Cardiomyopathy
Development of Chagas Cardiac Manifestations Among Texas Blood Donors

https://doi.org/10.1016/j.amjcard.2014.09.050Get rights and content

Highlights

  • Chagas disease cardiac manifestations were seen in 41% of Texas blood donors during a cross-sectional analysis.

  • Thirty-six percent of Chagas-positive blood donors were suspected locally acquired cases, putting them at high risk for being mistreated during their follow-up clinical evaluations despite having positive test results from the blood bank.

  • Blood donors with positive test results for the parasite that causes Chagas disease should be closely monitored for the development of cardiac manifestations.

Chagas disease, infection with the parasite Trypanosoma cruzi, has recently been identified as an important emerging parasitic disease in the United States. To describe the cardiac abnormalities in T. cruzi–positive blood donors in southeastern Texas, a pilot study of donors who had screened positive from 2007 to 2012 was performed. This one-time assessment included (1) a questionnaire to evaluate the source of infection, cardiac symptoms, and health co-morbidities; (2) electrocardiography; (3) echocardiography if electrocardiographic findings were abnormal; and (4) measurement of a high-sensitivity troponin T biomarker. Of those with confirmed infection, 41% (7 of 17) had electrocardiographic abnormalities consistent with Chagas cardiomyopathy. In addition, 36% (6 of 17) were suspected to be locally acquired cases. High-sensitivity troponin T serum levels increased with cardiac severity. In conclusion, cardiologists should consider Chagas disease in their differential diagnoses for patients who may have clinically compatible electrocardiographic changes or nonischemic cardiomyopathy, even if the patients have no histories of residing in Chagas-endemic countries.

Section snippets

Methods

This study was reviewed and approved by the institutional review boards at Baylor College of Medicine and the Gulf Coast Regional Blood Center. The Gulf Coast Regional Blood Center serves the greater Houston area and >170 hospitals and health care institutions in the 26-county Texas Gulf Coast, Brazos Valley, and East Texas region. Blood donors who tested positive on 2 repeat tests (repeat reactive) on the Ortho T. cruzi enzyme-linked immunosorbent assay system (Ortho-Clinical Diagnostics,

Results

We enrolled 17 blood donors with confirmed T. cruzi infection (Chagas disease) for a one-time assessment of cardiac health. The median age of our study population was 51 years (range 23 to 75), and the population was composed mostly of Hispanic (13 of 17) men (10 of 17). Thirty-six percent (6 of 17) were recognized as potential locally acquired infections. Those with evidence of locally acquired infection were mostly white (4 of 6) and male (4 of 6). One of the 6 participants was classified as

Discussion

Our study of T. cruzi–positive individuals identified by blood bank screening has several important findings. First, 41% had ECG abnormalities consistent with Chagas cardiac involvement, and most of these abnormalities (72%) met major ECG diagnostic criteria supportive of Chagas disease. Importantly, we also discovered that 36% of participants were suspected to have acquired their infection in southeastern Texas. These patients were largely non-Hispanic whites with no histories of travel to

Acknowledgment

The authors thank the study participants for their contribution to this study. The authors thank Nate Wolf for his translation services and contribution to this study. The authors thank Drs. Susan Montgomery, Susan Stramer, and Paul Cantey from the Centers for Disease Control and Prevention and the American Red Cross for kindly sharing their blood donor surveys, which served as a basis for the study questionnaire. Last, the authors thank Roche Diagnostics for providing in kind the hsTnT

References (21)

  • A. Rassi et al.

    Chagas disease

    Lancet

    (2010)
  • M.C. Nunes et al.

    Chagas disease: an overview of clinical and epidemiological aspects

    J Am Coll Cardiol

    (2013)
  • Centers for Disease Control and Prevention. American Trypanosomiasis. Available at: www.cdc.gov/parasites/chagas/....
  • World Health Organization. Chagas disease. Available at: http://www.who.int/tropics/chagas_disease/en/. Accessed on...
  • E.C. Sabino et al.

