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Review
. 2024 Jan 12;229(1):198-202.
doi: 10.1093/infdis/jiad404.

Chagas Disease Diagnostic Practices at Four Major Hospital Systems in California and Texas

Emily A Kelly  1 , Jose I Echeverri Alegre  2 , Katherine Promer  3 , Jesica Hayon  4 , Roumen Iordanov  4 , Khuzaima Rangwalla  5 , Jerry J Zhang  6 , Zian Fang  6 , Cindy Huang  6 , Cassiana E Bittencourt  7 , Sharon Reed  3   8 , Rosa M Andrade  9 , Caryn Bern  10 , Eva H Clark  4 , Jeffrey D Whitman  1
Affiliations
Review

Chagas Disease Diagnostic Practices at Four Major Hospital Systems in California and Texas

Emily A Kelly et al. J Infect Dis. .

Abstract

Background: Chagas disease (CD) is a parasitic disease that affects ∼300 000 people living in the United States. CD leads to cardiac and/or gastrointestinal disease in up to 30% of untreated people. However, end-organ damage can be prevented with early diagnosis and antiparasitic therapy.

Methods: We reviewed electronic health records of patients who underwent testing for CD at four hospital systems in California and Texas between 2016 and 2020. Descriptive analyses were performed as a needs assessment for improving CD diagnosis.

Results: In total, 470 patients were tested for CD. Cardiac indications made up more than half (60%) of all testing, and the most frequently cited cardiac condition was heart failure. Fewer than 1% of tests were ordered by obstetric and gynecologic services. Fewer than half (47%) of patients had confirmatory testing performed at the Centers for Disease Control and Prevention.

Discussion: Four major hospitals systems in California and Texas demonstrated low overall rates of CD diagnostic testing, testing primarily among older patients with end-organ damage, and incomplete confirmatory testing. This suggests missed opportunities to diagnose CD in at-risk individuals early in the course of infection when antiparasitic treatment can reduce the risk of disease progression and prevent vertical transmission.

Keywords: Trypanosoma cruzi; Chagas disease; United States; diagnosis; serology.

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Conflict of interest statement

Potential conflicts of interest. C. B. receives royalties from Wolters Kluwer publishers for UpToDate topics on epidemiology and management of Chagas disease. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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