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Wheelock A, Sandhu S, Reifler K, Carrion M, Bourque DL, Hamer DH, Hochberg NS. Improving Clinician Awareness of and Screening for Chagas Disease with an Educational Intervention. Am J Trop Med Hyg 2024; 111:380-386. [PMID: 38889732 PMCID: PMC11310624 DOI: 10.4269/ajtmh.23-0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/16/2024] [Indexed: 06/20/2024] Open
Abstract
Chagas disease is an underrecognized, chronic, and potentially life-threatening disease caused by the parasite Trypanosoma cruzi. We aimed to improve awareness and screening for Chagas disease among patients from endemic areas using a large safety-net academic hospital system in the United States. We developed an educational intervention consisting of a case-based didactic session presented to physicians, trainees, and other healthcare providers at conferences across different departments. Performance on a knowledge assessment administered before and after the presentation was analyzed with paired Student's t-test for within-subject difference testing. Institutional testing rates for T. cruzi were evaluated for an equal time period (29 months) before and after the start of the intervention. Testing rates were compared by a Welch's unequal variances t-test and by interrupted time series based on multivariate linear regression. Eleven educational sessions were held over the intervention period, and 103 participants completed the pre- and post-presentation surveys. The mean survey scores were 59.2% before the presentation and 96.6% after presentation (P <0.001). Trypanosoma cruzi testing during the postintervention period was significantly higher than testing during the pre-intervention period (171 patients pre-intervention versus 378 patients postintervention [P = 0.015]). Notable increases in testing from the pre-intervention to postintervention periods occurred among midwives (1-68 patients tested) and trainees (57-133 patients tested). Overall, 56/537 (10.4%) nonduplicate T. cruzi commercial screening tests were positive. Testing increased over time, both at an institutional level and within targeted departments. In addition to the educational program, other factors likely influenced expanded testing.
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Affiliation(s)
- Alyse Wheelock
- Section of Preventive Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Sukhmeet Sandhu
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Katherine Reifler
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Malwina Carrion
- Boston University Sargent College of Health and Rehabilitation Sciences, Boston, Massachusetts
| | - Daniel L. Bourque
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Davidson H. Hamer
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Center on Emerging Infectious Diseases, Boston University, Boston, Massachusetts
| | - Natasha S. Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
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Agudelo Higuita NI, Beatty NL, Forsyth C, Henao-Martínez AF, Manne-Goehler J. Chagas disease in the United States: a call for increased investment and collaborative research. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100768. [PMID: 38798947 PMCID: PMC11127192 DOI: 10.1016/j.lana.2024.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Chagas disease, caused by the protozoan Trypanosoma cruzi, is a highly overlooked parasitic infection within the United States. It affects an estimated 300,000 individuals, often remaining asymptomatic for years before triggering severe complications such as cardiomyopathy in 30-40% of cases. While many contract the disease in Latin America, its transmission by local vectors in the southern U.S. presents a significant challenge. Unfortunately, limited access to diagnosis and treatment persists, alongside unresolved gaps in healthcare systems and disease pathogenesis. In this viewpoint, we discuss the need for focused research and public health initiatives, with U.S. research institutions playing a crucial role in developing new treatments and identifying biomarkers. Furthermore, investigating the genetic variations of T. cruzi between North and South America is vital for improving diagnostic and treatment strategies. Urgent action is required to implement national and local programs, bolstering healthcare responses and advancing research efforts.Q4As per journal style section heading 'Introduction' is mandatory, hence we have introduced the heading. Please check, and correct if necessary.ResolvedQ5If there are any drug dosages in your article, please verify them and indicate that you have done so by initialing this query.ResolvedQ6Please supply the year of publication.ResolvedFootnoteView Edit Log9.
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Affiliation(s)
- Nelson Iván Agudelo Higuita
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Norman L. Beatty
- Department of Medicine, Division of Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Colin Forsyth
- Drugs for Neglected Diseases Initiative–North America, New York, NY, USA
| | - Andrés F. Henao-Martínez
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Henao-Martínez AF, Olivo-Freites C, Higuita NIA, Ferraz C, Franco-Paredes C, Tuells J, Woc-Colburn L, Villalpando-Carrión S, Chastain DB, Rassi A. Clinical Characteristics and Outcomes of Chagas Disease in the United States: A Multicenter Retrospective Analysis. Am J Trop Med Hyg 2023; 109:1006-1011. [PMID: 37696508 PMCID: PMC10622470 DOI: 10.4269/ajtmh.23-0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 09/13/2023] Open
Abstract
Chagas disease affects approximately 300,000 patients in the United States. We evaluated a multicenter U.S.-based network to obtain clinical characteristics and outcomes of chronic Chagas disease by disease forms. This was a U.S.-based, multicenter, population-based, retrospective cohort study. We queried TriNetX, a global research network, to identify patients with dual-positive IgG serology for Trypanosoma cruzi. We captured outcomes of interest for up to 5 years. We found 429 patients with evidence of dual-positive T. cruzi IgG out of 19,831 patients with an available test result from 31 U.S. medical centers. The positive proportion for those tested was 2.2%, up to 4.6% among Hispanics. We found a prevalence of a positive Chagas serology of 0.02% among Hispanics. Cardiomyopathy risk reached an annual rate of 1.3% during the initial 5 years of follow-up among patients with the indeterminate form. We found no new events for pulmonary embolism, sudden death, or left ventricular aneurysms at 5 years. Annual risks for arrhythmias and stroke for chronic Chagas cardiomyopathy (CCC) were 1.6% and 0.8%, respectively. The yearly mortality and hospitalization rates for CCC were 2.7% and 17.1%, respectively. Only 13 patients had a documented antitrypanosomal therapy course within 6 months after diagnosis. Of those receiving treatment, 10 patients received benznidazole and three nifurtimox. Chagas disease screening in patients from endemic areas living in the United States remains crucial. Chronic Chagas cardiomyopathy carries a considerable disease burden, translating into increased morbidity and mortality and an enlarging medical health service utilization.
