The clinically relevant pathognomonic consequences of human
infection by Trypanosoma cruzi are dilation and
hypertrophy of the left ventricle walls and thinning of the apex. The major complications and debilitating evolutionary outcomes of
chronic infection include
ventricular fibrillation,
thromboembolism and
congestive heart failure.
American trypanosomiasis (
Chagas disease) poses serious public healthcare and budgetary concerns. The currently available drugs, although effective against acute
infection, are highly toxic and ineffective in arresting or attenuating clinical disease symptoms in chronic patients. The development of an efficacious prophylactic
vaccine faces many challenges, and progress is slow, despite several years of effort. Studies in animal models and human patients have revealed the pathogenic mechanisms during
disease progression, pathology of disease and features of protective immunity. Accordingly, several
antigens,
antigen-delivery vehicles and adjuvants have been tested in animal models, and some efforts have been successful in controlling
infection and disease. This review will summarize the accumulated knowledge about the parasite and disease, as well as pathogenesis and protective immunity. The authors will discuss the efforts to date, and the challenges faced in achieving an efficient prophylactic
vaccine against human
American trypanosomiasis, and present the future perspectives.