Editing Chagas disease (section)

==Management==
[[File:NECT treatment (cropped).jpg|thumb|upright=0.7|alt=A brown glass bottle of pills, labeled "Lampit (nifurtimox)"|A bottle of [[nifurtimox]] tablets]]
Chagas disease is managed using [[antiparasitic drug]]s to eliminate ''T. cruzi'' from the body, and symptomatic treatment to address the effects of the infection.<ref name=Gua2019/> As of 2018, [[benznidazole]] and [[nifurtimox]] were the antiparasitic drugs of choice for treating Chagas disease,<ref name="Molina2018"/> though benznidazole is the only drug available in most of Latin America.<ref name="Ribeiro2019"/> For either drug, treatment typically consists of two to three oral doses per day for 60 to 90 days.<ref name="Molina2018"/> Antiparasitic treatment is most effective early in the course of infection: it eliminates {{nowrap|''T. cruzi''}} from 50 to 80% of people in the acute phase (WHO: "nearly 100 %"<ref>WHO. (13 April 2022). [https://www.who.int/news-room/fact-sheets/detail/chagas-disease-(american-trypanosomiasis) "Chagas disease (also known as American trypanosomiasis"]. ''Fact sheets''.</ref>), but only 20–60% of those in the chronic phase.<ref name=Gua2019/> Treatment of chronic disease is more effective in children than in adults, and the cure rate for congenital disease approaches 100% if treated in the first year of life.<ref name="Molina2018"/> Antiparasitic treatment can also slow the progression of the disease and reduce the possibility of congenital transmission.<ref name="WHO2019"/> Elimination of {{nowrap|''T. cruzi''}} does not cure the cardiac and gastrointestinal damage caused by chronic Chagas disease, so these conditions must be treated separately.<ref name=Gua2019/> Antiparasitic treatment is not recommended for people who have already developed dilated cardiomyopathy.<ref name="Nunes2018"/>

Benznidazole is usually considered the [[first-line treatment]] because it has milder [[adverse effect]]s than nifurtimox, and its efficacy is better understood.<ref name="Molina2018"/><ref name="Bern2019"/> Both benznidazole and nifurtimox have common [[side effect]]s that can result in treatment being discontinued. The most common side effects of benznidazole are skin rash, digestive problems, [[anorexia (symptom)|decreased appetite]], weakness, headache, and [[sleep disorder|sleeping problems]]. These side effects can sometimes be treated with [[antihistamine]]s or [[corticosteroid]]s, and are generally reversed when treatment is stopped.<ref name="Molina2018"/> However, benznidazole is discontinued in up to 29% of cases.<ref name="Molina2018"/> Nifurtimox has more frequent side effects, affecting up to 97.5% of individuals taking the drug.<ref name="Molina2018"/> The most common side effects are loss of appetite, weight loss, nausea and vomiting, and various [[neurological disorder]]s including mood changes, [[insomnia]], [[paresthesia]] and [[peripheral neuropathy]].<ref name="Molina2018"/> Treatment is discontinued in up to 75% of cases.<ref name="Molina2018"/><ref name="Bern2019"/> Both drugs are contraindicated for use in pregnant women and people with [[liver failure|liver]] or [[kidney failure]].<ref name="WHO2019"/> As of 2019, resistance to these drugs has been reported.<ref name="Ribeiro2019">{{cite journal |vauthors=Ribeiro V, Dias N, Paiva T, et al |title=Current trends in the pharmacological management of Chagas disease |journal=Int J Parasitol Drugs Drug Resist |volume=12 |pages=7–17 |date=December 2019 |pmid=31862616 |pmc=6928327 |doi=10.1016/j.ijpddr.2019.11.004 |type= Review}}</ref>

===Complications===
In the chronic stage, treatment involves managing the clinical manifestations of the disease. The treatment of Chagas cardiomyopathy is similar to that of other forms of heart disease.<ref name="Molina2018"/> [[Beta blocker]]s and [[ACE inhibitor]]s may be prescribed, but some people with Chagas disease may not be able to take the standard dose of these drugs because they have [[low blood pressure]] or a [[low heart rate]].<ref name="Molina2018"/><ref name="Nunes2018"/> To manage irregular heartbeats, people may be prescribed [[anti-arrhythmic drug]]s such as [[amiodarone]], or have a [[pacemaker]] implanted.<ref name="Bern2015"/> [[Blood thinner]]s may be used to prevent [[thrombosis|thromboembolism]] and [[stroke]].<ref name="Nunes2018"/> Chronic heart disease caused by untreated ''T. cruzi''  infection is a common reason for [[heart transplantation]] surgery.<ref name="PD7"/> Because transplant recipients take [[immunosuppressive drug]]s to prevent [[organ rejection]], they are monitored using PCR to detect reactivation of the disease. People with Chagas disease who undergo heart transplantation have higher survival rates than the average heart transplant recipient.<ref name="Nunes2018"/>

Mild gastrointestinal disease may be treated symptomatically, such as by using [[laxative]]s for constipation or taking a [[prokinetic]] drug like [[metoclopramide]] before meals to relieve esophageal symptoms.<ref name="Bern2015"/><ref name="Oliveira2019"/> Surgery to sever the muscles of the lower esophageal sphincter ([[cardiomyotomy]]) may be performed in more severe cases of esophageal disease,<ref name="Oliveira2019">{{cite book|vauthors=de Oliveira EC, ((da Silveira ABM)), Luquetti AO|title=Chagas Disease |veditors=Marcelo Altcheh J, Freilij H|url=https://books.google.com/books?id=WpyuDwAAQBAJ|series=Birkhäuser Advances in Infectious Diseases|date=9 September 2019|publisher=Springer Nature|location=Switzerland|isbn=978-3-030-00054-7|pages=243–62|chapter=Gastrointestinal Chagas Disease|doi=10.1007/978-3-030-00054-7_12|s2cid=203457516|issn=2504-3811}}</ref> and surgical removal of the affected part of the organ may be required for advanced megacolon and megaesophagus.<ref name="Bern2015"/><ref name="emed"/>