A 49-year-old man resident in Maryland consulted for dyspnoea of great efforts of two months of evolution.

A 49-year-old man resident in Maryland consulted for dyspnoea of great efforts of two months of evolution. His chest x-ray was taken showing cardiomegaly by enlargement of the left chambers and dilation of the left ventricle. Analysis of family history revealed that the patient lost his father of heart failure due to Chagas disease. Patient says that he lived for 20 years in an area close to Medellin (Colombia) before moving to the United States, working as a farmer. Patient remembers being mildly sick with Chagas disease when he was 18 years old, showing fever, fatigue, body aches. He could not afford the treatment at the time and the symptoms resumed in some days.Which phase of Chagas disease is the patient showing now? Are all the patients that had an acute infection with the parasite that causes this disease (Trypanosoma cruzi) going to show this later phase of the disease? Besides cardiac complications, what are the other complications that patients in this phase of Chagas disease could show? What is one of the main causes of this phase of Chagas disease that this patient is showing? Would you expecting to find T. cruzi in a blood smear from this patient?

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