Carlos Chagas
Encyclopedia
Carlos Justiniano Ribeiro Chagas, or Carlos Chagas (ˈkaʁlus ˈʃaɡɐs; 1879–1934), was a Brazil
Brazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...

ian sanitary physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

, scientist
Scientist
A scientist in a broad sense is one engaging in a systematic activity to acquire knowledge. In a more restricted sense, a scientist is an individual who uses the scientific method. The person may be an expert in one or more areas of science. This article focuses on the more restricted use of the word...

 and bacteriologist who worked as a clinician and researcher
Researcher
A researcher is somebody who performs research, the search for knowledge or in general any systematic investigation to establish facts. Researchers can work in academic, industrial, government, or private institutions.-Examples of research institutions:...

. He discovered Chagas disease
Chagas disease
Chagas disease is a tropical parasitic disease caused by the flagellate protozoan Trypanosoma cruzi. T. cruzi is commonly transmitted to humans and other mammals by an insect vector, the blood-sucking insects of the subfamily Triatominae most commonly species belonging to the Triatoma, Rhodnius,...

, also called American trypanosomiasis in 1909, while working at the Oswaldo Cruz Institute
Instituto Oswaldo Cruz
The Oswaldo Cruz Foundation is a scientific institution for research and development in biomedical sciences located in Rio de Janeiro, Brazil, it is considered one of the world's main public health research institutions. It was founded by Dr...

 in Rio de Janeiro. Chagas’ work is unique in the history of medicine
History of medicine
All human societies have medical beliefs that provide explanations for birth, death, and disease. Throughout history, illness has been attributed to witchcraft, demons, astral influence, or the will of the gods...

, because he was the only researcher so far to describe completely a new infectious disease
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...

: its pathogen
Pathogen
A pathogen gignomai "I give birth to") or infectious agent — colloquially, a germ — is a microbe or microorganism such as a virus, bacterium, prion, or fungus that causes disease in its animal or plant host...

, vector (Triatominae
Triatominae
The members of Triatominae , a subfamily of Reduviidae, are also known as conenose bugs, kissing bugs, assassin bugs or triatomines. Most of the 130 or more species of this subfamily are haematophagous, i.e. feed on vertebrate blood; a very few species feed on other invertebrates...

), host
Host (biology)
In biology, a host is an organism that harbors a parasite, or a mutual or commensal symbiont, typically providing nourishment and shelter. In botany, a host plant is one that supplies food resources and substrate for certain insects or other fauna...

, clinical manifestations and epidemiology
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...

. Chagas was also the first to discover and illustrate the parasitic fungal genus Pneumocystis
Pneumocystis pneumonia
Pneumocystis pneumonia or pneumocystosis is a form of pneumonia, caused by the yeast-like fungus Pneumocystis jirovecii...

, later infamously to be linked to PCP (Pneumocystis pneumonia
Pneumocystis pneumonia
Pneumocystis pneumonia or pneumocystosis is a form of pneumonia, caused by the yeast-like fungus Pneumocystis jirovecii...

 in AIDS victims).

Early life

Chagas was the son of José Justiniano das Chagas, a coffee farmer from Minas Gerais, and Mariana Cândida Chagas. After his secondary studies at Itu
Itu
Itu is an old and historic municipality in the state of São Paulo in Brazil. The population in 2009 was 157,384 and the area is 641.68 km². The elevation is 583 m. This place name comes from the Tupi language, meaning big waterfall. Itu is linked with the highway numbered the SP-75 and are flowed...

, São Paulo
São Paulo (state)
São Paulo is a state in Brazil. It is the major industrial and economic powerhouse of the Brazilian economy. Named after Saint Paul, São Paulo has the largest population, industrial complex, and economic production in the country. It is the richest state in Brazil...

 and São João del Rei
São João del Rei
São João del-Rei also spelled São João del Rey or São João del Rei is a historical city in the state of Minas Gerais, Brazil.Population: 40,600 inhabitants....

