ISPUB.com / IJID/2/1/8421
  • Author/Editor Login
  • Registration
  • Facebook
  • Google Plus

ISPUB.com

Internet
Scientific
Publications

  • Home
  • Journals
  • Latest Articles
  • Disclaimers
  • Article Submissions
  • Contact
  • Help
  • The Internet Journal of Infectious Diseases
  • Volume 2
  • Number 1

Original Article

Transfusion-Associated Chagas' Disease in the United States

J Lane, A Walker, R Ribeiro-Rodrigues, C Carter, J Stephens

Citation

J Lane, A Walker, R Ribeiro-Rodrigues, C Carter, J Stephens. Transfusion-Associated Chagas' Disease in the United States. The Internet Journal of Infectious Diseases. 2001 Volume 2 Number 1.

Abstract
 

Chagas' disease (American trypanosomiasis) is a zoonosis caused by Trypanosoma cruzi, a protozoan parasite that is endemic in Latin America and transmitted to humans most often by the bite of one of several species of reduvid (kissing) bugs. While less frequent than natural transmission, congenital infection and transmission by contaminated blood and/or organs also occurs.1 The majority of infected individuals remain asymptomatic; however, chronic Chagas' disease is a leading cause of heart failure in South and Central America, afflicting 16 to 18 million patients and causing nearly 50,000 deaths annually.2 There is no curative treatment for the chronic form. It is rare in North America but infected species of the vector, reservoir animals and seropositive individuals have been identified within the U.S..4,5,6

The prospect of T. cruzi spreading by transfusion has garnered concern in the U.S. public health arena. Infection by transfusion is second only to vector transmission in endemic areas and is likely underdiagnosed.7 There are incidental reports of transfusion-related infection in the U.S.3 The possibility that an asymptomatic infected individual might become a blood donor is real. Milei et al. 8 estimated that up to 370,000 chagasic patients reside in the U.S. Other studies estimate that seropositive individuals in the U.S. number over 350,000, with approximately 100,000 actually suffering from manifestations of chronic Chagas' disease.8,9 Leiby et al.6 reviewed multiple studies that investigated the prevalence of T. cruzi antibodies among blood donors in various regions of the U.S. Several studies have correlated the incidence of seropositivity with regard to birthplace and travel history. In one study, all seven individuals who tested positive serologically originated from endemic areas, while in a separate study, of 34 seropositive individuals, all but one was born in an endemic region.10

There is currently no routine testing of donated blood units for T. cruzi by U.S. blood banks. Screening for infection remains a debated issue as the cost-effectiveness is difficult to assess within the U.S. Current opinions differ regarding the value of identifying at-risk would-be blood donors by history of possible prior exposure. The foremost risk factor for occult infection has been recognized as “birth place in an endemic region.” Questionnaires that seek this information could be used to screen at-risk populations prior to blood donation but the benefit of excluding at-risk donors has not been established. Further discussion regarding current blood bank testing and cost-effectiveness is warranted as evidenced by the recent occurrence of three cases of Chagas' disease in the U.S. from an organ donor.1

Correspondence to

Jeffrey L. Stephens, M.D. Division of Infectious Disease Department of Internal Medicine Mercer University School of Medicine Medical Center of Central Georgia 777 Hemlock Street Hospital Box # 79 Macon, Georgia 31208 Phone: (478) 301-5850 Fax: (478) 301-5856 E-mail: stephens_j@mercer.edu

References

1. Zayas CF, Perlino C, Caliendo A, et al. Chagas disease after organ transplantation - United States, 2001. MMWR 2002; 51: 210-212.
2. Kirchoff LV. American Trypanosomiasis (Chagas' Disease) - A Tropical Disease Now in the United States. N Engl J Med 1993; 329:639-644.
3. Grant IH, Gold JWM, Wittner M, et al. Transfusion-Associated Acute Chagas' Disease Acquired in the United States. Ann Intern Med 1989; 111:849-851.
4. Pung OJ, Banks CW, Jones DN, et al. Trypanosoma cruzi in Wild Raccoons, Opossums, and Triatomine Bugs in Southeast Georgia, U.S.A. J Parasitol 1995; 81:324-326.
5. Kirchoff LV, Gam AA, Gilliam FC. American Trypanosomiasis (Chagas' Disease) in Central American Immigrants. Am J Med 1987; 82:915-920.
6. Leiby DA, Read EJ, Lenes BA, et al. Seroepidemiology of Trypanosoma cruzi, Etiologic Agent of Chagas' Disease, in US Blood Donors. J Infect Dis 1997; 176:1047-1052.
7. Wendel S, Gonzaga AL. Chagas' Disease and Blood Transfusion: A New World Problem? Vox Sang 1993; 64:1-12.
8. Milei J, Mautner B, Storino R, et al. Does Chagas' disease exist as an undiagnosed form of cardiomyopathy in the United States? Am Heart J 1992; 123:1732-1735.
9. Hagar JM, Rahimtoola SH. Chagas' Heart Disease in the United States. N Engl J Med 1991; 325:763-768.
10. Shulman IA, Appleman MD, Saxena S, et al. Specific antibodies to Trypanosoma cruzi amond blood donors in Los Angeles, California. Transfusion 1997; 37:727-731.

Author Information

Joshua E Lane, MD
Department of Internal Medicine, Section of Dermatology, The Medical College of Georgia

Anna N Walker, MD
Department of Pathology, Mercer University School of Medicine

Rodrigo Ribeiro-Rodrigues, PhD
Núcleo de Doenças Infecciosas and Pathology Department, Universidade Federal do Espírito Santo

Clint E Carter, PhD
Department of Biology, Vanderbilt University

Jeffrey L Stephens, MD
Department of Internal Medicine, Division of Infectious Disease, Mercer University School of Medicine

Download PDF

Your free access to ISPUB is funded by the following advertisements:

 

BACK TO TOP
  • Facebook
  • Google Plus

© 2013 Internet Scientific Publications, LLC. All rights reserved.    UBM Medica Network Privacy Policy