Findings in a case report published in Morbidity and Mortality Weekly Report suggest the possibility that exposure to Trypanosoma cruzi occurred locally in Missouri.
On December 13, 2017, the Missouri Department of Health and Senior Services was notified of a suspected case of Chagas disease in a patient who had donated blood. Laboratory screening of the blood donation revealed antibodies to T cruzi, the parasite that causes Chagas disease. No clinical symptoms of Chagas were found by physicians, and the patient had no travel history that would suggest a significant risk. There was no occupational exposure to the disease agent, and the patient had never received a blood transfusion or organ transplant. A Wiener recombinant antigen enzyme immunoassay of a sample from the patient was positive; a trypomastigote excreted secreted antigen immunoblot assay was negative. Confirmatory testing of the serum at the Centers for Disease Control and Prevention for T cruzi antibody was consistent with infection.
Taken together, these findings suggest that the patient was exposed autochthonously in Missouri. Despite the insect vector, triatomines, commonly referred to as kissing bugs, being previously identified in Missouri, no locally acquired Chagas cases had been identified by the state.
Locally acquired cases of Chagas are exceedingly rare in the United States, with only 28 being reported between 1955 and 2015. Most documented cases are among people originally from Latin America. However, in light of this report on the first documented autochthonous case of Chagas disease in Missouri, public health professionals should be aware of the possibility of locally acquired Chagas disease in the southern United States.
Turabelidze G, Vasudevan A, Rojas-Moreno C, et al. Autochthonous Chagas disease – Missouri, 2018. Morb Mortal Wkly Rep. 2020;69:193-195.