Chagas' Disease: Differential diagnosis

• Chagas’ cardiomyopathy. Differentiation from ischaemic, hypertensive or idiopathic cardiomyopathy is not always easy. The differential diagnosis includes high-output heart failure (anaemia, beriberi, hyperthyroidism, large AV-fistula and Paget’s disease of the bone), postpartum heart failure, acute rheumatic fever, valvular disease, congenital abnormalities, pericardial disorders and the sequelae of acute myocarditis (e.g. Coxsackie virus). A cor pulmonale is usually obvious. It is useful to have an electrocardiogram available and if possible an ultrasound evaluation.

• Mega-oesophagus: Achalasia of the oesophagus may be very similar to Chagas’ oesophageal dilation. Strictures, benign and malignant tumours should be ruled out.

• Megacolon may also occur in Hirschsprung’s disease [congenital megacolon] [aganglionosis of a rectal segment, frequency 1/5000], diabetic neuropathy, psychogenic (mainly in psychosis, schizophrenia), after stricture (e.g. upon ischaemic insult of the colon or rectal stricture due to schistosomiasis or lymphogranuloma venereum), chronic severe laxative misuse (senna, cascara, aloe), neurological diseases (Parkinson’s disease, myotonic dystrophy), chronic use of morphine analogues, chronic lead intoxication, Fabry’s disease (glycolipid accumulation), systemic sclerosis (scleroderma), severe hypothyroidism and amyloidosis.

Category: Medicine Notes