, he enrolled in the School of Mining Engineering at Ouro Preto
Ouro Preto
-History:Founded at the end of the 17th century, Ouro Preto was originally called Vila Rica, or "rich village," the focal point of the gold rush and Brazil's golden age in the 18th century under Portuguese rule....

, but changed to the Medical School of Rio de Janeiro in 1897, influenced by his uncle, who was a physician and owner of a hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....

 at that city. He graduated in 1902 and got his M.D. in the following year with a thesis on the hematology
Hematology
Hematology, also spelled haematology , is the branch of biology physiology, internal medicine, pathology, clinical laboratory work, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases...

 of malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...

, working at the new medical research institute created by noted physician and, later, friend and colleague, Oswaldo Cruz
Oswaldo Cruz
Oswaldo Gonçalves Cruz, better known as Oswaldo Cruz |São Paulo]] state, Brazil – February 11, 1917, Petrópolis, Rio de Janeiro state) was a Brazilian physician, bacteriologist, epidemiologist and public health officer and the founder of the Oswaldo Cruz Institute.He also occupied the 5th chair of...

 (1872–1917).

After a brief stint as a medical practitioner in the hinterlands, Chagas accepted a position in the port
Port
A port is a location on a coast or shore containing one or more harbors where ships can dock and transfer people or cargo to or from land....

 authority of Santos
Santos (São Paulo)
-Sister cities: Shimonoseki, Japan Nagasaki, Japan Funchal, Portugal Trieste, Italy Coimbra, Portugal Ansião, Portugal Arouca, Portugal Ushuaia, Argentina Havana, Cuba Taizhou. China Ningbo. China Constanţa, Romania Ulsan, South Korea Colón, Panama* Cadiz, Spain...

, São Paulo, with the mission of fighting the malaria epidemic which was affecting its workers. There he introduced an innovation, which consisted in using pyrethrum
Pyrethrum
Pyrethrum refers to several Old World plants of the genus Chrysanthemum which are cultivated as ornamentals for their showy flower heads. Pyrethrum is also the name of a natural insecticide made from the dried flower heads of C. cinerariifolium and C...

, an insecticide
Insecticide
An insecticide is a pesticide used against insects. They include ovicides and larvicides used against the eggs and larvae of insects respectively. Insecticides are used in agriculture, medicine, industry and the household. The use of insecticides is believed to be one of the major factors behind...

, to disinfect households, with surprising success. His published work on this method served as the basis of prevention
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...

 of malaria all over the world and was adopted by a service of the Ministry of Health in Brazil which was established expressly for this purpose.

The discovery of Chagas disease

In 1906, Chagas returned to Rio de Janeiro and joined the Oswaldo Cruz Institute
Instituto Oswaldo Cruz
The Oswaldo Cruz Foundation is a scientific institution for research and development in biomedical sciences located in Rio de Janeiro, Brazil, it is considered one of the world's main public health research institutions. It was founded by Dr...

, where he remained working for the rest of his life. In 1909, he was sent by the Institute to the small city of Lassance
Lassance
Lassance is a Brazilian municipality located in the north of the state of Minas Gerais. In 2007 the population was 6,458 in a total area of 3,213 km². It became a municipality in 1953.-Location and Distances:...

, near the São Francisco River
São Francisco River
The São Francisco is a river in Brazil. With a length of , it is the longest river that runs entirely in Brazilian territory, and the fourth longest in South America and overall in Brazil...

, to combat a malaria outbreak among the workers of a new railroad to the city of Belém
Belém
Belém is a Brazilian city, the capital and largest city of state of Pará, in the country's north region. It is the entrance gate to the Amazon with a busy port, airport and bus/coach station...

 in the Amazon
Amazon Rainforest
The Amazon Rainforest , also known in English as Amazonia or the Amazon Jungle, is a moist broadleaf forest that covers most of the Amazon Basin of South America...

. He stayed there for the next two years and soon was able to observe the peculiar infestation of the rural houses with a large hematophagous insect
Insect
Insects are a class of living creatures within the arthropods that have a chitinous exoskeleton, a three-part body , three pairs of jointed legs, compound eyes, and two antennae...

 of the genus Triatoma
Triatoma
Triatoma is a genus of assassin bug in the subfamily Triatominae The members of Triatoma are blood-sucking insects that can transmit serious diseases, such as Chagas disease....

