Why We Should Screen for Chagas 'Kissing Bug' Disease in Cardiology

Rachel R. Marcus, MD


March 07, 2019

This transcript has been edited for clarity.

Hi. My name is Rachel Marcus. I am a cardiologist in Washington, DC, and the medical director of LASOCHA, a nonprofit that works with Latin American immigrants who have Chagas disease.

I'd like to convince you that you should be screening for Chagas disease in your Latin American immigrant patients from non-island nations who come to see you in your cardiology clinic.

The first important point is that Chagas disease is in the United States. The Centers for Disease Control and Prevention estimates that 300,000 individuals nationwide have this parasitic infection.[1] In our work in the metropolitan DC area, we found that 4% of more than 1600 individuals that we screened have Chagas disease.

In two centers in the United States that have screened their Latin American immigrants with nonischemic cardiomyopathies for Chagas disease, 13%-19% of them were found to have Chagas disease as their underlying diagnosis.[2] In patients with bifascicular block, 17.9% were found to have Chagas disease,[3] and in Latin American immigrants with pacemakers, 7.5% had Chagas disease as the cause of their conduction abnormality.[4]

The second important point is that it really matters to make the diagnosis of Chagas disease. Chagas disease is a bad illness. Morbidity and mortality are associated with ejection fractions that are higher than the levels that we usually worry about in the cardiology clinic. Chagas disease patients are at risk for stroke, ventricular tachycardia, and serious bradyarrhythmias, and they have higher short-term mortality than patients with other cardiomyopathies. Chagas patients who have been transplanted are at risk for acute reactivation of their illness, and most importantly, Chagas disease can be passed transplacentally, so the children of an infected mother must be screened for the disease.

So, please, screen your patients for Chagas disease. You will find it, and it will matter. And if you have any questions about Chagas disease, please contact me. Thanks very much.

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