Recognizing and Reducing the Risks of Chagas Disease (American Trypanosomiasis) in Travelers

Abstract

Chagas disease, or American trypanosomiasis, is an arthropod‐borne protozoan infectious disease endemic throughout most of the Americas, caused by the trypanosome, Trypanosoma cruzi , and transmitted to humans by reduviid, or kissing, bugs. Reduviid bugs (phylum: Insecta, order: Hemiptera, family: Reduviidae, subfamily: Triatominae) transmit several zoonotic strains of T cruzi among many mammalian reservoir hosts throughout the Americas. Chagas disease is most commonly transmitted to humans via T cruzi –infected reduviid bug defecations near bite wounds or exposed mucosal surfaces. Chagas disease may also be transmitted congenitally, by ingestion of T cruzi –infected reduviids or their feces, by blood product transfusions, and by organ transplants. Indeterminate and chronic infections may be reactivated by immunosuppression, particularly human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS), and by pregnancy. Characterized by an influenza‐like illness acutely in adults, Chagas disease may result in chronic heart disease or gastrointestinal megasyndromes following a prolonged, indeterminate stage of subclinical infection. In its 2003 World Health Report, the World Health Organization (WHO) noted that Chagas disease caused more deaths from parasitic disorders than from any other parasitic disease in Latin America and that T cruzi was responsible for the third highest number of parasitic infections in the world following malaria and schistosomiasis.1 Chagasic heart disease has become an increasingly common indication for heart transplantation in Latin America and the United States.2,3 Chagas disease has now occurred in three US recipients of heart, kidney, liver, and pancreas transplants from a single Central American immigrant donor and in two US recipients of heart transplants from T cruzi –infected donors (Figure 1).3–5 Chagas disease may pose increasing communicable disease risks to travelers in endemic regions of the Americas, including beachside resort regions and interior rural regions. Figure 1 Trypanosoma cruzi metacyclic trypomastigote on a peripheral blood smear … Corresponding Author: James H. Diaz, MD, MPH&TM, DrPH, Program in Environmental and Occupational Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, 2021 Lakeshore Drive, Suite 200, New Orleans, LA 70122, USA. E‐mail: jdiaz{at}lsuhsc.edu.