Abstract

INTRODUCTION: Chagas disease (CD) is a parasitic infection caused by the protozoa Trypanosoma cruzi. Of the approximately 7 million people affected worldwide, an estimated 300,000 individuals reside in the United States. Increased migration from endemic areas, insufficient screening and limited access to care pose a substantial public health concern. Since a chronic, latent course often precedes symptom onset decades after exposure, the true prevalence of CD may exceed recent estimates. This review will examine CD prevalence in the US according to disease course and symptomatology.

METHODS: Studies published between 1989-2021 were retrieved by a comprehensive PubMed and EMBASE search using the following terms: Chagas disease, Trypanosoma cruzi, chronic, acute, prevalence, patient, population, diagnosis, mortality, cardiac, and gastrointestinal. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Descriptive statistical analysis was performed to analyze the obtained data.

OUTCOMES: We obtained 729 studies from our search, analyzing 22 studies and 3 datasets reporting both acute and chronic CD cases in the US from 1991-2021. Chronic cases were classified as cardiac, digestive, mixed, or indeterminate. Average prevalence of confirmed chronic CD was 5.8%. We reviewed an additional 19 case reports of 43 CD cases, of which 84% were chronic, mostly cardiac.

DISCUSSION: Our results suggest that, using real-world data, chronic CD is more prevalent in the US than recent estimates. Cardiac dysfunction is a substantial threat to affected individuals. However, our sample was small and likely reflective of a higher-risk population.