An indurated area of erythema and swelling (the chagoma) with local lymphadenopathy develops ≥1 week after parasite invasion and generally precedes malaise, fever, anorexia, and edema of the face and lower extremities.

• Romaña's sign—unilateral painless edema of the palpebrae and periocular tissues—occurs when the conjunctiva is the portal of entry.
• Acute disease resolves spontaneously within 4-8 weeks, and pts enter an asymptomatic phase of chronic infection.
• Symptomatic chronic disease becomes apparent years or even decades after initial infection.
  • - Cardiac symptoms are common and include rhythm disturbances, segmental or dilated cardiomyopathy, and thromboembolism.
  • - Pts can develop megaesophagus and suffer from dysphagia, odynophagia, chest pain, and regurgitation.
  • - Megacolon may develop, leading to abdominal pain, chronic constipation, fecaloma formation, obstruction, and volvulus.