Acute Pediatric Chagas Disease in Antioquia, Colombia: A Geographic Location of Suspected Oral Transmission

Abstract

Chagas disease, Trypanosoma cruzi infection, is an insidious cause of heart failure in Latin America. Early diagnosis and treatment are critical to prevent irreversible myocardial damage that progressively accumulates over decades. Several structural barriers account for the less than 1% of cases in Colombia being treated, including poor physician knowledge, especially considering that some regions are considered non-endemic. The two cases reported here represent an emerging epidemiologic scenario associated with pediatric Chagas disease. Both cases are suspected oral transmitted parasitic infection in a geographic region of Colombia (Andean region of Antioquia) where no previous oral transmission of Chagas disease had been reported. Their clinical histories and course of disease are presented here to increase physician awareness of the epidemiologic risk factors and clinical manifestations associated with pediatric oral Chagas disease in Antioquia department, Colombia.

Oral Chagas Disease in Colombia—Confirmed and Suspected Routes 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 ].…”

“…Since orange juice is not macerated but squeezed, it is not clear how the juice becomes contaminated, and thus, the speculation on sugar cane contamination. A case series published in 2022 described two pediatric cases of acute oral Chagas disease, supposedly related to the consumption of sugar cane juice, also called “guarapo de caña” in Spanish [ 17 ]. Similarly, animal studies demonstrate sugar cane juice can remain infective for up to twenty-four hours post-inoculation [ 64 ].…”

“…Colombia has now begun to see increased recognition of oral transmission of CD, which is likely due to the clinical significance of those infected in this manner. For those who acquire the infection via the oral route, it is common to manifest signs and symptoms of acute CD [ 17 , 18 ]. For other forms of CD, like the vector-borne infection, this is uncommon, and most will either be asymptomatic or only develop a mild, self-resolving febrile illness [ 1 ].…”

“…For those who acquire the infection via the oral route, it is common to manifest signs and symptoms of acute CD [17,18]. For other forms of CD, like the vector-borne infection, this is uncommon, and most will either be asymptomatic or only develop a mild, self-resolving febrile illness [1].…”