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Check Sample No. TM 044 TM272
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Family denied history of travel to Chagas-endemic areas or exposure to high-risk ... in a differential diagnosis if travel or exposure are consistent with T. ... – PowerPoint PPT presentation
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Title: Check Sample No. TM 044 TM272
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Check Sample No. TM 04-4(TM-272)
- Jeremy S. Miller, MD
- 10/25/05
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History and Physical
- 3 y/o girl with Grade IV Neuroblastoma presented
for autologous peripheral stem cell harvest
following 2 cycles chemotx - Routine peripheral blood smear
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History and Physical
- Blood smear contained uniflagellate protozoans w/
single mitochondrion located near the kinetoplast
morphologically consistent with Trypanosoma cruzi
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History and Physical
- Family denied history of travel to Chagas-endemic
areas or exposure to high-risk contacts - Total of 84 donor exposures
- Serum from 56 donors were tested by the CDC by
IFA screen for evidence of infection - 1 donor had a positive IFA test result (also
reported living in Chagas-endemic region)
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History and Physical
- Patients parasite burden decreased significantly
after antiparasitic therapy was initiated - Subsequent surgical exploration demonstrated
extensive residual tumor - Due to poor prognosis, autologous stem cell
transplant was not pursued
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Chagas Disease
- Described in 1909 by Brazilian physician Carlos
Chagas - First U.S. case in 1955
- As of September 2002, 6 cases of
transfusion-related Chagas disease have been
reported in the U.S.
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Chagas Disease
- Trypanosoma cruzi resides in mammalian host and
is transmitted by a blood-sucking triatomine
vector, the reduviid kissing bug
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Chagas Disease
- Within vector and host, the protozoan alternates
between amastigote and trypomastigote forms - Amastigote Intracellular, reproductive
- Trypomastigote Circulating, nondividing
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Chagas Disease
- Endemic in 21 Central and South American
countries from Mexico to Argentina
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Chagas Disease
- 18 million people affected
- Poverty is a significant risk factor
- Reduviid bug lives in the walls of mud huts
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Chagas Disease
- Seroprevalence in U.S. donor population 0.0 to
0.4 but difficult to estimate - Highest rate in community-directed whole blood
donations - Lowest rate in apheresis donations
- Congenital and solid organ transplant -associated
infections extremely rare - T. cruzi has been found in breast milk
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Chagas Disease
- Acute infection often asymptomatic or with mild
nonspecific symptoms - Only considered in a differential diagnosis if
travel or exposure are consistent with T. cruzi
infection
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Chagas Disease
- If symptomatic
- Inflammation at inoculation site
- Anorexia
- Fever
- Myocarditis
- Hepatosplenomegaly
- Lymphadenopathy
- Romanas sign
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Chagas Disease
- Underdiagnosed cause of cardiac pathology (often
attributed to CAD or Dilated Cardiomyopathy) - Biventricular enlargement
- Ventricular wall thinning
- Apical aneurysms
- Mural thrombi
- Chronic inflammation
- End result is CHF, arrhythmias, or sudden death
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Chagas Disease
- GI Pathology reflects effects of ruptured
pseudocysts in the gut leading to denervation - Motility disorders
- Obstructions
- Megaesophagus
- Megacolon
- Pulmonary Pathology
- Congestion
- Thromboemboli
- Aspiration pneumonia
- Neurologic findings are nonspecific
- Rarely invades into CSF and causes
menigoencephalitis
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Chagas Disease
- Diagnosis
- IFA screen
- Cross-reactivity with Leishmania species has been
reported - ELISA confirmation
- PCR (explanted heart tissue)
- Xenodiagnosis (rarely used clinically)
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Chagas Disease
- Prevention
- One study showed leukocyte-reduction filters to
remove parasites from whole blood, but efficacy
remains unproven - Gentian violet has been used for chemoprophylaxis
in endemic areas where reliable screening methods
are unavailable
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Chagas Disease
- Treatment
- Two antiparasitic medications have demonstrated
some efficacy but must be used early in the
infection - Nifurtimox
- Benznidazole (not available in U.S.)
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Thank you
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