    Ten-year incidence of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi-seropositive former blood donors

    Circulation

    (2013)
  • Blood donor screening for Chagas disease—United States, 2006-2007

    MMWR Morb Mortal Wkly Rep

    (2007)
  • L.V. Kirchhoff

    American trypanosomiasis (Chagas’ disease)—a tropical disease now in the United States

    N Engl J Med

    (1993)
  • C. Bern et al.

    Trypanosoma cruzi and Chagas’ disease in the United States

    Clin Microbiol Rev

    (2011)
  • P.T. Cantey et al.

    The United States Trypanosoma cruzi infection study: evidence for vector-borne transmission of the parasite that causes Chagas disease among United States blood donors

    Transfusion

    (2012)
  • American Association of Blood Banks. Chagas Biovigilance Network. Available at:...
There are more references available in the full text version of this article.

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    Most of the cases were thought to be related to immigration and were frequently not proven by serologic testing. When testing for CD in blood donors started in 2008, seropositivity to T. cruzi was found to be 1 in 6500 donors with 36% of them having clinical evidence of Chagasic cardiomyopathy.6 Infection in at least 5 of these cases is postulated to have occurred as autochthonous transmission in Texas.7

  • Characterization and Stability of Trypanosoma cruzi 24-C4 (Tc24-C4), a Candidate Antigen for a Therapeutic Vaccine Against Chagas Disease

    2018, Journal of Pharmaceutical Sciences
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    Notably, the disease is now emerging in the United States, Europe, Japan, and Australia due to increased migration and trade, with documented cases of vectorial, transfusional, congenital, and laboratory transmission.3,4 Furthermore, significant Chagas disease transmission and Chagasic cardiomyopathy is now present in Texas and possibly elsewhere in the United States.5,6 In addition to the public health impact of Chagas disease, the global economic burden was estimated to exceed $7 billion annually (including $630 million in health care costs) and over 800,000 disability-adjusted life years.7

  • Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC)

    2018, Journal of the American Society of Echocardiography
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    Locally acquired vector-borne infection has been documented in a handful of cases over the past 60 years and has been inferred in blood donors for whom acquisition of the infection in Latin America has been ruled out or judged unlikely.7,18,19 Direct assessments of prevalence in the United States are sparse and have been restricted to small-scale surveys or case series in populations chosen because of anticipated high risk (e.g., Latin American immigrants with nonischemic heart disease).20-22 Because of low provider awareness, cases of Chagas cardiomyopathy likely go unrecognized, and women at risk for vertical transmission to their infants are not screened.23,24

  • Molecular identification and genotyping of Trypanosoma cruzi DNA in autochthonous Chagas disease patients from Texas, USA

    2017, Infection, Genetics and Evolution
    Citation Excerpt :

    As part of the original cohort follow-up, cardiac evaluations were performed on all T. cruzi-positive blood donors. These assessments included an electrocardiogram performed by a trained technician and interpreted by a licensed physician (Garcia et al., 2015c). Of the 16 confirmed cases of locally-acquired T. cruzi infection, blood samples for genotyping were available for 15 donors.

  • Benznidazole and Posaconazole in Eliminating Parasites in Asymptomatic T. Cruzi Carriers: The STOP-CHAGAS Trial

    2017, Journal of the American College of Cardiology
    Citation Excerpt :

    Similarly, reducing the burden of disease and progression to cardiomyopathy is critical, as 5.7 to 9.4 million people around the world are currently infected with T. cruzi, and it is projected that 40,000 annual deaths associated with cardiac complications of Chagas infection will occur within the next 5 years (4). T. cruzi transmission has also been recently documented in the United States, with evidence of Chagas cardiac manifestations among Texas blood donors (21,22). There is presently no agreement on whether all patients with chronic asymptomatic Chagas infection should receive treatment with trypanocidal therapy (23), which justified using a placebo arm.

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This study was funded by the Baylor College of Medicine Cardiovascular Research Institute.

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