title: Chagas disease in the State of Amazonas: history, epidemiological evolution, risks of endemicity and future perspectives.
abstract: Chagas disease (CD) is a parasitic infection that originated in the Americas and is caused by Trypanosoma cruzi. In the last few years, the disease has spread to countries in North America, Asia and Europe due to the migration of Latin Americans. In the Brazilian Amazon, CD has an endemic transmission, especially in the Rio Negro region, where an occupational hazard was described for piaçaveiros (piassaba gatherers). In the State of Amazonas, the first chagasic infection was reported in 1977, and the first acute CD case was recorded in 1980. After initiatives to integrate acute CD diagnostics with the malaria laboratories network, reports of acute CD cases have increased. Most of these cases are associated with oral transmission by the consumption of contaminated food. Chronic cases have also been diagnosed, mostly in the indeterminate form. These cases were detected by serological surveys in cardiologic outpatient clinics and during blood donor screening. Considering that the control mechanisms adopted in Brazil's classic transmission areas are not fully applicable in the Amazon, it is important to understand the disease behavior in this region, both in the acute and chronic cases. Therefore, the pursuit of control measures for the Amazon region should be a priority given that CD represents a challenge to preserving the way of life of the Amazon's inhabitants.
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Maria das Graças Vale
authors.initials: Md
authors.lastname: Barbosa
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: João Marcos Bemfica Barbosa
authors.initials: JM
authors.lastname: Ferreira
authors.affiliation: Fundação de Vigilância em Saúde, Manaus, AM, Brazil.
authors.forename: Ana Ruth Lima
authors.initials: AR
authors.lastname: Arcanjo
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Rosa Amélia Gonçalves
authors.initials: RA
authors.lastname: Santana
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Laylah Kelre Costa
authors.initials: LK
authors.lastname: Magalhães
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Laise Kelma Costa
authors.initials: LK
authors.lastname: Magalhães
authors.affiliation: Programa de Pós Graduação em Biologia Urbana, Universidade Nilton Lins, Manaus, AM, Brazil.
authors.forename: Daniel Testa
authors.initials: DT
authors.lastname: Mota
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Nelson Ferreira
authors.initials: NF
authors.lastname: Fé
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Wuelton Marcelo
authors.initials: WM
authors.lastname: Monteiro
authors.affiliation: Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Henrique
authors.initials: H
authors.lastname: Silveira
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Jorge Augusto de Oliveira
authors.initials: JA
authors.lastname: Guerra
mesh_terms: D000818:Animals; D001938:Brazil / Q000453:epidemiology; D014355:Chagas Disease / Q000453:epidemiology* / Q000635:transmission; D019353:Endemic Diseases; D006801:Humans; D007303:Insect Vectors; D015995:Prevalence; D012307:Risk Factors