, a kind of "assassin bug" or "kissing" bug (barbeiro or "barber" in Portuguese
Portuguese language
Portuguese is a Romance language that arose in the medieval Kingdom of Galicia, nowadays Galicia and Northern Portugal. The southern part of the Kingdom of Galicia became independent as the County of Portugal in 1095...

, so called because it sucked the blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

 at night by biting the faces of its victims). He discovered that the intestine
Intestine
In human anatomy, the intestine is the segment of the alimentary canal extending from the pyloric sphincter of the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine...

s of these insects harbored flagellate
Flagellate
Flagellates are organisms with one or more whip-like organelles called flagella. Some cells in animals may be flagellate, for instance the spermatozoa of most phyla. Flowering plants do not produce flagellate cells, but ferns, mosses, green algae, some gymnosperms and other closely related plants...

 protozoa
Protozoa
Protozoa are a diverse group of single-cells eukaryotic organisms, many of which are motile. Throughout history, protozoa have been defined as single-cell protists with animal-like behavior, e.g., movement...

, a new species of the Trypanosoma
Trypanosoma
Trypanosoma is a genus of kinetoplastids , a monophyletic group of unicellular parasitic flagellate protozoa. The name is derived from the Greek trypano and soma because of their corkscrew-like motion. All trypanosomes are heteroxenous and are transmitted via a vector...

genre, and was able to prove experimentally that it could be transmitted to marmoset
Marmoset
Marmosets are the 22 New World monkey species of the genera Callithrix, Cebuella, Callibella, and Mico. All four genera are part of the biological family Callitrichidae. The term marmoset is also used in reference to the Goeldi's Monkey, Callimico goeldii, which is closely related.Most marmosets...

 monkeys which were bitten by the infected bug. Chagas named this new parasite Trypanosoma cruzi in honor of Oswaldo Cruz and later that year as Schizotrypanum cruzi and then once again as Trypanosoma cruzi.)

Chagas suspected that the parasite could cause human disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

, due to the prevalence of the insect
Insect
Insects are a class of living creatures within the arthropods that have a chitinous exoskeleton, a three-part body , three pairs of jointed legs, compound eyes, and two antennae...

 vector in human households and its habit of biting people, so he took blood samples and, on April 23, 1909, discovered for the first time the same Trypanosoma parasite in the blood of a three year-old girl. He also observed parasitic inclusions in the brain and myocardium which would explain some of the clinical manifestations in diseased people and closed the proposed life cycle of the parasite by suggesting that the armadillo
Armadillo
Armadillos are New World placental mammals, known for having a leathery armor shell. Dasypodidae is the only surviving family in the order Cingulata, part of the superorder Xenarthra along with the anteaters and sloths. The word armadillo is Spanish for "little armored one"...

 could be its natural reservoir
Natural reservoir
Natural reservoir or nidus, refers to the long-term host of the pathogen of an infectious disease. It is often the case that hosts do not get the disease carried by the pathogen or it is carried as a subclinical infection and so asymptomatic and non-lethal...

. To complete his work on the pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

 of the new disease, Chagas described 27 cases of the acute form of the disease and performed more than 100 autopsies
Autopsy
An autopsy—also known as a post-mortem examination, necropsy , autopsia cadaverum, or obduction—is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present...

 on patients who exhibited the chronic
Chronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...

 form.

His description of the new disease was to become a classic in medicine and brought him domestic and international distinction. He was elected to the National Academy of Medicine and received the prestigious Schaudinn Prize for the best work in protozoology
Protozoology
Protozoology is the study of protozoa, the "animal-like" protists. This term has become dated as our understanding of the evolutionary relationships of the eukaryota has improved....

 and tropical medicine
Tropical medicine
Tropical medicine is the branch of medicine that deals with health problems that occur uniquely, are more widespread, or prove more difficult to control in tropical and subtropical regions....

