American Trypanosoma (T. cruzi) causes Chagas' disease. Three strains of African Trypanosoma cause sleeping sickness. Chagas' disease is usually transmitted by the reduviid (kissing) bug, but infection can also follow breast-feeding and blood transfusion, as has occurred in the United States. A nodular swelling, or chagoma, develops at the site of inoculation following a bite. The acute phase of the disease can last 2 to 3 months, and patients present with fever, headache, anorexia, conjunctivitis, and myocarditis. Infants can develop meningocephalitis, and heart involvement can lead to congestive heart failure and ventricular aneurysms. The organism can attack the myenteric plexus of the gastrointestinal tract, resulting in megacolon. Chronic infection can result in a cardiomyopathy. Laboratory abnormalities include anemia, leukocytosis, an elevated sedimentation rate, and electrocardiographic changes. During the acute phase, trypomastigotes can be seen on a peripheral smear or cultured from the blood. In the chronic phase, the diagnosis is made with a complement fixation test, ELISA, or biopsy of the liver, spleen, or bone marrow. Treatment of acute Chagas' disease is with nifurtimox or benzindazole. Treatment of sleeping sickness is with suramin sodium.

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