Trypanosoma cruzi and Chagas' Disease in the United States
01 Oct 2011-Clinical Microbiology Reviews (American Society for Microbiology)-Vol. 24, Iss: 4, pp 655-681
TL;DR: The United States can play an important role in addressing the altered epidemiology of Chagas' disease in the 21st century as improved control of vector- and blood-borne T. cruzi transmission decreases the burden in countries where the disease is historically endemic.
Abstract: Summary: Chagas' disease is caused by the protozoan parasite Trypanosoma cruzi and causes potentially life-threatening disease of the heart and gastrointestinal tract. The southern half of the United States contains enzootic cycles of T. cruzi, involving 11 recognized triatomine vector species. The greatest vector diversity and density occur in the western United States, where woodrats are the most common reservoir; other rodents, raccoons, skunks, and coyotes are also infected with T. cruzi. In the eastern United States, the prevalence of T. cruzi is highest in raccoons, opossums, armadillos, and skunks. A total of 7 autochthonous vector-borne human infections have been reported in Texas, California, Tennessee, and Louisiana; many others are thought to go unrecognized. Nevertheless, most T. cruzi-infected individuals in the United States are immigrants from areas of endemicity in Latin America. Seven transfusion-associated and 6 organ donor-derived T. cruzi infections have been documented in the United States and Canada. As improved control of vector- and blood-borne T. cruzi transmission decreases the burden in countries where the disease is historically endemic and imported Chagas' disease is increasingly recognized outside Latin America, the United States can play an important role in addressing the altered epidemiology of Chagas' disease in the 21st century.
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Baylor College of Medicine1, Institute for Health Metrics and Evaluation2, Imperial College London3, Anglia Ruskin University4, Institut de recherche pour le développement5, University of London6, Johns Hopkins University7, Texas A&M University8, University of Oklahoma Health Sciences Center9, Erasmus University Rotterdam10, International Livestock Research Institute11, Swiss Tropical and Public Health Institute12, Brandeis University13, Case Western Reserve University14, Watford General Hospital15, Stanford University16
TL;DR: The publication of the Global Burden of Disease Study 2010 and the accompanying collection of Lancet articles in December 2012 provided the most comprehensive attempt to quantify the burden of almost 300 diseases, injuries, and risk factors, including neglected tropical diseases (NTDs).
Abstract: The publication of the Global Burden of Disease Study 2010 (GBD 2010) and the accompanying collection of Lancet articles in December 2012 provided the most comprehensive attempt to quantify the burden of almost 300 diseases, injuries, and risk factors, including neglected tropical diseases (NTDs) [1]–[3]. The disability-adjusted life year (DALY), the metric used in the GBD 2010, is a tool which may be used to assess and compare the relative impact of a number of diseases locally and globally [4]–[6]. Table 1 lists the major NTDs as defined by the World Health Organization (WHO) [7] and their estimated DALYs [1]. With a few exceptions, most of the NTDs currently listed by the WHO [7] or those on the expanded list from PLOS Neglected Tropical Diseases [8] are disablers rather than killers, so the DALY estimates represent one of the few metrics available that could fully embrace the chronic effects of these infections.
Table 1
Estimated DALYs (in millions) of the NTDs from the Global Burden of Disease Study 2010.
Disease DALYs from GBD 2010 (numbers in parentheses indicate 95% confidence intervals) [1]
NTDs 26.06 (20.30–35.12)
Intestinal nematode infections 5.19 (2.98–8.81)
Hookworm disease 3.23 (1.70–5.73)
Ascariasis 1.32 (0.71–2.35)
Trichuriasis 0.64 (0.35–1.06)
Leishmaniasis 3.32 (2.18–4.90)
Schistosomiasis 3.31 (1.70–6.26)
Lymphatic filariasis 2.78 (1.8–4.00)
Food-borne trematodiases 1.88 (0.70–4.84)
Rabies 1.46 ((0.85–2.66)
Dengue 0.83 (0.34–1.41)
African trypanosomiasis 0.56 (0.08–1.77)
Chagas disease 0.55 (0.27–1.05)
Cysticercosis 0.50 (0.38–0.66)
Onchocerciasis 0.49 (0.36–0.66)
Trachoma 0.33 (0.24–0.44)
Echinococcosis 0.14 (0.07–0.29)
Yellow fever <0.001
Other NTDs * 4.72 (3.53–6.35)
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* Relapsing fevers, typhus fever, spotted fever, Q fever, other rickettsioses, other mosquito-borne viral fevers, unspecified arthropod-borne viral fever, arenaviral haemorrhagic fever, toxoplasmosis, unspecified protozoal disease, taeniasis, diphyllobothriasis and sparganosis, other cestode infections, dracunculiasis, trichinellosis, strongyloidiasis, enterobiasis, and other helminthiases.
