742. Evaluation of Chagas Disease Diagnostic Testing Practices in Four Hospital Systems in California and Texas

Abstract

Background Chagas disease (CD) is a neglected parasitic disease that affects >6 million people in the Americas, including >200,000 people in the United States (US). Medical provider knowledge of CD is key to decreasing morbidity and transmission; however, few studies have assessed diagnostic practices in US health systems serving at-risk patients. Our study aimed to describe existing provider approaches to diagnosing CD in California and Texas. Methods Site-based research teams at four hospital systems (the University of California [UC] San Francisco [UCSF], San Diego [UCSD], Irvine [UCI], and the Harris Health System [HHS] in Houston, TX) retrospectively identified patients ≥18 years old tested for CD between 2016-2019 and systematically extracted electronic medical record data using complementary electronic data entry forms. Specifically, eligible patients were identified using laboratory orders at UCSF and UCI, while the remaining sites employed SlicerDicer (Epic Systems). This study was approved by institutional review boards at each site. Results We identified 333 patients tested for CD, including 109 from UCSF, 88 from UCSD, 25 from UCI, and 111 from HHS. These patients had 125, 99, 31, and 181 tests sent to commercial laboratories, respectively. Test reactivity varied by system with the greatest percent reactivity among tests ordered at UCI (23%) followed by UCSD (16%), HHS (15%), and UCSF (10%). Among patients who screened positive for CD by commercial assays, confirmatory testing through the Centers for Disease Control and Prevention was sought for 100% at UCI; 59% at HHS, 55% at UCSF, and 40% at UCSD. The medical specialty that most often ordered CD testing was Cardiology at all UC sites (UCSF, 50%; UCSF, 55%; UCI, 35%) and Internal Medicine at HHS (46%; Cardiology ordered 13%). Only one recorded CD test was ordered by an Obstetrics/Gynecology service at any site. Conclusion These early results report positivity rates between our healthcare systems and demonstrate inconsistency in attaining recommended confirmatory testing, as well as a paucity of CD testing ordered through Obstetrics/Gynecology despite risk of congenital transmission. These findings suggest areas of opportunity to improve provider awareness and lay a foundation for standardizing CD diagnostic practices in the US. Disclosures Caryn Bern, MD, MPH, UpToDate (Wolters Kluwer) (Other Financial or Material Support, Author Royalties)

Chagas Disease Diagnostic Testing in Two Academic Hospitals in New Orleans, Louisiana: A Call to Action

“…Neonates are at an increased risk of being neglected since they do not present the usual signs and cannot express their symptoms [36]. In our study, the youngest patient being evaluated was 4 years old; thus, no testing was performed in the neonatal period, similar to what was reported in San Francisco [27]. This is even more important given that if Chagas disease is found in infants the treatment is considered curative, with 90% cure rates in those treated within the first year of life [42].…”

“…Two similar studies evaluating the disease frequency have been performed, one in San Francisco, California, between 2016 and 2019 and the other in Denver, Colorado, between 2006 and 2020. At the University of San Francisco Hospital in California, they found that 109 patients were evaluated for Chagas disease in a 3-year span, accounting for 36 patients per year [ 27 ]. At the University of Colorado Hospital, 1156 patients were evaluated for Chagas disease in a 14-year span, which is 83 patients per year [ 28 ].…”

“…To our knowledge, a national study evaluating diagnostic frequency of Chagas disease has not been conducted. We were not able to evaluate country of origin, but the San Francisco and the Denver studies showed that their confirmed positive cases came exclusively from those born in Latin America [ 27 ]. In New Orleans, the number of Hispanics has been increasing in the past decades, from 58,545 (4% of the population) in 2000 to 116,254 (9% of the population) in 2020 [ 29 ].…”

“…However, a survey by the American College of Obstetricians and Gynecologists demonstrated that most members never considered Chagas disease as a diagnosis from their patients coming from endemic countries [ 34 ]. A recent abstract from San Fransisco, California, noted that none of their Chagas tests came from the obstetrician/gynecology service [ 27 ]. It is important to identify mothers with Chagas disease and to identify risk factors for vertical transmission that are associated with increased vertical transmission, such as maternal parasitic load [ 12 ].…”

“…We retrospectively evaluated electronic medical records of a three-year period (2018–2020), similar to a recent study [ 27 ].…”