Chagas Disease in the New York City Metropolitan Area

Abstract

Background Chagas disease, caused by the parasite Trypanosoma cruzi, once considered a disease confined to Mexico, Central America, and South America, is now an emerging global public health problem. An estimated 300 000 immigrants in the United States are chronically infected with T. cruzi. However, awareness of Chagas disease among the medical community in the United States is poor. Methods We review our experience managing 60 patients with Chagas disease in hospitals throughout the New York City metropolitan area and describe screening, clinical manifestations, EKG findings, imaging, and treatment. Results The most common country of origin of our patients was El Salvador (n = 24, 40%), and the most common detection method was by routine blood donor screening (n = 21, 35%). Nearly half of the patients were asymptomatic (n = 29, 48%). Twenty-seven patients were treated with either benznidazole or nifurtimox, of whom 7 did not complete therapy due to side effects or were lost to follow-up. Ten patients had advanced heart failure requiring device implantation or organ transplantation. Conclusions Based on our experience, we recommend that targeted screening be used to identify at-risk, asymptomatic patients before progression to clinical disease. Evaluation should include an electrocardiogram, echocardiogram, and chest x-ray, as well as gastrointestinal imaging if relevant symptoms are present. Patients should be treated if appropriate, but providers should be aware of adverse effects that may prevent patients from completing treatment.

Temporal changes in the clinical-epidemiological profile of patients with Chagas disease at a referral center in Brazil

“…Studies on the clinical epidemiological profile of patients with chronic CD in urban centers reported that the mean age showed the same increasing trend in the last decades, ranging from 37.7 to 67.5 years 12 , 13 , 15 , 20 - 22 . Studies conducted in nonendemic regions of the Northern Hemisphere, where patients migrated from South America, especially Bolivia and Central America, reported younger patients with chronic CD with a mean age ranging from 28.5 to 47 years 16 - 18 , 34 - 37 , reflecting the lack of CD vectorial transmission control in their countries of origin and that CD vectorial transmission remained active in rural areas. The present study showed a progressive increase over time in the age of patients who were included in the study cohort during the 5-year intervals of the study period, with the mean age increasing from 44.3 to 57.1 years.…”

“…Studies on the clinical form of CD conducted in urban areas have shown that the cardiac form predominates, with a prevalence ranging from 56% to 66% 12 - 16 , 22 , 23 Few studies have reported a higher incidence of the indeterminate form, varying between 56% and 81.6% 17 , 20 . These differences in the prevalence of clinical forms are attributed to the profile of the healthcare unit.…”

“…With globalization, the disease has spread to countries in the Northern Hemisphere, particularly in the United States and Spain 11 . Because of this new geographic rearrangement of CD, studies describing the clinical and epidemiological profile of patients with chronic CD have been conducted in urban healthcare facilities in both endemic 12 - 15 and nonendemic regions 16 - 19 . Some of these facilities have also become reference centers for the treatment of CD that offer specialized care 20 - 23 .…”

Cross-Sectional Study of Swallowing Phases in Cases of Megaesophagus Caused by Chagas Disease

“…The long experience with Chagas disease patients in countries in Latin America and other continents [ 1 , 2 ] shows no evidence that they have more pulmonary infections than the population in general. However, cases with esophageal dilation and content retention are exposed to aspiration of such esophageal content, which may happen after esophageal-pharyngeal reflux [ 39 ].…”

“…Chagas disease, a consequence of infection with flagellate protozoan Trypanosoma cruzi, affects mainly the heart and digestive system [1][2][3][4][5]. The whole digestive system has its function impaired to some degree [4,5], whereas the changes caused by the disease in the esophagus and colon have clinical importance, as they can result in megaesophagus and megacolon, leading to dysphagia and constipation [2,4,5].…”