Acute Chagas Disease Outbreak among Military Personnel, Colombia, 2021

Abstract

We report an acute Chagas disease outbreak among soldiers in Colombia. Trypanosoma cruzi infection was confirmed through parasitology, serology, and molecular methods. Among 9 affected soldiers, 2 died; 7 were hospitalized and received benznidazole treatment, which produced favorable outcomes. Personnel patrolling rural areas in Colombia could be at increased risk for Chagas disease.

Oral Chagas Disease in Colombia—Confirmed and Suspected Routes of Transmission

“…Since the first reported evidence of oral transmission in 1965, outbreaks of oral Chagas disease have gained importance as an emerging route of transmission. In some regions, it is considered to be the transmission mode in up to 50% of cases in certain geographical locations like in the Amazon basin [ 40 ]. Due to the severity of the disease, many who become infected via oral ingestion will manifest significant signs and symptoms of acute CD, which can lead to fulminant myocarditis and heart failure, meningoencephalitis, and even life-threatening shock from parasitemia [ 11 , 12 , 13 , 14 , 17 , 18 , 40 , 41 ].…”

“…Symptoms and rapid disease progression in those who are immunocompetent are not common among other forms of transmission like vectorial, congenital, or transfusion-related transmission [ 4 ]. The vast majority of those with acute oral Chagas have fever (71–100%), but other systemic symptoms are notable and include facial edema, lower extremity edema, myalgia, generalized lymphadenopathy, abdominal discomfort, dyspnea, vomiting, diarrhea, hepatomegaly, splenomegaly, headache, chest pain, cutaneous erythematous rash, jaundice, arthralgia, epistaxis, hematemesis, melena, and palpitations [ 11 , 12 , 13 , 14 , 17 , 18 , 40 , 41 ]. Facial edema, typically involving the entire face and portions of the lips, is present in 57–100% of those with acute oral CD [ 4 , 40 ].…”

“…The vast majority of those with acute oral Chagas have fever (71–100%), but other systemic symptoms are notable and include facial edema, lower extremity edema, myalgia, generalized lymphadenopathy, abdominal discomfort, dyspnea, vomiting, diarrhea, hepatomegaly, splenomegaly, headache, chest pain, cutaneous erythematous rash, jaundice, arthralgia, epistaxis, hematemesis, melena, and palpitations [ 11 , 12 , 13 , 14 , 17 , 18 , 40 , 41 ]. Facial edema, typically involving the entire face and portions of the lips, is present in 57–100% of those with acute oral CD [ 4 , 40 ]. This can be differentiated from vectorial transmission, where we more commonly see unilateral periorbital swelling (a.k.a.…”

“…This can be differentiated from vectorial transmission, where we more commonly see unilateral periorbital swelling (a.k.a. Romaña’s sign) in those with acute symptoms [ 4 , 40 ]. The robust systemic immune response that is seen in those with acute oral CD is suggested to occur due to a more efficient transmission after penetration through the oral, pharyngeal, and gastric mucosa.…”

“…Cardiac abnormalities are seen more frequently after oral transmission of T. cruzi as opposed to vectorial transmission [ 40 , 41 , 42 , 43 ]. Of these, electrocardiographic abnormalities are reported in a majority of patients, specifically ventricular polarization disturbances and pericardical involvement in young soldiers in Colombia [ 40 , 42 ].…”