Editing Chagas disease (section)

==Signs and symptoms==
[[File:Chagoma.jpg|thumb|alt=Black and white photo of a young boy with a swollen right eye|An acute Chagas disease infection with swelling of the right eye (Romaña's sign)]]
Chagas disease occurs in two stages: an [[acute (medicine)|acute]] stage, which develops one to two weeks after the insect bite, and a [[chronic condition|chronic]] stage, which develops over many years.<ref name="Molina2018"/><ref name="Bern2015"/><ref name=PD7/> The acute stage is often symptom-free.<ref name="Molina2018"/> When present, the symptoms are typically minor and not specific to any particular disease.<ref name=Bern2015>{{cite journal |vauthors=Bern C |title=Chagas' disease |journal=N. Engl. J. Med. |volume=373 |issue=5 |pages=456–66 |date=July 2015 |pmid=26222561 |doi=10.1056/NEJMra1410150 |type= Review}}</ref> Signs and symptoms include fever, [[malaise]], headache, and [[Hepatomegaly|enlargement of the liver]], [[splenomegaly|spleen]], and [[lymphadenopathy|lymph nodes]].<ref name="WHO2019"/><ref name="Molina2018"/><ref name="Bern2015"/> Sometimes, people develop a swollen nodule at the site of infection, which is called "[[Cecilio Romaña|Romaña]]'s sign" if it is on the eyelid, or a "chagoma" if it is elsewhere on the skin.<ref name="Bern2015"/><ref>{{Cite web|url=https://www.cdc.gov/parasites/chagas/gen_info/detailed.html|title=Chagas Disease – Detailed Fact Sheet|publisher=CDC-Centers for Disease Control and Prevention|website=www.cdc.gov|access-date=15 April 2020|archive-url=https://web.archive.org/web/20190816154641/https://www.cdc.gov/parasites/chagas/gen_info/detailed.html|archive-date=16 August 2019|url-status=live}}</ref> In rare cases (less than 1–5%), infected individuals develop severe acute disease, which can involve [[myocarditis|inflammation of the heart muscle]], [[Pericardial effusion|fluid accumulation around the heart]], and [[meningoencephalitis|inflammation of the brain and surrounding tissues]], and may be life-threatening. The acute phase typically lasts four to eight weeks and resolves without treatment.<ref name="Molina2018"/>

Unless treated with [[antiparasitic drug]]s, individuals remain infected with {{nowrap|''T. cruzi''}} after recovering from the acute phase. Most chronic infections are asymptomatic, which is referred to as ''indeterminate'' chronic Chagas disease. However, over decades with the disease, approximately 30–40% of people develop organ dysfunction (''determinate'' chronic Chagas disease), which most often affects the [[Human heart|heart]] or [[digestive system]].<ref name="Molina2018"/><ref name="Bern2015"/>

The most common long-term manifestation is [[Cardiomyopathy|heart disease]], which occurs in 14–45% of people with chronic Chagas disease.<ref name="Molina2018"/> People with Chagas heart disease often experience [[palpitations|heart palpitations]], and sometimes [[Syncope (medicine)|fainting]], due to irregular heart function. By [[electrocardiogram]], people with Chagas heart disease most frequently have [[arrhythmia]]s. As the disease progresses, the heart's [[Ventricle (heart)|ventricles]] become enlarged ([[dilated cardiomyopathy]]), which reduces its ability to pump blood. In many cases the first sign of Chagas heart disease is [[heart failure]], [[thromboembolism]], or chest pain associated with abnormalities in the [[microvasculature]].<ref name="Nunes2018"/>

Also common in chronic Chagas disease is damage to the digestive system, which affects 10–21% of people.<ref name="Molina2018"/> Enlargement of the [[esophagus]] or [[Colon (organ)|colon]] are the most common digestive issues.<ref name="PD7"/> Those with [[Megaesophagus|enlarged esophagus]] often experience pain ([[odynophagia]]) or trouble swallowing ([[dysphagia]]), [[acid reflux]], [[cough]], and weight loss. Individuals with [[megacolon|enlarged colon]] often experience [[constipation]], and may develop severe [[Intestinal obstruction|blockage of the intestine]] or its [[bowel ischaemia|blood supply]]. Up to 10% of chronically infected individuals develop [[Polyneuropathy|nerve damage]] that can result in numbness and altered [[reflex]]es or movement.<ref name="Molina2018"/> While chronic disease typically develops over decades, some individuals with Chagas disease (less than 10%) progress to heart damage directly after acute disease.<ref name="Nunes2018">{{cite journal |vauthors=Nunes MC, Beaton A, Acquatella H, et al |title=Chagas cardiomyopathy: an update of current clinical knowledge and management: a scientific statement from the American Heart Association |journal=Circulation |volume=138 |issue=12 |pages=e169–e209 |date=September 2018 |pmid=30354432 |doi=10.1161/CIR.0000000000000599 |doi-access=free |type= Review}}</ref>

Signs and symptoms differ for people infected with {{nowrap|''T. cruzi''}} through less common routes. People infected through ingestion of parasites tend to develop severe disease within three weeks of consumption, with symptoms including fever, [[vomiting]], [[shortness of breath]], cough, and pain in the chest, [[Abdominal pain|abdomen]], and [[myalgia|muscles]].<ref name="Molina2018"/> Those infected [[congenital]]ly typically have few to no symptoms, but can have mild non-specific symptoms, or severe symptoms such as [[jaundice]], [[respiratory distress]], and heart problems.<ref name="Molina2018"/> People infected through organ transplant or [[blood transfusion]] tend to have symptoms similar to those of [[vector (epidemiology)|vector]]-borne disease, but the symptoms may not manifest for anywhere from a week to five months.<ref name="Molina2018"/> Chronically infected individuals who become [[immunosuppression|immunosuppressed]] due to [[HIV]] infection can have particularly severe and distinct disease, most commonly characterized by [[Encephalitis|inflammation in the brain]] and surrounding tissue or [[brain abscess]]es.<ref name="Bern2015"/> Symptoms vary widely based on the size and location of brain abscesses, but typically include fever, headaches, seizures, loss of sensation, or [[Focal neurologic signs|other neurological issues]] that indicate particular sites of nervous system damage.<ref>{{cite journal|title=American Trypanosomiasis (Chagas Disease) |vauthors=Echeverria LE, Morillo CA |journal=Infectious Disease Clinics of North America |volume=33 |issue=1 |date=February 2019 |pages=119–134 |doi=10.1016/j.idc.2018.10.015|pmid=30712757 |s2cid=73446292 }}</ref> Occasionally, these individuals also experience acute heart inflammation, [[Skin condition#Lesions|skin lesions]], and disease of the stomach, intestine, or [[peritoneum]].<ref name="Bern2015"/>