https://orcid.org/0000-0003-3047-4234
Figures
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
Editor: Paul J. Brindley, George Washington University School of Medicine and Health Sciences, UNITED STATES
Published: November 12, 2020
Copyright: © 2020 Beucler et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
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].
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.
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 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.
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