copyright rules by territory/France applies? Or are there more relaxed rules for photographs of copyrighted works?
 * France doesn't have freedom of panorama for 3D works, never mind 2D. However, the text at the bottom of the poster suggests it may actually be the product of the university named rather than the government? Nikkimaria (talk) 02:21, 14 April 2020 (UTC)
 * Hmmm is there anything that would make you feel comfortable that this image is usable here? I can reach out to the university, but I'm not sure who would have the authority to release the image. Should we just consider this image unsuitable in its current form? Ajpolino (talk) 02:32, 14 April 2020 (UTC)
 * Thanks again! Ajpolino (talk) 02:11, 14 April 2020 (UTC)
 * Bottom line is at present the image is mistagged. To determine whether there is an appropriate tag and what it might be we need more information about the provenance of the original poster - who created it, when, etc. Incidentally there are what appear to be much clearer images of this same poster indexed in Google Images, just unfortunately not with any more useful source information. Nikkimaria (talk) 02:46, 14 April 2020 (UTC)
 * I've replaced the image with a picture of a bed net. It seems unlikely that the university would release the poster under a free license, so I don't think we should keep it in the article for now. Might be a good idea to nominate it for deletion on Commons and see what they have to say. SpicyMilkBoy (talk) 03:03, 14 April 2020 (UTC)
 * Not sure if is watching, so pinging her to followup questions ... I don’t speak images. Sandy Georgia  (Talk)  02:13, 14 April 2020 (UTC)

Image sizes
James has adjusted up all of the image sizes, to a level that causes MOS:SANDWICH to come back, after I corrected all of that once. FAs must comply with MOS. The image sizes are also overpowering the text; Wikipedia is not a picture book. Sandy Georgia (Talk)  18:20, 15 April 2020 (UTC)
 * Yah I am unable to make out the text here. Doc James  (talk · contribs · email) 21:37, 15 April 2020 (UTC)
 * Yeah these CDC lifecycles are pretty ubiquitous across parasitology, but unfortunately they're so text heavy that you can't read them unless they're hugely expanded. My personal preference is to leave it small and have readers click-to-expand if they're interested. I don't think the life cycle stage names are so critical that we need a huge image. If folks feel differently, I can try to find a simpler life cycle diagram. Ajpolino (talk) 22:19, 15 April 2020 (UTC)
 * I can make out the middle one a little easier but agree these are not great as thumbnails. Doc James  (talk · contribs · email) 22:33, 15 April 2020 (UTC)
 * I don't think they are generally going to be readable anyway (I can't read any of them, but I'm not a youngster), and the reader will have to click on them to read them, so see no reason to have them take over the article. I have to click on them, and then even expand them, to be able to read them, and most of our readers probably are not going to be that interested, so it makes little sense to have the image dominate the page. Also, since you all are still working on image issues above, is it premature to deal with SANDWICH until you know which images you will settle on? Or is that all settled now?  Sandy Georgia  (Talk)  22:39, 15 April 2020 (UTC)

Map
This map still matches this one by the CDC https://www.cdc.gov/parasites/cme/chagas/lesson_1/5.html I will reach out to PAHO about the possibility of getting this under an open license https://www.paho.org/en/node/49722

Doc James (talk · contribs · email) 02:44, 26 April 2020 (UTC)


 * How about a map like this from NEJM in 2015? Fairly easy to make.  Doc James  (talk · contribs · email) 02:53, 26 April 2020 (UTC)
 * I like this one and have asked for release under an open license aswell.
 * Our image is also very much supported by this  Doc James  (talk · contribs · email) 02:56, 26 April 2020 (UTC)
 * Thanks for finding a source for the current map - now we can say what time frame it represents, at least. It would be great if we could get one of the more recent map under a free license. Thanks for doing the legwork. SpicyMilkBoy (talk) 03:03, 26 April 2020 (UTC)

Okay will upload these. and added the 4th one Doc James  (talk · contribs · email) 02:59, 26 April 2020 (UTC)
 * I prefer the NEJM map though. Doc James  (talk · contribs · email) 03:07, 26 April 2020 (UTC)
 * SpicyMilkBoy had posted 2016 DALYs data above. If that data is map-ified for the world, it looks like this (also displayed at right).


 * I picked the colors fairly arbitrarily and colored by order of magnitude of total DALYs lost (i.e. I didn't adjust for the population sizes). I uploaded it as an SVG, so it's editable if someone is interested in a different color scheme or finer gradations. For a "zoomed" version of, e.g. just the Western Hemisphere, you can just screenshot the part of the map you like (or I can remove the other half of the planet). That said, I'm happy with the maps available! Thanks DocJames for all the work finding these maps! Ajpolino (talk) 19:47, 27 April 2020 (UTC)
 * awesome work, thanks so much! I'll add it to the article. SpicyMilkBoy (talk) 21:34, 27 April 2020 (UTC)