, on June 22, 1912. The contenders were luminaries such as Paul Ehrlich
Paul Ehrlich
Paul Ehrlich was a German scientist in the fields of hematology, immunology, and chemotherapy, and Nobel laureate. He is noted for curing syphilis and for his research in autoimmunity, calling it "horror autotoxicus"...

 (1854–1915), Emile Roux (1853–1933), Ilya Mechnikov
Ilya Ilyich Mechnikov
Ilya Ilyich Mechnikov was a Russian biologist, zoologist and protozoologist, best remembered for his pioneering research into the immune system. Mechnikov received the Nobel Prize in Medicine in 1908, shared with Paul Ehrlich, for his work on phagocytosis...

 (1845–1916), Charles Laveran (1845–1922), Charles Nicolle
Charles Nicolle
Charles Jules Henry Nicolle was a French bacteriologist who received the Nobel Prize in Medicine for his identification of lice as the transmitter of epidemic typhus.- Biography :...

 (1866–1936) and Sir William Boog Leishman
William Boog Leishman
Lieutenant-General Sir William Boog Leishman FRS was a Scottish pathologist and British Army medical officer. He was Director-General of Army Medical Services from 1923 to 1926....

 (1865–1926), several of them who had already received or would receive the Nobel Prize
Nobel Prize
The Nobel Prizes are annual international awards bestowed by Scandinavian committees in recognition of cultural and scientific advances. The will of the Swedish chemist Alfred Nobel, the inventor of dynamite, established the prizes in 1895...

 for Medicine. Chagas was twice nominated for the Nobel Prize, in 1913 and 1921, but never received the award.

Chagas was also the first to discover the parasitic fungal genus Pneumocystis
Pneumocystis pneumonia
Pneumocystis pneumonia or pneumocystosis is a form of pneumonia, caused by the yeast-like fungus Pneumocystis jirovecii...

 in the lungs of his Trypanosome-experimentally infected animals. At the time he did not recognize it as a separate organism and therefore he described his genus Schizotrypanum to accommodate both life-cycles that he illustrated beautifully. But, his discovery led others to further investigate and describe Pneumocystis as a distinct genus, which is now known to be a fungus. Chagas, followed the literature closely and quickly confirmed the distinction, whereupon he again adopted the name Trypanosoma cruzi that he had originally coined. Pneumocystis is now linked to another disease, PCP or Pneumocystis pneumonia
Pneumocystis pneumonia
Pneumocystis pneumonia or pneumocystosis is a form of pneumonia, caused by the yeast-like fungus Pneumocystis jirovecii...

 caused by one species (P. jirovecii) but the original Pneumocystis species seen by Chagas in Guinea pig
Guinea pig
The guinea pig , also called the cavy, is a species of rodent belonging to the family Caviidae and the genus Cavia. Despite their common name, these animals are not in the pig family, nor are they from Guinea...

s has not yet been named as a separate species.

Later life

After the death of his mentor in 1917, Chagas accepted Cruz's directorship of the Institute, a post he held until his death in 1934. From 1920 to 1924 he became the director of the Department of Health in Brazil. Chagas was very active in organizing special health care and prevention services and campaigns for the Spanish flu
Spanish flu
The 1918 flu pandemic was an influenza pandemic, and the first of the two pandemics involving H1N1 influenza virus . It was an unusually severe and deadly pandemic that spread across the world. Historical and epidemiological data are inadequate to identify the geographic origin...

 epidemics, sexually transmitted diseases, leprosy
Leprosy
Leprosy or Hansen's disease is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Named after physician Gerhard Armauer Hansen, leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions...

, pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...

, tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

 and rural endemic
Endemic (epidemiology)
In epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. For example, chickenpox is endemic in the UK, but malaria is not...

 diseases. He created a nursing
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....

 school and was the founder of the concept of sanitary medicine, the first chair of tropical medicine and the graduate study of hygiene
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...

.

Chagas' discovery was recognized at home and abroad as one of the most important achievements in parasitology
Parasitology
Parasitology is the study of parasites, their hosts, and the relationship between them. As a biological discipline, the scope of parasitology is not determined by the organism or environment in question, but by their way of life...

