Chagas in Children Unmasked With Multimodality Imaging

Chagas disease is typically acquired during childhood but evolves into chronic cardiomyopathy over decades in 30% to 40% of infected individuals. Among Latin America-born patients with newly diagnosed nonischemic cardiomyopathy in the United States, 13% to 19% have Chagas disease as the underlying etiology.

We present 3 pediatric cases illustrating the mechanistic connection between childhood infection and lifetime cardiomyopathy risk: 1) acute myocarditis with cardiac arrest and complete recovery after early benznidazole treatment; 2) fulminant myocarditis requiring venoarterial extracorporeal membrane oxygenation with severely reduced global longitudinal strain and left ventricular apical thrombus; and 3) chronic cardiomyopathy with myocardial fibrosis on cardiac magnetic resonance and regional strain abnormalities. Speckle-tracking echocardiography and cardiac magnetic resonance revealed the mechanistic substrate for disease progression.

These cases demonstrate the spectrum of pediatric Chagas cardiomyopathy from reversible acute myocarditis to established fibrosis. Speckle-tracking echocardiography and cardiac MRI revealed the mechanistic substrate for disease progression, detecting subclinical dysfunction and fibrosis that predict progression to overt cardiomyopathy.

Early recognition and treatment of pediatric Chagas disease prevents adult cardiomyopathy by interrupting persistent parasitemia. Speckle-tracking echocardiography and cardiac magnetic resonance detect subclinical dysfunction and fibrosis predicting disease progression.