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Review
. 2019 Nov 27;33(1):e00023-19.
doi: 10.1128/CMR.00023-19. Print 2019 Dec 18.

Chagas Disease in the United States: a Public Health Approach

Caryn Bern  1 , Louisa A Messenger  2 , Jeffrey D Whitman  3 , James H Maguire  4
Affiliations
Review

Chagas Disease in the United States: a Public Health Approach

Caryn Bern et al. Clin Microbiol Rev. .

Abstract

Trypanosoma cruzi is the etiological agent of Chagas disease, usually transmitted by triatomine vectors. An estimated 20 to 30% of infected individuals develop potentially lethal cardiac or gastrointestinal disease. Sylvatic transmission cycles exist in the southern United States, involving 11 triatomine vector species and infected mammals such as rodents, opossums, and dogs. Nevertheless, imported chronic T. cruzi infections in migrants from Latin America vastly outnumber locally acquired human cases. Benznidazole is now FDA approved, and clinical and public health efforts are under way by researchers and health departments in a number of states. Making progress will require efforts to improve awareness among providers and patients, data on diagnostic test performance and expanded availability of confirmatory testing, and evidence-based strategies to improve access to appropriate management of Chagas disease in the United States.

Keywords: Chagas disease; Trypanosoma cruzi; United States; triatomine.

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Figures

FIG 1
FIG 1
Trypanosoma cruzi morphological forms. (A) The replicating epimastigote form in culture (Giemsa stain). (B) Trypomastigote in a peripheral blood smear from a patient with acute Chagas disease (Giemsa stain). (C) Nest of amastigotes within a cardiac myocyte in a patient with chronic Chagas disease (hematoxylin and eosin stain). Courtesy of the Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention.
FIG 2
FIG 2
Photographs of U.S. triatomine species of the genera Triatoma and Paratriatoma. Image size relative to the scale bar represents the average length of each species. The Triatoma incrassata photo is courtesy of E. Barrera Vargas, the T. recurva and Paratriatoma hirsuta photos are courtesy of R. Hoey-Chamberlain and C. Weirauch, and the T. protracta protracta photo is courtesy of G. Lawrence (DPDM/CDC). All other images are from reference (photos by S. Kjos).
FIG 3
FIG 3
Ranges of the four most frequently identified triatomine species in the continental United States. Based on references provided in Table 2.
See this image and copyright information in PMC

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