Trypanosoma cruzi and Chagas' Disease in the United States

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Abstract
SUMMARY: Chagas' disease is caused by the protozoan parasiteTrypanosoma cruziand causes potentially life-threatening disease of the heart and gastrointestinal tract. The southern half of the United States contains enzootic cycles ofT. cruzi, involving 11 recognized triatomine vector species. The greatest vector diversity and density occur in the western United States, where woodrats are the most common reservoir; other rodents, raccoons, skunks, and coyotes are also infected withT. cruzi.In the eastern United States, the prevalence ofT. cruziis highest in raccoons, opossums, armadillos, and skunks. A total of 7 autochthonous vector-borne human infections have been reported in Texas, California, Tennessee, and Louisiana; many others are thought to go unrecognized. Nevertheless, mostT. cruzi-infected individuals in the United States are immigrants from areas of endemicity in Latin America. Seven transfusion-associated and 6 organ donor-derivedT. cruziinfections have been documented in the United States and Canada. As improved control of vector- and blood-borneT. cruzitransmission decreases the burden in countries where the disease is historically endemic and imported Chagas' disease is increasingly recognized outside Latin America, the United States can play an important role in addressing the altered epidemiology of Chagas' disease in the 21st century.

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