Even DALYs, however, do not tell the complete story of the harmful effects from NTDs. Some of the specific and potential shortcomings of GBD 2010 have been highlighted elsewhere [9]. Furthermore, DALYs measure only direct health loss and, for example, do not consider the economic impact of the NTDs that results from detrimental effects on school attendance and child development, agriculture (especially from zoonotic NTDs), and overall economic productivity [10], [11]. Nor do DALYs account for direct costs of treatment, surveillance, and prevention measures. Yet, economic impact has emerged as an essential feature of the NTDs, which may trap people in a cycle of poverty and disease [10]–[12]. Additional aspects not considered by the DALY metrics are the important elements of social stigma for many of the NTDs and the spillover effects to family and community members [13], [14], loss of tourism [15], and health system overload (e.g., during dengue outbreaks). Ultimately NTD control and elimination efforts could produce social and economic benefits not necessarily reflected in the DALY metrics, especially among the most affected poor communities [11].
842 citations
Cites background from "Trypanosoma cruzi and Chagas' Disea..."
...and Implications for the Neglected Tropical Diseases Peter J. Hotez1,2,3.*, Miriam Alvarado4, Marı́a-Gloria Basáñez5, Ian Bolliger4, Rupert Bourne6, Michel Boussinesq7, Simon J. Brooker8, Ami Shah Brown9, Geoffrey Buckle10, Christine M. Budke11, Hélène Carabin12, Luc E. Coffeng4,13, Eric M. Fèvre14,15, Thomas Fürst5,16,17, Yara A. Halasa18, Rashmi Jasrasaria4, Nicole E. Johns4, Jennifer Keiser16,17, Charles H. King19, Rafael Lozano4, Michele E. Murdoch20, Simon O’Hanlon5, Sébastien D. S. Pion7, Rachel L. Pullan8, Kapa D. Ramaiah21, Thomas Roberts22, Donald S. Shepard18, Jennifer L. Smith8, Wilma A. Stolk13, Eduardo A. Undurraga18, Jürg Utzinger16,17, Mengru Wang4, Christopher J. L. Murray4.*, Mohsen Naghavi4.* 1 National School of Tropical Medicine at Baylor College of Medicine, Houston, Texas, United States of America, 2 Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Houston, Texas, United States of America, 3 James A. Baker III Institute at Rice University, Houston, Texas, United States of America, 4 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America, 5 Imperial College London, London, United Kingdom, 6 Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, United Kingdom, 7 Institut de Recherche pour le Développement, Montpellier, France, 8 London School of Hygiene and Tropical Medicine, London, United Kingdom, 9 Inovio Pharmaceuticals, Inc., Blue Bell, Pennsylvania, United States of America, 10 Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America, 11 Texas A&M University, College Station, Texas, United States of America, 12 University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America, 13 Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, 14 Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom, 15 International Livestock Research Institute, Nairobi, Kenya, 16 Swiss Tropical and Public Health Institute, Basel, Switzerland, 17 University of Basel, Basel, Switzerland, 18 Brandeis University, Waltham, Massachusetts, United States of America, 19 Case Western Reserve University, Cleveland, Ohio, United States of America, 20 Watford General Hospital, Watford, United Kingdom, 21 Vector Control Research Centre, Pondicherry, India, 22 Stanford University School of Medicine, Stanford, California, United States of America...
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...In Bolivia and Peru, food-borne trematodiases rank closely with Chagas disease as the leading NTDs, while emerging information about Chagas disease in the United States [50] may eventually make it an important NTD there as well....
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...Bern C, Kjos S, Yabsley M, Montgomery S (2011) Trypanosoma cruzi and Chagas’ disease in the United States....
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TL;DR: A brief update on the epidemiology, clinical manifestations, diagnosis, and treatment of Chagas disease is provided.
