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Introduction. Classically, Chagas disease (ChD) is a rural disease with vectorial transmission. Oral transmission and the gradual increase of the finding of Panstrongylus geniculatus in Caracas, Venezuela, warrant an update of the epidemiological situation. Objective. To communicate the epidemiological, clinical and laboratorial diagnostic characteristics of Trypanosoma cruzi human transmission in Caracas. Materials and Methods. We selected cases of the Immunology Department at the Tropical Medicine Institute-Caracas studying also their contacts and inspecting the patient's house. The laboratory diagnosis was based on parasite demonstration in blood and determination of specific antibodies by ELISA and indirect hemagglutination. Results. Between 1998 and 2007, ChD was diagnosed in 75 persons born and living in Caracas. Three infants with acute myocarditis and demonstration of chagasic infection died during that period. P. geniculatus was found in some patient's houses. An outbreak of ChD in 103 persons, whose common risk was the ingestion of manually prepared juice in the morning snack, took place in an urban school. We explain the clinical characteristics of vectorial and oral cases in the city of Caracas and give particular diagnosis features. Conclusions. Although P. geniculatus is not an efficient vector, its coexistence with humans in Caracas is making food contamination possible and is forcing vectorial transmission. There must be an under recording of cases because the ChD screening is not done routinely. The demonstration of urban transmission of Trypanosoma cruzi should lead to modifications in the control strategy of ChD. [ABSTRACT FROM AUTHOR]

Introduction: Chagas disease (ChD) is usually transmitted to man by cutaneous penetration of parasites contained in the feces of haematofagous vectors known as "kissing bugs or chipos". however, other transmission mechanisms may occur. herein, we report the first diagnosed case of an epidemic outbreak of acute oral transmitted ChD occurred in December 2007 in a school of Caracas. Clinical case: A 9 year old schoolgirl, coming from Caracas, was hospitalized with daily fever 39-40°C and chills of three weeks duration, sickness, vomitting, astenia, mialgias, cervical adenopathies, hepatomegaly, facial and inferior members edema. The laboratory tests showed lymphomonocytosis, negative serologies for mononucleosis and dengue. In the blood smear done to rule out malaria, tripomastigote of Trypanosoma cruzi was found. ElISA-Igm, ElISA-IgG, indirect hemaglutination, polymerase chain reaction, culture and mice inoculation were all positive for ChD. Few days after, similar cases were detected and it was carried out the epidemiological link that allowed the recognition of an urban outbreak of ChD of oral transmission. The patient evolved satisfactorily after being treated with nifurtimox. Discussion: In the oral form of transmission of the ChD, signs of entrance do not exist, the clinical manifestations as high and prolonged fever and edema are common to other pathologies. In patients with fever of unknown origin, blood smear as well as search for specific Igm and IgG for ChD should be included as part of the diagnosis. Conclusion: The first case is described in detailed form, considered index case of the outbreak of acute Chagas acquired by food ingestion in a school of Chacao's county in Caracas. [ABSTRACT FROM AUTHOR]