Letters to the Editor

Chagas Disease Is a Consideration in Latino Patients



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Am Fam Physician. 2013 Nov 1;88(9):566.

Original Article: Caring for Latino Patients

Issue Date: January 1, 2013

See additional reader comments at: http://www.aafp.org/afp/2013/0101/p48.html

TO THE EDITOR: We read this article with great interest. However, the author did not mention Chagas disease among the special medical conditions that disproportionately affect persons from Central and South America.

Worldwide, an estimated 8 million persons—mainly in continental Latin America—are thought to have Chagas disease.1 An estimated 300,000 of these persons live in the United States.1

Chagas disease is caused by Trypanosoma cruzi, a protozoan parasite transmitted principally by bloodsucking insects of the subfamily Triatominae1 that typically live in cracks in the walls of mud and straw houses in rural Latin American communities. Transmission can also occur congenitally and by laboratory accidents, contamination of food with feces of triatomines, and transfusion or transplantation of infected blood or organs.1

Acute infection with T. cruzi is usually asymptomatic and is followed by a chronic asymptomatic phase that, in about one-third of cases, leads to severe organ involvement (cardiomyopathy and/or intestinal megasyndromes) after 10 to 30 years.1 The infection may reactivate and cause severe manifestations in immunosuppressed patients.1

A cross-sectional study showed that 13% of Latino immigrants with dilated cardiomyopathy who were living in New York City had Chagas disease.2 It has been diagnosed in U.S. organ and blood recipients3 and in an infant born to a Bolivian mother.4

Chronic Chagas disease can be diagnosed through serologic testing, whereas parasitologic and molecular testing is useful for acute, congenital, and reactivated infections.1 Antitrypanosomal treatment is recommended for patients with acute, congenital, or reactivated infections, and for patients younger than 18 years who have chronic disease. Antiparasitic treatment should generally be offered to adults without advanced heart disease because it appears to slow the development and progression of Chagas disease cardiomyopathy; it generally should not be offered to patients who have advanced chagasic cardiomyopathy with congestive heart failure.5 Health care professionals should be aware of Chagas disease to provide appropriate care to Latino patients and help stop transmission of the disease.

Author disclosure: No relevant financial affiliations.

REFERENCES

1. Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388–1402.

2. Kapelusznik L, Varela D, Montgomery SP, et al. Chagas disease in Latin American immigrants with dilated cardiomyopathy in New York City. Clin Infect Dis. 2013;57(1):e7.

3. Bern C, Kjos S, Yabsley MJ, Montgomery SP. Trypanosoma cruzi and Chagas' disease in the United States. Clin Microbiol Rev. 2011;24(4):655–681.

4. Centers for Disease Control and Prevention. Congenital transmission of Chagas disease – Virginia, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(26):477–479.

5. Bern C, Montgomery SP, Herwaldt BL, et al. Evaluation and treatment of Chagas disease in the United States: a systematic review. JAMA. 2007;298(18):2171–2181.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.



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