title: Prevalence of Chagas heart disease in a region endemic for Trypanosoma cruzi: evidence from a central Bolivian community.
abstract: BACKGROUND
  Though the incidence of new Trypanosoma cruzi infections has decreased significantly in endemic regions in the Americas, medical professionals continue to encounter a high burden of resulting Chagas disease among infected adults. The current prevalence of Chagas heart disease in a community setting is not known; nor is it known how recent insecticide vector control measures may have impacted the progression of cardiac disease in an infected population.
  
  
  OBJECTIVE
  We sought to determine the current prevalence of T. cruzi infection and associated Chagas heart disease in a Bolivian community endemic for T. cruzi.
  
  
  METHODS
  Nested within a community serosurvey in rural and periurban communities in central Bolivia, we performed a cross-sectional cardiac substudy to evaluate adults for historical, clinical, and electrocardiographic evidence of cardiac disease. All adults between the ages of 20 and 60 years old with T. cruzi infection and those with a clinical history, physical exam, or electrocardiogram consistent with cardiac abnormalities were also scheduled for echocardiography.
  
  
  RESULTS
  Of the 604 cardiac substudy participants with definitive serology results, 183 were seropositive for infection with T. cruzi (30.3%). Participants who were seropositive for T. cruzi infection were more likely to have conduction system defects (1.6% vs. 0% for complete right bundle branch block and 10.4% vs. 1.9% for any bundle branch block; p = 0.008 and p < 0.001, respectively). However, there was no statistically significant difference in the prevalence of bradycardia among seropositive versus seronegative participants. Echocardiogram findings were not consistent with a high burden of Chagas cardiomyopathy: valvulopathies were the most common abnormality, and few participants were found to have low ejection fraction or left ventricular dilatation. No participants had significant heart failure.
  
  
  CONCLUSIONS
  Though almost one-third of adults in the community were seropositive for T. cruzi infection, few had evidence of Chagas heart disease.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA. Electronic address: jessica.yager@downstate.edu.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Yager
authors.affiliation: Centro Universitario de Medicina Tropical, Facultad de Medicina y CEADES Salud y Medio Ambiente, Universidad Mayor de San Simon, Cochabamba, Bolivia.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Lozano Beltran
authors.affiliation: Centro Universitario de Medicina Tropical, Facultad de Medicina y CEADES Salud y Medio Ambiente, Universidad Mayor de San Simon, Cochabamba, Bolivia.
authors.forename: Faustino
authors.initials: F
authors.lastname: Torrico
authors.affiliation: Asociacion Benefica PRISMA, Lima, Peru; Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
mesh_terms: D000328:Adult; D001838:Bolivia / Q000453:epidemiology; D001919:Bradycardia / Q000453:epidemiology*; D002037:Bundle-Branch Block / Q000453:epidemiology*; D002598:Chagas Cardiomyopathy / Q000453:epidemiology*; D014355:Chagas Disease / Q000453:epidemiology / Q000276:immunology; D002846:Chromatography, Affinity; D003430:Cross-Sectional Studies; D004452:Echocardiography; D004562:Electrocardiography; D019353:Endemic Diseases; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006386:Hemagglutination Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016036:Seroepidemiologic Studies; D014349:Trypanosoma cruzi / Q000276:immunology; D055815:Young Adult