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Abstract
The eradication of the vector Rhodnius prolixus from Central America was heralded as a victory for controlling transmission of Trypanosoma cruzi, the parasite that causes Chagas disease. While public health officials believed this milestone achievement would effectively eliminate Chagas disease, case reports of acute vector transmission began amassing within a few years. This investigation employed a cross-sectional serosurvey of children either presenting with fever for clinical care or children living in homes with known triatomine presence in the state of Sonsonate, El Salvador. Over the 2018 calendar year, a 2.3% Chagas disease seroprevalence among children with hotspot clustering in Nahuizalco was identified. Positive serology was significantly associated with dogs in the home, older participant age, and a higher number of children in the home by multivariate regression. Concomitant intestinal parasitic infection was noted in a subset of studied children; 60% having at least one intestinal parasite and 15% having two or more concomitant infections. Concomitant parasitic infection was statistically associated with an overall higher parasitic load detected in stool by qPCR. Lastly, a four-fold higher burden of stunting was identified in the cohort compared to the national average, with four-fifths of mothers reporting severe food insecurity. This study highlights that polyparasitism is common, and a systems-based approach is warranted when treating Chagas disease seropositive children.
Highlights
Infection with Trypanosoma cruzi parasite results in a chronic lifelong illness, called Chagas disease, that causes cardiac and intestinal organomegalies in a subset of patients
This investigation revealed a foci of pediatric Chagas disease presented in a contemporary context of comorbid clinical concerns
In parallel with these studies, Nahuizalco was identified as the epicenter of pediatric Chagas disease in this investigation, which has an elevation of approximately 600 meters
Summary
Infection with Trypanosoma cruzi parasite results in a chronic lifelong illness, called Chagas disease, that causes cardiac and intestinal organomegalies in a subset of patients. In endemic Latin American countries, infections traditionally occur in youth with chronic clinical manifestations presenting later in life. Acute vector-borne infection can be indicated by appearance of a chagoma or Romaña’s sign, yet most acute infections are believed to be asymptomatic or present with general flu-like illnesses that self-resolve. Irreversible clinical manifestations typically present, resulting in serious personal health and societal economic impacts [1,2]. Less than 1% of Chagas disease patients receive lifesaving antiparasitic medication [3,4], most often due to lack of infection status knowledge and/or lack of healthcare access [5]. Several studies have indicated that children respond best to treatment as evidenced by higher percentages of serologic titer reductions and lower treatment discontinuation rates [6]
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