Globalization of Chagas disease: A growing concern in nonendemic countries.

Chagas disease, caused by the parasite Trypanosoma cruzi, is a major cause of morbidity and mortality in Central and South America. Initial infection and ensuing chronic infection often go undetected in the human host. High seroprevalence of T. cruzi infection is well documented in endemic areas. Designated as “a neglected tropical disease” by the World Health Organization, rural economically disadvantaged and marginalized populations in endemic countries traditionally have the highest rates of infection. As economic hardship, political instability, and the search for opportunity spur migration of infected humans from endemic to non-endemic areas of the world, blood bank data have documented rising seroprevalence of T. cruzi in traditionally nonendemic areas. In these areas, T. cruzi is transmitted through blood transfusion, organ transplantation, and maternal-fetal mechanisms. Increasing awareness of large numbers of infected immigrants in nonendemic countries, and the medical care they require, has focused attention on the need for strategic programs for screening affected populations, education of healthcare providers, and provision of necessary medical services for those infected. Physicians in nonendemic countries should be able to recognize signs and symptoms of acute and chronic Chagas disease as migration and globalization increase the burden of disease in non-endemic areas.