Incidence

Megacolon, one of the clinical manifestations of Chagas' disease or American trypanozomiasis, is described in all endemic areas. The change of the natural triatominae's habitat into human domicile exposed more than 90 million individuals to infection risk, including populations from the south of the United States to Argentina.21,22 However, better living standards in North American dramatically diminished the potential of vector transmission of Chagas' disease. In fact, there are even marked regional differences in the incidence of megacolon among Latin American populations suffering from Chagas' disease. These differences are probably due to different protozoa strain prevalences over these areas. Brazilian investigators have reported the largest number of cases with particularly high incidences in the states of Sao Paulo, Minas Gerais, Goias, and Bahia.

Outside Brazil, megacolon is found in Chile, where, according to Atias23 megacolon is more frequent than is megaesophagus. Chagasic megacolon is also found in Argentina, more commonly in the northern provinces.24 Autochthonous cases have also been reported in Peru and Bolivia25, while in other endemic areas of Chagas' disease, including Venezuela, Colombia, and Panama, chagasic megacolon is not found. These reports reinforce the theory of different protozoa strains. In the central region of Brazil, megacolon is the most common of all colon diseases (Fig. 25.2).

D1STHIBUIÇÏO OEOîniHC» OOS PKtHCIUll rftlATOWÎNEOS TflAN3Mtï30ftE3 DA OOLrtÇA DE CHAGAS (ModifieadA d*

D1STHIBUIÇÏO OEOîniHC» OOS PKtHCIUll rftlATOWÎNEOS TflAN3Mtï30ftE3 DA OOLrtÇA DE CHAGAS (ModifieadA d*

Figure 25.2. Map of geographic distribution of Chagas'disease in Latin America.

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