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Background  Outbreaks of acute Chagas disease associated with oral transmission are easily detected nowadays with trained health personnel in areas of low endemicity, or in which the vector transmission has been interrupted. Given the biological and genetic diversity of  Trypanosoma cruzi , the high morbidity, mortality, and the observed therapeutic failure, new characteristics of these outbreaks need to be addressed at different levels, both in  Trypanosoma cruzi  as in patient response. The aim of this work was to evaluate the patient’s features involved in six outbreaks of acute Chagas disease which occurred in Santander, Colombia, and the characteristics of  Trypanosoma cruzi  clones isolated from these patients, to establish the potential relationship between the etiologic agent features with host behavior.    Methods  The clinical, pathological and epidemiological aspects of outbreaks were analyzed. In addition,  Trypanosoma cruzi  clones were biologically characterized both  in vitro  and in vivo, and the susceptibility to the classical trypanocidal drugs nifurtimox and benznidazole was evaluated.  Trypanosoma cruzi  clones were genotyped by means of mini-exon intergenic spacer and cytochrome b genes sequencing.    Results  All clones were DTU I, and based on the mini-exon intergenic spacer, belong to two genotypes: G2 related with sub-urban, and G11 with rural outbreaks. Girón outbreak clones with higher susceptibility to drugs presented G2 genotype and C/T transition in  Cyt b . The outbreaks affected mainly young population (±25.9 years), and the mortality rate was 10 %. The cardiac tissue showed intense inflammatory infiltrate, myocardial necrosis and abundant amastigote nests. However, although the gastrointestinal tissue was congestive, no inflammation or parasites were observed.    Conclusions  Although all clones belong to DTU I, two intra-DTU genotypes were found with the sequencing of the mini-exon intergenic spacer, however there is no strict correlation between genetic groups, the cycles of the parasite or the clinical forms of the disease.  Trypanosoma cruzi  clones from Girón with higher sensitivity to nifurtimox presented a particular G2 genotype and C/T transition in  Cyt b . When the diagnosis was early, the patients responded well to antichagasic treatment, which highlights the importance of diagnosis and treatment early to prevent fatal outcomes associated with these acute episodes.    Electronic supplementary material  The online version of this article (doi:10.1186/s13071-015-1218-2) contains supplementary material, which is available to authorized users.

Acute chagas outbreaks: molecular and biological features of Trypanosoma cruzi isolates, and clinical aspects of acute cases in Santander, Colombia