**5. Clinical presentation**

As mentioned above, Chagas disease has two phases of development, the acute and the chronic period. The acute phase can occur at any age, has an incubation period of 4–14 days, and a duration of 2–4 months. It is asymptomatic in 95% of cases when symptoms occur, these include fever (75%), inflammation in the inoculation site (inoculation chagoma, 25%), unilateral eyelid edema (Romaña-Mazza sign; when the conjunctiva is the gateway, 50%) (**Figure 2**), lymphadenopathy, and hepatosplenomegaly. The acute phase lasts 4–8 weeks, and parasitemia decreases substantially from day 90 onwards. A severe acute phase occurs in less than 1–5% of patients, including manifestations, such as acute myocarditis, pleural effusion, and meningoencephalitis (mortality risk 0.2–0.5% [8].

Cases of congenital infection are generally characterized by the absence of symptoms in 70–80% of cases. The remaining 20–30% may have signs and symptoms, such as prematurity, low weight for gestational age, edema, jaundice, respiratory distress, persistent tachycardia, hepatosplenomegaly, and anemia. Occasionally sepsis, fever, hydrops fetalis, rash, petechiae, lymphadenopathy, meningoencephalitis, cerebral calcifications, fundus abnormalities, interstitial pneumonia, myocarditis.

**Figure 2.** *Flagellated tripoamastigote causing the circulating phase of the disease.*

It can be classified as asymptomatic, early symptoms (<less than 30 days old), or late symptoms (> 30 days old) [8].

The specific symptoms, which occur in the chronic stage, will depend directly on the organ that is affected and the damage that has occurred during the entire period of the disease. There is an asymptomatic chronic phase. This is characterized by the absence of symptoms and the presence of parasitemia and/or positive serology. This form can persist but only 30% of the patient the rest may progress to symptomatic form over a period of 10–30 years.

The symptomatic phase consists of the presence of chronic heart disease (cardiomegaly) represents the main cause of mortality and/or gastrointestinal disease (megaesophagus, megacolon, megaileum, megastomach, megabladder, megaduodenum, and megajejunum) with fluctuating parasitemia levels.
