Background: Chagas disease is a leading cause of cardiac failure in Latin America. Due to poor safety profiles and efficacy of currently available therapeutics, prevention is a priority for the millions living at risk for acquiring this clinically important vector-borne disease. Triatomine vectors of the Chagas disease parasite, Trypanosoma cruzi, are found in the southwestern United States, but risk for autochthonous transmission is thought to be low. The role of ectoparasitic mites is under-explored regarding the ecology of triatomines and Chagas disease transmission. Methods: Triatomine collections were performed using three common entomologic techniques in 2020–2021 from four different locations in southern Arizona and New Mexico. Triatomines were analyzed visually under a 112.5× microscope for the presence of externally attached mites. Following mite removal, triatomines were tested for T. cruzi infection by PCR. Results: Approximately 13% of the collected triatomines had mites securely attached to their head, thorax, abdomen, and legs. More than one mite attached was a common finding among ectoparasitized triatomines. Mite presence, however, did not statistically influence triatomine T. cruzi status. Conclusions: Our findings add to a growing body of literature demonstrating the sustainability of mite-infested triatomine populations throughout the Western Hemisphere. Future investigations are warranted to better understand the biologic impact of triatomine mites and their potential to serve as a potential biological control tool.

TORCH pathogens are a group of globally prevalent infectious agents that may cross the placental barrier, causing severe negative sequalae in neonates, including fetal death and lifelong morbidity. TORCH infections are classically defined by Toxoplasma gondii, other infectious causes of concern (e.g., syphilis, Zika virus, malaria, human immunodeficiency virus), rubella virus, cytomegalovirus, and herpes simplex viruses. Neonatal disorders and congenital birth defects are the leading causes of neonatal mortality in Central America’s Northern Triangle, yet little is known about TORCH congenital syndrome in this region. This review synthesizes the little that is known regarding the most salient TORCH infections among pregnant women and neonates in Central America’s Northern Triangle and highlights gaps in the literature that warrant further research. Due to the limited publicly available information, this review includes both peer-reviewed published literature and university professional degree theses. Further large-scale studies should be conducted to clarify the public health impact these infections in this world region.

Congenital Chagas disease is a growing concern, prioritized by the World Health Organization for public health action. El Salvador is home to some of the highest Chagas disease (Trypanosoma cruzi infection) burdens in the Americas, yet pregnancy screening remains neglected. This pilot investigation performed a maternal T. cruzi surveillance study in Western El Salvador among women presenting for labor and delivery. From 198 consented and enrolled pregnant women, 6% were T. cruzi positive by serology or molecular diagnosis. Half of the infants born to T. cruzi-positive women were admitted to the NICU for neonatal complications. Geospatial statistical clustering of cases was noted in the municipality of Jujutla. Older women and those knowing an infected relative or close friend were significantly more likely to test positive for T. cruzi infection at the time of parturition. In closing, maternal T. cruzi infections were significantly higher than national HIV or syphilis maternal rates, creating an urgent need to add T. cruzi to mandatory pregnancy screening programs.

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Tick-borne diseases including rickettsial diseases are increasing in incidence worldwide. Many rickettsial pathogens can cause disease which is commonly underdiagnosed and underreported; Rickettsia pathogens in the spotted fever group (SFGR) are thus classified as neglected bacterial pathogens. The Central American region shoulders a large proportion of the global neglected disease burden; however, little is known regarding SFGR disease here. Although development varies, four of the seven countries in this region have both the highest poverty rates and SFGR disease burdens (El Salvador, Honduras, Guatemala, and Nicaragua), compared to Belize, Panama, and Costa Rica. Utilizing the Human Development Index (HDI), we compared published articles related to SFGR Rickettsia prevalence in the lowest-HDI-scoring countries to the highest-HDI-scoring countries. Our analysis identified a distinct dichotomy in publication, and by proxy, potentially awareness and knowledge of SFGR tick-borne disease in Central America, where the least-developed countries are at the highest risk for, yet the most vulnerable to, SFGR disease.

Spotted fever group rickettsioses (SFGR) are caused by a group of tick-borne pathogens that are increasing in incidence globally. These diseases are typically underreported and undiagnosed in low- and middle-income countries, and thus, have been classified as neglected bacterial pathogens. Countries with high poverty, low human development index score, and limited health infrastructure—like El Salvador in Central America—lack necessary surveillance for SFGR and other tick-borne pathogens. This paucity of baseline SFGR infection prevalence leaves vulnerable populations at risk of misdiagnosis. Further, tick-borne disease burdens in El Salvador are severely limited. To lay the foundation for tick-borne disease epidemiology in El Salvador, our team conducted two different enzyme-linked immunosorbent assays (ELISA) on banked human sera samples from a cohort of approximately 1000 pediatric participants from a high-risk vector-borne disease population. Eleven percent of all tested banked pediatric sera were positive for at least one ELISA assay at the time of enrollment: 10.7% were positive for only IgM antibodies (acute SFGR infection), and 2.5% were positive for IgG antibodies (a past SFGR infection). Older, male, children enrolled during the wet season, with a household history of infectious disease and higher maternal education level had higher odds of SFGR antibodies. Additionally, children from households with domestic poultry birds and previous knowledge of other vector-borne diseases had significantly reduced odds of SFGR antibodies. The large percentage of acute SFGR infections indicates that it continues to remain an underreported and undiagnosed issue in El Salvador and the Central American region. Much is still unknown regarding the complexity of the tick, animal host, and human host ecology transmission cycle of SFGR in El Salvador.

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