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Published on: January 27, 2019
Trypanosoma cruzi and Chagas' Disease in the United States
Caryn Bern1, Sonia Kjos, Michael J Yabsley
1Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. cxb9@cdc.gov
Insights
Chagas disease, caused by Trypanosoma cruzi, affects the heart and gastrointestinal tract. While endemic in Latin America, the United States sees cases from vectors and imported infections, necessitating updated public health strategies.
Area of Science:
- Veterinary Medicine
- Infectious Diseases
- Parasitology
Background:
- Chagas disease is a serious parasitic infection caused by Trypanosoma cruzi.
- The parasite can lead to life-threatening cardiac and gastrointestinal conditions.
- Enzootic cycles of T. cruzi exist in the southern United States, involving various triatomine vector species and animal reservoirs.
Purpose of the Study:
- To describe the epidemiology of Chagas disease in the United States.
- To identify the vectors and reservoirs of Trypanosoma cruzi in the US.
- To highlight the changing patterns of Chagas disease transmission and the role of the US in addressing it.
Main Methods:
- Review of existing literature on Trypanosoma cruzi vectors and reservoirs in the US.
- Analysis of reported autochthonous, transfusion-associated, and organ donor-derived human infections.
- Assessment of the prevalence of T. cruzi in different animal hosts and geographic regions.
Main Results:
- Eleven triatomine vector species are recognized in the southern US, with higher diversity and density in the western regions.
- Woodrats are common reservoirs in the west, while raccoons, opossums, armadillos, and skunks are key reservoirs in the east.
- Seven autochthonous human infections were reported, alongside seven transfusion-associated and six organ donor-derived cases.
Conclusions:
- The United States has established enzootic cycles of Trypanosoma cruzi with diverse vectors and reservoirs.
- While autochthonous infections are rare, imported cases are increasing due to immigration and organ/blood donations.
- The US must adapt public health strategies to manage the evolving epidemiology of Chagas disease.
Abstract:
Chagas' disease is caused by the protozoan parasite Trypanosoma cruzi and causes potentially life-threatening disease of the heart and gastrointestinal tract. The southern half of the United States contains enzootic cycles of T. cruzi, involving 11 recognized triatomine vector species. The greatest vector diversity and density occur in the western United States, where woodrats are the most common reservoir; other rodents, raccoons, skunks, and coyotes are also infected with T. cruzi. In the eastern United States, the prevalence of T. cruzi is highest in raccoons, opossums, armadillos, and skunks. A total of 7 autochthonous vector-borne human infections have been reported in Texas, California, Tennessee, and Louisiana; many others are thought to go unrecognized. Nevertheless, most T. cruzi-infected individuals in the United States are immigrants from areas of endemicity in Latin America. Seven transfusion-associated and 6 organ donor-derived T. cruzi infections have been documented in the United States and Canada. As improved control of vector- and blood-borne T. cruzi transmission decreases the burden in countries where the disease is historically endemic and imported Chagas' disease is increasingly recognized outside Latin America, the United States can play an important role in addressing the altered epidemiology of Chagas' disease in the 21st century.
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