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PREAMBLEOur mission was to develop evidence-based American Association for Thoracic Surgery (AATS) consensus focused on the surgical treatment of infective endocarditis (IE) and perioperative questions: when to operate, how to prepare the patient for operation, how to operate, and other issues relevant to managing and following patients after surgery. [1][2][3][4][5][6][7][8] The writing committee included 4 cardiac surgeons, 1 cardiologist, 2 infectious disease specialists, and Dr Eugene H. Blackstone. The draft produced was reviewed by invited additional experts, including 4 cardiac surgeons, 1 anesthesiologist, 1 cardiologist, 2 imaging experts, 3 infectious disease specialists, and 1 neurologist (See Appendix E1).

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Key Points Question What is the risk of developing cardiomyopathy among patients with the acute phase of Chagas infection or the indeterminate chronic form of Chagas disease? Findings In this systematic review and meta-analysis of 32 studies of patients with Chagas disease, the pooled estimated annual rate of cardiomyopathy was 4.6% among patients with acute Chagas infection and 1.9% among patients with indeterminate chronic Chagas disease. Meaning The findings indicate that asymptomatic individuals with indeterminate chronic Chagas disease without cardiac injury and individuals with acute Chagas infection may have a significant risk of developing chronic cardiomyopathy.

Abstract. Autochthonous transmission of Trypanosoma cruzi in the United States is rarely reported. Here, we describe five newly identified patients with autochthonously acquired infections from a small pilot study of positive blood donors in southeast Texas. Case-patients 1-4 were possibly infected near their residences, which were all in the same regioñ 100 miles west of Houston. Case-patient 5 was a young male with considerable exposure from routine outdoor and camping activities associated with a youth civic organization. Only one of the five autochthonous case-patients received anti-parasitic treatment. Our findings suggest an unrecognized risk of human vector-borne transmission in southeast Texas. Education of physicians and public health officials is crucial for identifying the true disease burden and source of infection in Texas.