. He was twice nominated for the Nobel Prize in Physiology or Medicine
Nobel Prize in Physiology or Medicine
The Nobel Prize in Physiology or Medicine administered by the Nobel Foundation, is awarded once a year for outstanding discoveries in the field of life science and medicine. It is one of five Nobel Prizes established in 1895 by Swedish chemist Alfred Nobel, the inventor of dynamite, in his will...

 (in 1913 and 1921), but he never received the award. Chagas' main foe was Dr. Júlio Afrânio Peixoto
Júlio Afrânio Peixoto
Dr. Júlio Afrânio Peixoto was a Brazilian physician, writer, politician, historian, university president, and pioneering eugenicist...

, the leader of eugenics
Eugenics
Eugenics is the "applied science or the bio-social movement which advocates the use of practices aimed at improving the genetic composition of a population", usually referring to human populations. The origins of the concept of eugenics began with certain interpretations of Mendelian inheritance,...

 in Brazil
Brazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...

, who held many academical titles and was fluent in several foreign languages. Afrânio Peixoto campaigned against Carlos Chagas and his great work, and nobody was granted the Nobel Prize in medicine in 1921, when Carlos Chagas was the only real candidate for the prize.

He did, however, persuade Argentine physician Dr. Salvador Mazza
Salvador Mazza
Salvador Mazza was a noted Argentine physician and epidemiologist, best known for his strides in helping control American trypanosomiasisan endemic disease among the rural, poor majority of early 20th century South America....

 to research the epidemic, leading to the latter's confirmation of the existence of trypanosoma cruzi
Trypanosoma cruzi
Trypanosoma cruzi is a species of parasitic euglenoid trypanosomes. This species causes the trypanosomiasis diseases in humans and animals in America...

in Argentina in 1927, and eventually to government action. Chagas died in Rio de Janeiro from an acute heart infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

 in 1934, at only 55 years of age.

One of his sons, Dr. Carlos Chagas Filho
Carlos Chagas Filho
Carlos Chagas Filho was a Brazilian physician, biologist and scientist active in the field of neuroscience. He was internationally renowned for his investigations on the neural mechanisms underlying the phenomenon of electrogenesis by the electroplaques of electric fishes...

 (1910–2000), became an eminent and internationally recognized scientist in the field of neurophysiology
Neurophysiology
Neurophysiology is a part of physiology. Neurophysiology is the study of nervous system function...

 and president of the Pontifical Academy of Sciences
Pontifical Academy of Sciences
The Pontifical Academy of Sciences is a scientific academy of the Vatican, founded in 1936 by Pope Pius XI. It is placed under the protection of the reigning Supreme Pontiff. Its aim is to promote the progress of the mathematical, physical and natural sciences and the study of related...

. Another son, Evandro Chagas
Evandro Chagas
Evandro Chagas , was a Brazilian physician and biomedical scientist specializing in tropical medicine.He was born in Rio de Janeiro, the eldest son of Carlos Chagas , noted physician and scientist who discovered Chagas disease, and brother of Carlos Chagas Filho , also a noted physician and...

 (1905–1940), was also a physician and researcher in tropical medicine
Tropical medicine
Tropical medicine is the branch of medicine that deals with health problems that occur uniquely, are more widespread, or prove more difficult to control in tropical and subtropical regions....

, who died accidentally at 35 years of age. His name is honoured by the important biomedical institution Instituto Evandro Chagas, in Belém
Belém
Belém is a Brazilian city, the capital and largest city of state of Pará, in the country's north region. It is the entrance gate to the Amazon with a busy port, airport and bus/coach station...

, state of Pará
Pará
Pará is a state in the north of Brazil. It borders the Brazilian states of Amapá, Maranhão, Tocantins, Mato Grosso, Amazonas and Roraima. To the northwest it also borders Guyana and Suriname, and to the northeast it borders the Atlantic Ocean. The capital is Belém.Pará is the most populous state...

.

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