Year: 2021
Type: article
Abstract: Chagas disease, caused by the parasite Trypanosoma cruzi, is a leading cause of heart failure in Latin America, with a significantly worse prognosis than other causes of cardiomyopathy. 1 Unfortunately, less than 1% of infected persons in the United States and endemic countries receive antiparasitic treatment.2,3 The lack of standardized surveillance and prompt treatment leaves infected individuals vulnerable to life-long chronic infection, which in 20% to 30% of infected individuals can manifest as gastrointestinal tract organomegaly or cardiac system abnormalities.In those who develop cardiac disease, illness manifests as dilated cardiomyopathy, thromboembolism, or sudden cardiac death.4 Immunocompromised patients can develop severe disease during the acute phase or reactivation at any point during their lifetime.Reactivation typically manifests as myocarditis or central nervous system (CNS) disease, and should be considered in those diagnosed with HIV infection, or those undergoing cancer chemotherapy or receiving organ or bone marrow transplantation.5 This neglected tropical disease has increasingly become globalized as immigrant populations from endemic areas of Central and South America establish themselves in the United States, Europe, Japan, and elsewhere.6 More than 300,000 infected immigrants live in the United States, and more live in Spain and other non-endemic countries, 7 highlighting the need for expansive awareness among the medical community.Mounting evidence supports Chagas disease surveillance in Latinx immigrants in the United States, where up to 20% of cases presenting with classic Chagas disease clinical signs and symptoms or epidemiological risk factors are misdiagnosed.8,9 As the recent coronavirus disease 2019 pandemic has taught us, these vulnerable groups are particularly susceptible to poor health-care access, and the imperative to diagnose this chronic, silent killer has never been greater.HIV-infected patients are particularly susceptible to T. cruzi reactivation, manifesting as meningoencephalitis, CNS chagomas, acute myocarditis, and other sequelae.10 Although patients with reactivation disease can be treated with standard therapy (e.g., benznidazole), 11 delayed diagnosis can prove fatal.An article in this issue of the American Journal of Tropical Medicine and Hygiene highlights the importance of heightened Chagas disease surveillance among HIVinfected patients.Reimer-McAtee et al. 12 conducted a cross-sectional study of T. cruzi prevalence among a Bolivian cohort of ambulatory and hospitalized HIV-infected individuals, identifying 28% T. cruzi seropositivity, and reactivation disease in 12.5% of T. cruzi seropositive individuals.They present compelling evidence that, regardless of specific signs or
Authors: Melissa S. Nolan, Natasha S. Hochberg
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W3193889703