511 citations
TL;DR: The economic burden of Chagas disease is similar to or exceeds those of other prominent diseases globally (eg, rotavirus $2·0 billion, cervical cancer $4·7 billion) even in the USA, where the disease has not been traditionally endemic, suggesting an economic argument for more attention and efforts towards control.
Abstract: Summary Background As Chagas disease continues to expand beyond tropical and subtropical zones, a growing need exists to better understand its resulting economic burden to help guide stakeholders such as policy makers, funders, and product developers. We developed a Markov simulation model to estimate the global and regional health and economic burden of Chagas disease from the societal perspective. Methods Our Markov model structure had a 1 year cycle length and consisted of five states: acute disease, indeterminate disease, cardiomyopathy with or without congestive heart failure, megaviscera, and death. Major model parameter inputs, including the annual probabilities of transitioning from one state to another, and present case estimates for Chagas disease came from various sources, including WHO and other epidemiological and disease-surveillance-based reports. We calculated annual and lifetime health-care costs and disability-adjusted life-years (DALYs) for individuals, countries, and regions. We used a discount rate of 3% to adjust all costs and DALYs to present-day values. Findings On average, an infected individual incurs US$474 in health-care costs and 0·51 DALYs annually. Over his or her lifetime, an infected individual accrues an average net present value of $3456 and 3·57 DALYs. Globally, the annual burden is $627·46 million in health-care costs and 806 170 DALYs. The global net present value of currently infected individuals is $24·73 billion in health-care costs and 29 385 250 DALYs. Conversion of this burden into costs results in annual per-person costs of $4660 and lifetime per-person costs of $27 684. Global costs are $7·19 billion per year and $188·80 billion per lifetime. More than 10% of these costs emanate from the USA and Canada, where Chagas disease has not been traditionally endemic. A substantial proportion of the burden emerges from lost productivity from cardiovascular disease-induced early mortality. Interpretation The economic burden of Chagas disease is similar to or exceeds those of other prominent diseases globally (eg, rotavirus $2·0 billion, cervical cancer $4·7 billion) even in the USA (Lyme disease $2·5 billion), where Chagas disease has not been traditionally endemic, suggesting an economic argument for more attention and efforts towards control of Chagas disease. Funding Bill & Melinda Gates Foundation, the National Institute of General Medical Sciences Models of Infectious Disease Agent Study.
501 citations
TL;DR: Several clinical aspects of the disease, such as chronic Chagas disease without detectable cardiac pathology, as well as dysautonomia, some specific features, and the principles of treatment of chronic cardiomyopathy are focused on.
325 citations
Cites background from "Trypanosoma cruzi and Chagas' Disea..."
...Similarly, patients with ChD are not aware of their infection and can potentially transmit the parasite through blood or organ donation [3]....
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...The disease can also be transmitted through blood transfusions, organ donations, and from mother to child at birth, which are matters of concern in non-endemic regions [3]....
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...Although the vector is found in the southern half of the United States, very few cases of insect-transmitted disease have been documented [3]....
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...The disease is now observed in cities in the Americas and Europe where immigrants of endemic countries now live [3, 8]....
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TL;DR: The most updated information on diagnosis, screening, and treatment of T cruzi infection, focusing primarily on its cardiovascular aspects is summarized, to increase the recognition of Chagas cardiomyopathy in low-prevalence areas and to improve care for patients with ChagAs heart disease around the world.
Abstract: Background: Chagas disease, resulting from the protozoan Trypanosoma cruzi, is an important cause of heart failure, stroke, arrhythmia, and sudden death. Traditionally regarded as a tropical diseas...
277 citations
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Abstract: The survival rate (average, 50%) of patients undergoing cardiopulmonary transplantation falls well below that expected for cardiac transplantation alone. We give a broad overview of the various grounds upon which this difference is likely based and discuss recent advances in each area: 1) criteria for the selection of candidates and donors, 2) methods for ex-vivo preservation of donor organs, 3) technical execution of the operative procedure, and 4) prevention of postoperative infection. In connection with the prevention of postoperative infection, we discuss the potential for the development of a chronic obliterative disease that, once established, has proved inexorable. Current efforts are focused on detection when the process is in an early, reversible stage, and on research into causation. (Texas Heart Institute Journal 1987; 14:364-368)
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