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Epidemiology of Chagas Disease in the USA: High-Risk Patient Populations for Screening

  • Yagahira Castro
  • Rachel MarcusEmail author
Chagas (M Nolan, Section Editor)
  • 3 Downloads
Part of the following topical collections:
  1. Topical Collection on Chagas

Abstract

Purpose of Review

The goals of this paper are to review the current data on the prevalence of Chagas disease in the USA and to describe the obstacles to expanding screening efforts.

Recent Findings

Latin American immigrants appear to be at a significantly higher risk of contracting Chagas disease than are individuals born in the USA, though the risk of autochthonous transmission is likely underestimated. Rates of Chagas disease in the community are variable, and likely depend on the specific makeup of the immigrant community, specifically the country of origin. In patients with cardiac disease, Chagas disease becomes a more likely diagnosis as the degree of cardiac impairment progresses, and up to 19% of immigrants with non-ischemic cardiomyopathy may have this disease. Barriers to screening include lack of awareness, cost of testing, and insufficient access to accurate tests.

Summary

Chagas disease is more prevalent than generally thought by the US medical community and is a significant cause of cardiac illness in Latin American immigrants. Efforts to expand access to screening should focus on raising awareness of these data, improving serologic tests for diagnosis, and expanding access to tests.

Keywords

Chagas disease Reactivation of Chagas Trypanosoma cruzi Immigrants 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Kirchhoff L, Gam AA, Gilliam FC. American trypanosomiasis (Chagas disease) in Central American immigrants. Am J Med. 1987;82(5):915–20.CrossRefGoogle Scholar
  2. 2.
    Hagar J, Rahimtoola S. Chagas heart disease in the United States. NEJM. 1991;325:763–8.CrossRefGoogle Scholar
  3. 3.
    Bern C, Montgomery S. Chagas disease in the United States. Clin Infect Dis. 2009;49(5):e52–4.CrossRefGoogle Scholar
  4. 4.
    Custer B, Agapova M, Bruhn R, Cusick R, Kamel H, Tomasulo P, et al. Epidemiologic and laboratory findings from 3 years of testing in United States blood donors for Trypanosoma cruzi. Transfusion. 2012;52(9):1901–11.CrossRefGoogle Scholar
  5. 5.
  6. 6.
    Garcia M, Murray K, Hotez P, et al. Development of Chagas cardiac manifestations in Texas blood donors. Am J Cardiol. 2015;115:113–7.CrossRefGoogle Scholar
  7. 7.
    Cantey P, Stramer S, Townsend R, et al. Trypanosoma cruzi infection study: evidence for vector-born transmission of the parasite that causes Chagas disease among United States blood donors. Transfusion. 2012;52(9):1922–30.CrossRefGoogle Scholar
  8. 8•.
    Meymandi S, Forsyth C, Soverow J, et al. Prevalence of Chagas disease in the Latin American-born population of Los Angeles, Clin Infect Dis. 2017;64(9):1182–8. Dr. Meymandi et al. performed the first major screening program of Latin American immigrants at risk for Chagas disease. They found an overall prevalence of 1.24%, with higher rates in El Salvadorian immigrants and individuals from specific regions in Mexico.Google Scholar
  9. 9.
    Webber B, Pawlak M, Valtier S, et al. Prevalence and seroprevalence of Trypanosoma cruzi infection in a military population in Texas. Am J Trop Med Hyg. 2017;97(5):1477–81.CrossRefGoogle Scholar
  10. 10.
    Manne-Goehler J, Davis J, Perez J, et al. The Results of a Primary-Care Based Screening Program for Trypanosoma Cruzi in East Boston, Massachussets Abstract ID week. 2018.Google Scholar
  11. 11.
    Edwards M, Rench M, Todd C, et al. Perinatal screening for Chagas disease in southern Texas. J Pediatr Infect Dis Soc. 2015;4(1):67–70.CrossRefGoogle Scholar
  12. 12•.
    Traina M, Hernandez S, Sanchez D, et al. Prevalence of Chagas disease in a U.S. population of Latin American immigrants with conduction abnormalities on electrocardiogram. PLOS Negl Trop Dis. 2017;11(1):e0005244. Dr. Traina and colleagues tested patients from Chagas-endemic countries with conduction abnormalities on their ECGs for Chagas disease. While there was an overall prevalence of 5% for Chagas disease, 18% of patients with bifascicular block (RBBB and LAFB) tested positive for T Cruzi infection. CrossRefGoogle Scholar
  13. 13.
    Park S, Sanchez D, Traina M, et al. The Prevalence of Chagas Disease among Latin American Immigrants with Pacemakers in a Los Angeles, California. AJTMH. 96(5):1139–42.Google Scholar
  14. 14•.
    Traina M, Sanchez D, Hernandez S, et al. Prevalence and impact of Chagas disease among Latin American immigrants with nonischemic cardiomyopathy in Los Angeles, California. Circ Heart Fail. 2015;8:938–43. Dr. Traina and colleagues assessed seroprevalence of T. cruzi infection in Latin American immigrants with non-ischemic cardiomyopathy and found a rate of 19%. CrossRefGoogle Scholar
  15. 15.
    Kapelusznik L, Varela D, Montgomery S, et al. Chagas disease in Latin American immigrants with dilated cardiomyopathy in New York City. Clin Infect Dis. 2013;57(1):e7.CrossRefGoogle Scholar
  16. 16.
    Verani J, Montgomery S, Schulkin J, et al. Survey of obstetrician-gynecologists in the United States about Chagas disease. Am J Trop Med Hyg. 2010;83(4):891–5.CrossRefGoogle Scholar
  17. 17.
    Edwards M, Abaniye F, Montgomery S. Survery of pediatric infection disease society members about congenital Chagas disease. Ped Infect Dis J. 2018;37(1):e24–7.Google Scholar
  18. 18.
    Pane S, Giancola M, Piselli P. Serological evaluation for Chagas disease in migrants from Latin American countries resident in Rome, Italy. BMC Infect Dis. 2018;18:212–9.CrossRefGoogle Scholar
  19. 19.
    Guzman-Gomez D, Lopez-Monteon A, Lagunes-Castro M, et al. Highly discordant serology against Trypanosoma cruzi in Central Veracruz, Mexico: role of the antigen ysed for diagnostic. Parasit Vectors. 2015;8:466.CrossRefGoogle Scholar
  20. 20.
    Mita-Mendoza N, McMahon E, Kenneson A, et al. Chagas disease in southern coastal ecuador: coinfections with arboviruses and a comparison of serologic assays for chagas disease diagnosis. in press.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Bloomberg School of Public HealthWashingtonUSA
  2. 2.Medstar Union Memorial Hospital and LASOCHAWashingtonUSA

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