Etiology of Chagas disease myocarditis: autoimmunity, parasite persistence, or both?

In Chagas disease, caused by Trypanosoma cruzi, the scarcity of parasites in the chronic phase of the disease contrasts with the severe cardiac pathology observed in similar to30% of chronic patients, and suggests a role for autoimmunity as the origin of the pathology. Recent studies on parasite detection, however, suggest that parasite persistence is the main cause of Chagas disease. To date, there is no conclusive evidence for the pathogenic role of either autoimmunity or parasite-specific immunity. Here, the most recent evidence in favour of each hypothesis is discussed.