The bite of the bug around the eyes allows the trypanosomes to gain entry through the conjunctiva. This often results in one-sided swelling around the eye (periorbital edema) and swelling of the eyelid (Romana sign). If the entry is through the skin, a lesion called a chagoma appears. The initial lesion may go unrecognized, however, and no symptoms may appear until after more than 15 years when symptoms of chronic disease emerge. In about 10% of infected individuals acute symptoms such as muscle aches and pains, fever, sweating, and enlargement of the liver and spleen occur. If the parasitic infection involves the cardiac muscle, an acute myocarditis and heart failure may supervene causing death. Lesions may spread to involve the endocardium and stimulate the flowing blood to form a clot that may embolize. The pericardium may be involved causing pericardial effusions. Young children become more seriously ill than young adults, and in more than 10% the acute disease is fatal. Many patients recover, however, and symptoms disappear over 1–2 years. More than 40% of infected patients after a relatively symptom-free interval of several years reveal signs and symptoms of chronic Chagas disease.

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