Frequency of Trypanosoma cruzi parasitemia among infected blood donors with a potential association between parasite lineage and transfusion transmission

Abstract

Based on lineage determination for donors with parasitemia; hemoculture positivity associated with presumptive parasite lineage; and implicated donors from US, Canadian, and Spanish transfusion cases, donors from Southern South America are significantly more likely to have parasitemia and transmit infection to blood recipients (TcII, TcV, or TcVI vs. TcI). Thus, parasite lineage may be associated with risk of transfusion-transmitted T. cruzi.

Chagas Disease in the United States: a Public Health Approach

“…In an analysis of approximately 14 million blood donations in 2008, the overall seroprevalence was 1/27,500, with the highest rates in Florida (1/3800), followed by California (1/8300) (301). Cone donors implicated in recognized transfusion transmissions, these data support the hypothesis that TcII/V/VI infections result in higher parasite loads, and therefore higher bloodborne transmission risk, compared to TcI (222,293).…”

“…When acute or reactivation meningoencephalitis is suspected, cerebrospinal fluid samples should be concentrated by thin-layer cell preparation technique, stained and examined by light microscopy. Microscopy is useful due to fast turnaround time, wide availability and high specificity, but its sensitivity is lower than that of molecular techniques (222,223).…”

“…Even legal immigrants have lower access than citizens to publically funded health insurance in most states; concerns about revealing immigration status may make patients reluctant to seek care (324 (325). With the exception of the Ortho ELISA, which is also licensed for blood donor screening (222,284,326), there is a paucity of data on the performance of these assays in specimens from populations in the US, or in the likely predominant countries of origin of infected U.S. residents (Mexico, El Salvador, Guatemala, Honduras) (280,301,308). Discordant serology has been reported as a particular problem in Mexico (327).…”

A systematic review of the Trypanosoma cruzi genetic heterogeneity, host immune response and genetic factors as plausible drivers of chronic chagasic cardiomyopathy

“…TcI has been reported to be the most abundant DTU across the American continent, being detected among a wide range of reservoirs and triatomines, in which its presence is derived predominantly from sylvatic rather than domestic transmission cycles. The infection of humans by this DTU is concentrated in the north of South America reaching the centre of America, and is mainly associated with chagasic cardiomyopathy, predominantly in the domestic cycle (Zingales et al ., 2009; Leiby et al ., 2017). It has been reported that this particular DTU plays an important role in severe forms of chagasic heart disease (Guhl, 2013; Guhl and Ramírez, 2013).…”

“…Studies on TcII have shown that this DTU of T. cruzi prevails in the central and southern regions of America, and is related to transmission of the domestic cycle. TcII has been associated with the clinical manifestations of moderate chagasic cardiomyopathy, concomitant with mega syndromes such as megacolon and megaesophagus, also associated with blood donors (Zingales et al ., 2009; Guhl and Ramírez, 2013; Leiby et al ., 2017). In addition, Bisio and coworkers confirmed that TcII was present in two patients with cardiac manifestations.…”