Evaluation and Treatment of Chagas Disease in the United States

摘要: ContextBecause of population migration from endemic areas and newly instituted blood bank screening, US clinicians are likely to see an increasing number patients with suspected or confirmed chronic Trypanosoma cruzi infection (Chagas disease).ObjectiveTo examine the evidence base provide practical recommendations for evaluation, counseling, etiologic treatment T infection.Evidence AcquisitionLiterature review conducted based on a systematic MEDLINE search all available years through 2007; additional articles, reports, book chapters; input experts in field.Evidence SynthesisThe patient diagnosed Chagas disease should undergo medical history, physical examination, resting 12-lead electrocardiogram (ECG) 30-second lead II rhythm strip. If this evaluation is normal, no further testing indicated; ECG be repeated annually. findings suggest heart disease, comprehensive cardiac including 24-hour ambulatory monitoring, echocardiography, exercise testing, recommended. gastrointestinal tract symptoms present, barium contrast studies performed. Antitrypanosomal recommended cases acute congenital reactivated infection, individuals 18 younger. In adults aged 19 50 without advanced may slow development progression cardiomyopathy generally offered; considered optional those older than years. Individualized decisions balance potential benefit, prolonged course, frequent adverse effects drugs. Strong consideration given previously untreated human immunodeficiency virus expecting organ transplantation.ConclusionsChagas presents challenge United States. Despite gaps base, current knowledge sufficient make guide appropriate management, disease.