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Background  Chagas disease is caused by the haemoflagellate protozoan  Trypanosoma cruzi . Currently,  T. cruzi  recognizes seven discrete typing units (DTUs): TcI to TcVI and Tcbat. The genetic diversity of  T. cruzi  is suspected to influence the clinical outcome. Acute clinical manifestations, which include myocarditis and meningoencephalitis, are sometimes fatal; occur most frequently in children and in immunocompromised individuals. Acute disease is often overlooked, leading to a poor prognosis.    Case presentation  A 38-year-old man from a subtropical area of the Andes mountains of Ecuador was hospitalized after 3 weeks of evolution with high fever, chills, an enlarged liver, spleen, and lymph nodes, as well as facial edema. ECG changes were also observed.  T. cruzi  was identified in blood smears, culture and amplification of DNA by PCR. Tests for anti- T. cruzi  IgG and IgM and HIV were negative. Molecular typing by restriction fragment length polymorphism (PCR-RFLP) determined the parasite to DTU TcI. In the absence of a timely anti- T. cruzi  medication, the patient died.    Conclusions  This is a case of severe pathogenicity and the virulence of a DTU TcI strain in an adult patient. The severe acute Chagas disease was probably overlooked due to limited awareness and its low incidence. Our findings suggest that  T. cruzi  DTU TcI strains circulating in Ecuador are capable of causing fatal acute disease. Early diagnosis and prompt treatment is of paramount importance to avoid fatalities in acute infections.

Fatal acute Chagas disease by Trypanosoma cruzi DTU TcI, Ecuador