Chagas Disease in HIV-Infected Patients: It’s Time to Consider the Diagnosis

Nolan, Melissa S.; Hochberg, Natasha S.

doi:10.4269/ajtmh.21-0681

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…To ensure prompt treatment, physician awareness of Chagas disease should also be increased, to minimize misinformation surrounding Chagas disease. [43][44][45] For example, in this investigation, one donor reported being told no treatment was available, and another was informed that local triatomines were not infected with T. cruzi despite contrary scientific evidence. 20 Serologic discrepancies remain a prominent hindrance for Chagas disease.…”

Section: Discussionmentioning

confidence: 94%

“…Thus, positive donors would also benefit from enhanced notification letters with recommendations for physician follow‐up. To ensure prompt treatment, physician awareness of Chagas disease should also be increased, to minimize misinformation surrounding Chagas disease 43–45 . For example, in this investigation, one donor reported being told no treatment was available, and another was informed that local triatomines were not infected with T. cruzi despite contrary scientific evidence 20 …”

Section: Discussionmentioning

confidence: 98%

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Evidence of likely autochthonous Chagas disease in the southwestern United States: A case series of Trypanosoma cruzi seropositive blood donors

et al. 2022

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Background: Chagas disease is a parasitic infection that can insidiously cause non-ischemic cardiomyopathy. Given the largely silent nature of this progressive disease, asymptomatic blood donors pose potential blood transfusion risk.Blood donation screening has become an unintentional form of Chagas disease surveillance, with thousands of new cases identified since national surveillance was initiated in 2007.Study Design and Methods: We recruited T. cruzi-positive blood donors identified from California and Arizona blood centers for confirmatory blood screening and assessment of lifetime infection risk. Results: Among eight suspected cases, we identified four confirmed US autochthonous infections. The current manuscript details the transmission sources, healthcare-seeking behaviors post-blood donation resulting, and

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 98%

Evidence of likely autochthonous Chagas disease in the southwestern United States: A case series of Trypanosoma cruzi seropositive blood donors

et al. 2022

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“…Despite sustaining "hundreds" of bites from triatomines over a 10-year period, frequently finding them inside his home, and evidence of T. cruzi-infected triatomines collected from inside the home, our patient did not have clinical or serological evidence of chronic CD. There has been some concern that certain T. cruzi DTU strains found within certain geographic regions in Mexico, as well as Central and South America, have discordant serological testing results [29][30][31][32]. The sensitivity and specificity of our available CD serological tests have not been assessed among those with autochthonous CD in the US at this time.…”

Section: Discussionmentioning

confidence: 99%

Anaphylactic Reactions Due to Triatoma protracta (Hemiptera, Reduviidae, Triatominae) and Invasion into a Home in Northern California, USA

Beatty

White

Bhosale

et al. 2021

Insects

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Background: Triatoma protracta is a triatomine found naturally throughout many regions of California and has been shown to invade human dwellings and bite residents. A man living in Mendocino County, California, reported developing anaphylactic reactions due to the bite of an “unusual bug”, which he had found in his home for several years. Methods: We conducted environmental, entomological, and clinical investigations to examine the risk for kissing bug invasion, presence of Trypanosoma cruzi, and concerns for Chagas disease at this human dwelling with triatomine invasion. Results: Home assessment revealed several risk factors for triatomine invasion, which includes pack rat infestation, above-ground wooden plank floor without a concrete foundation, canine living in the home, and lack of residual insecticide use. Triatomines were all identified as Triatoma protracta. Midgut molecular analysis of the collected triatomines revealed the detection of T. cruzi discrete typing unit I among one of the kissing bugs. Blood meal PCR-based analysis showed these triatomines had bitten humans, canine and unidentified snake species. The patient was tested for chronic Chagas disease utilizing rapid diagnostic testing and laboratory serological testing, and all were negative. Conclusions: Triatoma protracta is known to invade human dwellings in the western portions of the United States. This is the first report of T. cruzi-infected triatomines invading homes in Mendocino County, California. Triatoma protracta is a known vector responsible for autochthonous Chagas disease within the United States, and their bites can also trigger serious systemic allergic reactions, such as anaphylaxis.

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“…In approximately 30% of patients, this cellular damage cycle cryptically continues at an accelerated pace until advanced disease clinically manifests. The factors that contribute to pathogenesis and reactivation are largely unknown but are hypothesized to correlate with parasite discrete typing unit [ 48 , 49 , 50 ], high-fat diets [ 51 , 52 ], co-infections [ 53 , 54 ], and host immunogenetics [ 55 ]. Murine models indicate three potential pathogenic pathways collectively, independently, or in verse contribute to cellular damage: autoimmune, neurogenic, or pro-inflammatory damage mediated by certain cytokines such as interleukin (IL)-6 and IL-17 [ 3 , 46 , 56 , 57 , 58 , 59 , 60 , 61 ].…”

Section: Oral T Cruzi Transmission Pathogenicitymentioning

confidence: 99%

Oral Chagas Disease in Colombia—Confirmed and Suspected Routes of Transmission

Beatty,

Arango-Ferreira,

Gual-Gonzalez

et al. 2024

TropicalMed

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Chagas disease (CD) remains endemic throughout many regions of Colombia despite implementing decades of vector control strategies in several departments. Some regions have had a significant decrease in vectorial transmission, but the oral ingestion of Trypanosoma cruzi through consumption of contaminated food and drink products is increasingly described. This form of transmission has important public health relevance in Colombia due to an increase in reported acute CD cases and clinical manifestations that often lead to significant morbidity and mortality. Oral CD in Colombia has been associated with the consumption of contaminated fruit juices, such as palm wine, sugar cane, or tangerine juice and water for consumption, or contaminated surfaces where food has been prepared. Another interesting route of oral transmission includes ingestion of unbeknownst infected armadillos’ blood, which is related to a traditional medicine practice in Colombia. Some earlier reports have also implemented consumption of infected bush meat as a source, but this is still being debated. Within the Amazon Basin, oral transmission is now considered the principal cause of acute CD in these regions. Furthermore, new cases of acute CD are now being seen in departments where CD has not been documented, and triatomine vectors are not naturally found, thus raising suspicion for oral transmission. The oral CD could also be considered a food-borne zoonosis, and odoriferous didelphid secretions have been implemented in contaminating the human dwelling environment, increasing the risk of consumption of infectious metacyclic trypomastigotes. In this article, we will discuss the complex transmission dynamics of oral CD in Colombia and further examine the unique clinical manifestations of this route of infection. New insights into the oral transmission of Trypanosoma cruzi are being discovered in Colombia, which can help bring increased awareness and a better understanding of this neglected tropical disease to reduce the burden of CD throughout Latin America.

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Chagas Disease in HIV-Infected Patients: It’s Time to Consider the Diagnosis

Abstract: This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provide the original author and source are credited.

Cited by 3 publications

References 21 publications

Evidence of likely autochthonous Chagas disease in the southwestern United States: A case series of Trypanosoma cruzi seropositive blood donors

Evidence of likely autochthonous Chagas disease in the southwestern United States: A case series of Trypanosoma cruzi seropositive blood donors

Anaphylactic Reactions Due to Triatoma protracta (Hemiptera, Reduviidae, Triatominae) and Invasion into a Home in Northern California, USA

Oral Chagas Disease in Colombia—Confirmed and Suspected Routes of Transmission

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