Abstract
Background
Chagas disease, caused by the parasite Trypanosoma cruzi, once considered a disease confined to Mexico, Central America, and South America, is now an emerging global public health problem. An estimated 300 000 immigrants in the United States are chronically infected with T. cruzi. However, awareness of Chagas disease among the medical community in the United States is poor.
Methods
We review our experience managing 60 patients with Chagas disease in hospitals throughout the New York City metropolitan area and describe screening, clinical manifestations, EKG findings, imaging, and treatment.
Results
The most common country of origin of our patients was El Salvador (n = 24, 40%), and the most common detection method was by routine blood donor screening (n = 21, 35%). Nearly half of the patients were asymptomatic (n = 29, 48%). Twenty-seven patients were treated with either benznidazole or nifurtimox, of whom 7 did not complete therapy due to side effects or were lost to follow-up. Ten patients had advanced heart failure requiring device implantation or organ transplantation.
Conclusions
Based on our experience, we recommend that targeted screening be used to identify at-risk, asymptomatic patients before progression to clinical disease. Evaluation should include an electrocardiogram, echocardiogram, and chest x-ray, as well as gastrointestinal imaging if relevant symptoms are present. Patients should be treated if appropriate, but providers should be aware of adverse effects that may prevent patients from completing treatment.
Document Type
Article
Publication Date
5-6-2020
Digital Object Identifier (DOI)
https://doi.org/10.1093/ofid/ofaa156
Repository Citation
Zheng, Crystal; Quintero, Orlando; Revere, Elizabeth K.; Oey, Michael B.; Espinoza, Fabiola; Puius, Yoram A.; Ramirez-Baron, Diana; Salama, Carlos R.; Hidalgo, Luis F.; Machado, Fabiana S; Saeed, Omar; Shin, Jooyoung; Patel, Snehal R.; Coyle, Christina M.; and Tanowitz, Herbert B., "Chagas Disease in the New York City Metropolitan Area" (2020). Internal Medicine Faculty Publications. 208.
https://uknowledge.uky.edu/internalmedicine_facpub/208
Notes/Citation Information
Published in Open Forum Infectious Diseases, v. 7, issue 5, ofaa156, p. 1-8.
© The Author(s) 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/ by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com.