Chagas disease and the US blood supply.
OBJECTIVE
To describe new developments in blood-bank screening and management of patients with chronic Trypanosoma cruzi infection in the United States.


RESULTS
The first US Food and Drug Administration licensed serological test for T. cruzi blood screening went into widespread usage in January 2007. More than 500 confirmed T. cruzi-infected donations were detected by mid-June 2008. Until recently, drug therapy was recommended for acute and congenital infections, but seldom for chronic infections, which were believed to respond poorly. However, in the 1990s, efficacy was demonstrated in two placebo-controlled trials of benznidazole in children with chronic T. cruzi infection. In 2006, a nonrandomized, nonblinded trial demonstrated that benznidazole treatment may slow progression of cardiomyopathy and decrease mortality risk in infected adults.


CONCLUSIONS
Blood-bank screening will continue to detect T. cruzi-infected donors. Based on recent data, antitrypanosomal treatment is recommended for all acute and congenital T. cruzi infections, reactivated infection, and chronically infected children. In adults aged 19-50 years without advanced heart disease, treatment should generally be offered; management should be individualized for older adults. Less toxic, more effective drugs, a sensitive, specific assay for response to treatment, and improved healthcare access would promote more effective management.
Bern
Caryn
C
Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. CBern@cdc.gov
Montgomery
Susan P
SP
Katz
Louis
L
Caglioti
Sally
S
Stramer
Susan L
SL
D000328:Adult; D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D001771:Blood Banks; D001782:Blood Donors; D014355:Chagas Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission*; D002648:Child; D006801:Humans; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014349:Trypanosoma cruzi / Q000302:isolation & purification*; D014481:United States / Q000453:epidemiology
D000913:Antibodies, Protozoan; D014344:Trypanocidal Agents