ISSUES WE FACE
Chagas disease is an infection caused by the parasite, Trypanosoma Cruzi. It is spread to humans mainly by insects vectors ("Vinchuca" bugs) found in the rural areas of Central and South America. In the acute illness patients experience mild symptoms of fever, aches and swelling of the eyelids, but this stage usually goes unnoticed. The infection then remains silent and many patients never develop any future symptoms, but some go on to develop serious complications such as enlarged esophagus, enlarged colon and more importantly severe heart disease manifested by heart failure, malignant ventricular arrhythmias, including sudden death, and slow rhythms due to sinus node dysfunction and heart block.
Bolivia has the highest incidence and prevalence of Chagas in the world, with around 1.8 million people affected, representing 18% of the Bolivian population, mostly affecting people of low economic status. The risk of parasite infection is greatest in rural areas with poor quality housing; therefore this is a prototypical disease of the poor. Economic growth in countries such as Brazil and Argentina has contributed effectively to reduce prevalence of Chagas but poverty and endemic residential location in Bolivia are associated with high burden of Chagas in the community and an ongoing need for advanced cardiac care for a significant number of adults.
In Bolivia, 45,000 deaths a year are attributed to Chagas and heart disease accounts for the number one cause of death; about 55-65% of deaths are due to sudden cardiac death, 25-30% are due to heart failure and 10-15% are due to stroke. During the chronic phase of Chagas, patients are at risk for extremely slow heart rates caused by complete heart block or sinus node disease as well as fast heart rates due to ventricular tachycardia. Permanent pacemaker and cardiac defibrillator implantations are key in the treatment of patients suffering from these conditions, sometimes supplemented by radiofrequency catheter ablation for atrial flutters and ventricular tachycardia. However, most patients in rural South America are not able to have access and/or afford these therapies.
RHEUMATIC HEART DISEASE
Rheumatic heart disease refers to the condition in which the heart is damaged as a result of rheumatic fever, an inflamatory disease related to a throat infection caused by group A Streptococcus, an illness that typically occurs in childhood. Rheumatic heart disease has a heavy burden in children and
young adults living in the developing world, with poor access to medical care, currenty affecting at least 15 million people in low income regions.
The disease affects mainly the heart valves, mitral and aortic, causing the valves to narrow or to leak. The key to management of rheumatic heart disease is prevention with early treatment of strep throat with antibiotics. However in developing countries and poverty-stricken areas most children with strep throat do not have access to physicians and antibiotics. In patients with established rheumatic valvular disease costly invasive procedures from percutaneous valvular interventions to heart surgery are usually needed.