CASE REPORT: ORALLY TRANSMITTED ACUTE CHAGAS’ DISEASE FROM A CASE IN A PUBLIC HOSPITAL IN BUCARAMANGA CITY, COLOMBIA.

CONCEPTS Chagas’ disease, a zoonosis caused by Trypanosoma cruzi, is present in South America. Can be vectorborne, bloodborne and congenital infection. It shows tropism through smooth cardiac and gastrointestinal muscle, as well as nerve and reticuloendothelial tissue. Inoculation site evidence, prolonged fever syndrome, and general malaise lasting between 2 and 8 weeks characterize its acute phase. Direct parasitaemia detection study or indirect serology make diagnosis. Detection of acute infections is infrequent and confirmation of oral transmission is difficult. We report one case of acute Chagas associated with oral transmission. CASE PRESENTATION Previously healthy schoolchild, with fever lasting 15 days, and facial edema. Antecedents along immediately preceding month: father, mother and pregnant sister showing acute fever syndrome associated with dyspnea with thick-drop testing positive for Chagas. Rural area dwellers of a cane and mud house. Admitted in hospital with no evidence of clinical deterioration, chagoma, cardiac or neurologic signs. Inpatient underwent treatment with benznidazol after negative malaria thick drop testing and positive micro-hematocrit by Strout method. Absence of adverse reactions, with normal hemogram, electrocardiogram, thorax X-ray and echocardiogram, followed three days later by positive ELISA: 0.63, positive immunofluorescence: 1:128 and positive PCR for Chagas. Patient left hospital to complete 60-day treatment, and follow-up by means of hepatic and renal function testing as well as hemogram. DISCUSSION Chagas’ disease is endemic in Colombia, with differential diagnosis in cases of protracted fever, in risk locations. Absence of entrance lesion in outbreak situation strongly suggests oral transmission.