Heart Transplantation for Chagas Cardiomyopathy in the United States

Kransdorf, E.; Czer, L.; Luthringer, Daniel; Patel, Jignesh; Montgomery, Susan P.; Velleca, A.; Mirocha, James; Zakowski, P.; Zabner, Rachel; Gaultier, Cyril R.; Qvarnström, Yvonne; Benedict, Theresa; Steurer, Frank; Bosserman, Elizabeth; Paddock, Christopher D.; Rafiei, M.; Kobashigawa, Jon A.

doi:10.1111/ajt.12507

Cited by 61 publications

(48 citation statements)

References 24 publications

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“…Cardiac transplantation is an effective method of managing Chagas' cardiomyopathy with refractory heart failure; systematic posttransplantation PCR monitoring enables early diagnosis and treatment of T. cruzi reactivation. 42 The management of gastrointestinal Chagas' disease is similar to that for idiopathic achalasia or megacolon. 34 Esophageal symptoms may be mitigated by drugs that relax the sphincter or by laparoscopic myotomy.…”

Section: A Bor At or Y DI Agnosismentioning

confidence: 99%

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Chagas’ Disease

2015

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T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med 373;5 nejm.org July 30, 2015 456Review Article C hagas' disease is caused by the protozoan parasite Trypanosoma cruzi, which is transmitted when the infected feces of the triatomine vector are inoculated through a bite site or through an intact mucous membrane of the mammalian host (Fig. 1). 2 Vectorborne transmission is limited to areas of North America, Central America, and South America. Both in endemic and in nonendemic areas, other infection routes include transfusion, organ and bone marrow transplantation, and congenital transmission. Outbreaks attributed to contaminated food or drink have been reported in northern South America, where transmission cycles involving wild vector populations and mammalian reservoir hosts are prominent. 3 Infection is lifelong in the absence of effective treatment. The most important consequence of T. cruzi infection is cardiomyopathy, which occurs in 20 to 30% of infected persons. 4 Epidemiol ogyThe global epidemiologic profile of Chagas' disease is the result of two major forces: domestic vectorborne transmission over the lifetime of the current population of Latin America and large-scale rural-to-urban migration over the past 50 years (Fig. 2). 2,4 The most epidemiologically important vectors live in the cracks in mud walls and thatched roofs of rustic rural houses. Inhabitants of infested houses are repeatedly exposed to the vector and parasite over many years. Stercorarian transmission (i.e., transmission through the feces of an infected vector) is relatively inefficient: the incidence of T. cruzi infection is generally estimated to be less than 1% per year. 6,7 The highest estimated incidence is 4% per year, in the hyperendemic Bolivian Chaco. 8 In an endemic setting, continued transmission over time results in a pattern of increasing prevalence of both infection and cardiomyopathy with increasing age. 8,9 Over the past several decades, millions of infected persons have moved from endemic rural villages to Latin American cities, and hundreds of thousands now live in the United States, Spain, and other countries outside Latin America. 10,11 Latin America has made substantial progress toward the control of Chagas' disease. 4 The estimated global prevalence of T. cruzi infection declined from 18 million in 1991, when the first regional control initiative began, to 5.7 million in

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Section: A Bor At or Y DI Agnosismentioning

confidence: 99%

“…41,42 T. cruzi reactivation should be considered in the differential diagnosis of febrile episodes and apparent rejection crises. In addition to fever and acute myocarditis in the transplanted heart, symptoms may include panniculitis.…”

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confidence: 99%

Chagas’ Disease

2015

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“…Several cases of transmission caused by transplantation of livers or kidneys from seropositive donors have been recorded, although the risk is lower than for hearts [60]. Parasites can be frequently detected in skeletal muscle in some chronic mouse infection models [20, 52, 75, 80, 81].…”

Section: Elusively Reclusive: T Cruzi In the Chronic Phasementioning

confidence: 99%

Putting Infection Dynamics at the Heart of Chagas Disease

Lewis

Kelly

2016

Trends in Parasitology

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In chronic Trypanosoma cruzi infections, parasite burden is controlled by effective, but non-sterilising immune responses. Infected cells are difficult to detect because they are scarce and focally distributed in multiple sites. However, advances in detection technologies have established a link between parasite persistence and the pathogenesis of Chagas heart disease. Long-term persistence likely involves episodic reinvasion as well as continuous infection, to an extent that varies between tissues. The primary reservoir sites in humans are not definitively known, but analysis of murine models has identified the gastrointestinal tract. Here, we highlight that quantitative, spatial and temporal aspects of T. cruzi infection are central to a fuller understanding of the association between persistence, pathogenesis and immunity, and for optimising treatment.

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“…When available, reported time from transplant to CDR ranged from 11 to 23 weeks . While most reports of CDR have been published from Latin America, recent cases have been documented in the United States …”

Section: Introductionmentioning

confidence: 99%