TY - JOUR
T1 - Chagas disease in the new york city metropolitan area
AU - Zheng, Crystal
AU - Quintero, Orlando
AU - Revere, Elizabeth K.
AU - Oey, Michael B.
AU - Espinoza, Fabiola
AU - Puius, Yoram A.
AU - Ramirez-Baron, Diana
AU - Salama, Carlos R.
AU - Hidalgo, Luis F.
AU - Machado, Fabiana S.
AU - Saeed, Omar
AU - Shin, Jooyoung
AU - Patel, Snehal R.
AU - Coyle, Christina M.
AU - Tanowitz, Herbert B.
N1 - Publisher Copyright:
© 2020 Oxford University Press. All rights reserved.
PY - 2020
Y1 - 2020
N2 - 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%). Twentyseven 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.
AB - 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%). Twentyseven 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.
KW - Chagas disease
KW - Heart transplant
KW - New York City
KW - Nonendemic countries
KW - Trypanosoma cruzi
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U2 - 10.1093/OFID/OFAA156
DO - 10.1093/OFID/OFAA156
M3 - Article
AN - SCOPUS:85101374527
SN - 2328-8957
VL - 7
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 5
M1 - ofaa156
ER -