Recommendations for Screening and Diagnosis of Chagas Disease in the United States
Colin Forsyth, Jennifer Manne‐Goehler, Caryn Bern, Jeffrey D. Whitman, Natasha S. Hochberg, Morven S. Edwards, Rachel Marcus, Norman Beatty, Yagahira E. Castro-Sesquen, Christina Coyle, Paula Stigler Granados, Davidson H. Hamer, James H. Maguire, Robert H. Gilman, Sheba Meymandi
Abstract
BACKGROUND: Chagas disease affects an estimated 326 000-347 000 people in the United States and is severely underdiagnosed. Lack of awareness and clarity regarding screening and diagnosis is a key barrier. This article provides straightforward recommendations, with the goal of simplifying identification and testing of people at risk for US healthcare providers. METHODS: A multidisciplinary working group of clinicians and researchers with expertise in Chagas disease agreed on 6 main questions, and developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, after reviewing the relevant literature on Chagas disease in the United States. RESULTS: Individuals who were born or resided for prolonged time periods in endemic countries of Mexico and Central and South America should be tested for Trypanosoma cruzi infection, and family members of people who test positive should be screened. Women of childbearing age with risk factors and infants born to seropositive mothers deserve special consideration due to the risk of vertical transmission. Diagnostic testing for chronic T. cruzi infection should be conducted using 2 distinct assays. CONCLUSIONS: Increasing provider-directed screening for T. cruzi infection is key to addressing this neglected public health challenge in the United States.