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Affiliation(s)
- Andrés F. Henao-Martínez
- Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, Colorado
| | | | - Nelson I. Agudelo Higuita
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Carolina Ferraz
- Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, Aurora, Colorado
| | - Carlos Franco-Paredes
- Hospital Infantil de México, Ciudad de México, Mexico
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama
| | - Jose Tuells
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
| | | | | | - Daniel B. Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, Georgia
| | - Anis Rassi
- Division of Cardiology, Anis Rassi Hospital, Goiânia, Brazil
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Lynn MK, Dye-Braumuller KC, Beatty NL, Dorn PL, Klotz SA, Stramer SL, Townsend RL, Kamel H, Vannoy JM, Sadler P, Montgomery SP, Rivera HN, Nolan MS. Evidence of likely autochthonous Chagas disease in the southwestern United States: A case series of Trypanosoma cruzi seropositive blood donors. Transfusion 2022; 62:1808-1817. [PMID: 35895440 PMCID: PMC9543114 DOI: 10.1111/trf.17026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
Background Chagas disease is a parasitic infection that can insidiously cause non‐ischemic cardiomyopathy. Given the largely silent nature of this progressive disease, asymptomatic blood donors pose potential blood transfusion risk. Blood donation screening has become an unintentional form of Chagas disease surveillance, with thousands of new cases identified since national surveillance was initiated in 2007. Study Design and Methods We recruited T. cruzi‐positive blood donors identified from California and Arizona blood centers for confirmatory blood screening and assessment of lifetime infection risk. Results Among eight suspected cases, we identified four confirmed US autochthonous infections. The current manuscript details the transmission sources, healthcare‐seeking behaviors post‐blood donation resulting, and clinical course of disease among persons without any history of travel to endemic Latin American countries. Discussion This manuscript presents four additional US‐acquired Chagas disease cases and identifies an opportunity for blood centers to assist in confronting barriers surrounding Chagas disease in the US.
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Affiliation(s)
- Mary K Lynn
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Kyndall C Dye-Braumuller
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Norman L Beatty
- Division of Infectious Diseases & Global Medicine, Department of Medicine, University of Florida, Gainesville, Florida, USA.,Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Patricia L Dorn
- Department of Biological Sciences, Loyola University New Orleans, New Orleans, Louisiana, USA
| | - Stephen A Klotz
- Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | | | - Hany Kamel
- Corporate Medical Affairs, Vitalant, Scottsdale, Arizona, USA
| | | | - Patrick Sadler
- Central California Blood Center, Fresno, California, USA
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilda N Rivera
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa S Nolan
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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The Importance of Screening for Chagas Disease Against the Backdrop of Changing Epidemiology in the USA. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:185-193. [PMID: 36105114 PMCID: PMC9463514 DOI: 10.1007/s40475-022-00264-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
Purpose of Review This review seeks to identify factors contributing to the changing epidemiology of Chagas disease in the United States of America (US). By showcasing screening programs for Chagas disease that currently exist in endemic and non-endemic settings, we make recommendations for expanding access to Chagas disease diagnosis and care in the US. Recent Findings Several factors including but not limited to increasing migration, climate change, rapid population growth, growing urbanization, changing transportation patterns, and rising poverty are thought to contribute to changes in the epidemiology of Chagas disease in the US. Outlined are some examples of successful screening programs for Chagas disease in other countries as well as in some areas of the US, notably those which focus on screening high-risk populations and are linked to affordable and effective treatment options. Summary Given concerns that Chagas disease prevalence and even risk of transmission may be increasing in the US, there is a need for improving detection and treatment of the disease. There are many successful screening programs in place that can be replicated and/or expanded upon in the US. Specifically, we propose integrating Chagas disease into relevant clinical guidelines, particularly in cardiology and obstetrics/gynecology, and using advocacy as a tool to raise awareness of Chagas disease.
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Livingston EG, Duggal R, Dotters-Katz S. Screening for Chagas Disease during Pregnancy in the United States-A Literature Review. Trop Med Infect Dis 2021; 6:tropicalmed6040202. [PMID: 34941658 PMCID: PMC8704518 DOI: 10.3390/tropicalmed6040202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/13/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Obstetrician-gynecologists in the United States have little clinical experience with the epidemiology, pathophysiology, diagnosis, and treatment of Chagas disease. The number of US parturients born in Central and South America has continued to increase over the last 20 years, making US obstetricians more and more likely to care for Chagas-infected mothers who may never be identified until dealing with long-term consequences of the disease. A literature search demonstrates that few US obstetric care providers recognize the risk of vertical transmission for the neonate and the missed opportunity of infant treatment to decrease disease prevalence. Most women will be asymptomatic during pregnancy, as will their neonates, making routine laboratory screening a necessity for the identification of at-risk neonates. While the benefits of treating asymptomatic women identified in pregnancy are not as clear as the benefits for the infants, future health screenings for evidence of the progression of Chagas disease may be beneficial to these families. The literature suggests that screening for Chagas in pregnancy in the US can be done in a cost-effective way. When viewed through an equity lens, this condition disproportionately affects families of lower socioeconomic means. Improved education of healthcare providers and appropriate resources for diagnosis and treatment can improve this disparity in health outcomes.
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