A tribute to Cecilio Romaña: Romaña’s sign in Chagas disease

Abstract

Introduction Chagas disease refers to the infection by the parasite Trypanosoma cruzi, transmitted by the bite of species of Triatoma, also known as the kissing bug. Cecilio Romaña in the province of Chaco, Argentina. https://doi.org/10.1371/journal.pntd.0008836.g003 During those times, people slept in thatched cottages which provided an environment that was particularly hospitable for the Reduviid bug, also known as the kissing bug, for its characteristic blood-sucking bite on the face. Acta Trop. 2010;115:5–13. pmid:20382097 About the Authors: Nathan Beucler * E-mail: [email protected] Affiliations Neurosurgery Department, Sainte-Anne Military Teaching Hospital, Toulon, France, Ecole du Val-de-Grâce, Paris, France ORCID logo https://orcid.org/0000-0003-3047-4234 Faustino Torrico Affiliation: Faculty of Medicine, Universidad Mayor de San Simon, Cochabamba, Bolivia ORCID logo https://orcid.org/0000-0002-5609-1824 David Hibbert Affiliation: Department of Internal Medicine, UC San Diego Medical Center, San Diego, California, United States of America

Introduction

Chagas disease refers to the infection by the parasite Trypanosoma cruzi, transmitted by the bite of species of Triatoma, also known as the kissing bug. The disease plagued South America at a pandemic scale during the early 20th century [1]. At that time, a few researchers devoted themselves to this infection, like Carlos Chagas, Emmanuel Dias, Emile Roubaud, or even Cecilio Romaña (Fig 1). The latter described the transmission pathway through the conjunctiva that leads to periorbital painless swelling, which is known as the Romaña’s sign and indicates acute Chagas disease (Fig 2) [2].

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Fig 1. Cecilio Romaña working with Emile Roubaud.

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Fig 2. Girl with Romaña’s sign taken in the courtyard of the Faculty of Medicine, Universidad Mayor de San Simón, Bolivia around 1980.

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Testimony

During a consultation in the middle of the night in the emergency department of Sainte-Anne Military Teaching Hospital in France, we incidentally met Louis Alexandre Romaña, son of Cecilio Romaña. By personal curiosity, we asked him about his father.

“Dr. Cecilio Romaña is known to the world for Romaña’s sign, but to me, he was my father. Beyond his interests in medicine, he was a sculptor, a writer, and a researcher in northern Argentina. At that time, there was an extensive indigenous population working in the logging industry who were falling severely ill to Chagas disease on an epidemic scale (Fig 3). He began studying the disease and met with Evandro Chagas, the son of Carlos Chagas, in Brazil. Through his research he discovered the periorbital swelling syndrome (1935), which is one of the initial signs of Trypanosoma cruzi invading the bloodstream.

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Fig 3. Cecilio Romaña in the province of Chaco, Argentina.

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During those times, people slept in thatched cottages which provided an environment that was particularly hospitable for the Reduviid bug, also known as the kissing bug, for its characteristic blood-sucking bite on the face. At night this insect would climb down from the roof, bite the inhabitant’s face and defecate the T. cruzi parasite. The bite is irritating to the skin which would cause people to scratch and rub the stool into their eye allowing the trypanosome parasite to penetrate through the conjunctiva which causes inflammation. The Brazilians decided that it would be called Romaña’s sign in honor of his discovery.”

In memory of Dr. Cecilio Romaña, 1899–1997 (S1 Text)

Louis Alexandre Romaña, son of Cecilio Romaña

July 31, 2019

Discussion

Because of vector control, acute Chagas disease with Romaña’s sign has become a rarity, even in South America [3]. These pictures remind us of 50 years of tropical medicine, from Romaña’s discovery in the 1930s as recounted by his son to a girl with acute Chagas disease in Bolivia in the 1980s.

Permission to reuse material

Louis-Alexandre Romaña has granted permission for the reuse of the photographs that he owns and that he has provided (Figs 1 and 3) and for his letter. Written permission is included as Supporting information.

Dr. Faustino TORRICO has granted permission for the reuse of the photograph that he owns and that he has provided (Fig 2).

Supporting information

S1 Text. Original text in French.

https://doi.org/10.1371/journal.pntd.0008836.s001

(DOCX)

S1 Authorization. Authorization to publish testimony.

https://doi.org/10.1371/journal.pntd.0008836.s002

(JPG)

Acknowledgments

The authors wish to thank Louis-Alexandre Romaña for his honesty in his testimony regarding his father (S1 Authorization; authorization to publish testimony) and for the generosity of sharing his father’s photographs.

Citation: Beucler N, Torrico F, Hibbert D (2020) A tribute to Cecilio Romaña: Romaña’s sign in Chagas disease. PLoS Negl Trop Dis 14(11): e0008836. https://doi.org/10.1371/journal.pntd.0008836

References

1. Dias J, Silveira A, Schofield C. The impact of Chagas disease control in Latin America: a review. Memórias do Instituto Oswaldo Cruz. 2002;97:603–612. pmid:12219120

2. Romana C. About um initial symptom or diagnostic value for acute form of Chagas disease: esquizotripanósica unilateral conjunctivitis: hypothesis on the front door conjunctival disease. 22nd ed. Mission de Estudios de Patologia Regional Argentina; 1935.

3. Coura JR, Borges-Pereira J. Chagas disease: 100 years after its discovery. A systemic review. Acta Trop. 2010;115:5–13. pmid:20382097