Experiences with Diagnosis and Treatment of Chagas Disease at a United States Teaching Hospital-Clinical Features of Patients with Positive Screening Serologic Testing.

Peter Hyson,Esther Benamu,Poornima Ramanan,Carlos Franco-Paredes,Kellie Hawkins,Jonathan Schultz,Luisa Mestroni,Anis Rassi,Andrés F Henao-Martínez,Matthew Taylor,Maria Da Consolação Moreira,Lilian Vargas Barahona,Laura C Pedraza-Arévalo

doi:10.3390/tropicalmed6020093

Abstract

Chagas disease (CD) is the third most common parasitic infection globally and can cause cardiac and gastrointestinal complications. Around 300,000 carriers of CD live in the U.S., with about 3000 of those in Colorado. We described our experience in diagnosing CD at a Colorado teaching hospital to revise screening eligibility criteria. From 2006 to 2020, we reviewed Trypanosoma cruzi (TC) IgG serology results for 1156 patients in our institution. We identified 23 patients (1.99%) who had a positive test. A total of 14/23 (60%) of positive serologies never had confirmatory testing, and 7 of them were lost to follow up. Confirmatory testing, performed in 9 patients, resulted in being positive in 3. One additional case of CD was identified by positive tissue pathology. All four confirmed cases were among patients born in Latin America. While most of the testing for CD at our institution is part of the pretransplant screening, no confirmed cases of CD derived from this strategy. Exposure risk in this population is not always documented, and initial positive results from screening are not always confirmed. The lack of standardized screening protocols for CD in our institution contributes to underdiagnosis locally and in health systems nationwide. Given a large number of individuals in the U.S. with chronic CD, improved screening is warranted.

Highlights

Chagas disease (CD), caused by the parasite Trypanosoma cruzi, is a public health problem of significance in Latin America, where it is endemic
A positive serological test for T. cruzi, usually enzyme-linked immunosorbent assay (ELISA) by ARUP lab (Salt Lake City, UT, USA), is followed up by a collection of a second blood sample, which is sent to the Centers for Disease Control and Prevention (CDC) for confirmatory testing with enzyme immunoassay (EIA) and T. cruzi excreted-secreted antigen blotting (TESA-blot) [16]
Epic EHR showed that Trypanosoma cruzi IgG was ordered for 1156 paThe UCH(1.99%)

Summary

Introduction

Chagas disease (CD), caused by the parasite Trypanosoma cruzi, is a public health problem of significance in Latin America, where it is endemic. It affects other parts of the world via the immigration of affected individuals. CD has a global annual cost estimated at $627.46 million and 806,170 disability adjusted life-years, 10% of which is shouldered by the U.S [3]. It has been called “the most important parasitic disease in the Western Hemisphere”, given the disease burden is 7.5× that of malaria [4]

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