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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Public health and clinical screening for Chagas disease in the United States

Public health and clinical screening for Chagas disease in the United States
Target population Screening methods Primary goal Secondary goal Intervention details and effectiveness Published estimates of Chagas disease prevalence
Blood donors Serology Prevent transmission Refer infected persons for management Discard screen-positive donations; highly effective Approximately 1/15,000 first-time donors, up to 1/2700 in high-risk areas[1]
Organ donors Risk-based*, serology Prevent transmission   Heart from infected donor not used; use of other organs with appropriate monitoring; highly effective 0.9% in combined risk-based and serologic donor screening[2]
Pregnant females from Latin America; infants born to infected mothers Maternal serology, serial testing of infants; serology in siblings Detect and treat infected infants early in life Refer infected mothers and their other children for treatment Early treatment of infants; treatment of mothers after lactation ends; treat infected siblings; highly effective in infants and children, moderate in young mothers Approximately 10 mothers and <1 infected child per 4000 high-risk females (majority born in Latin America)[3]
Immigrants from Latin AmericaΔ and individuals with other risk factors* Risk-based*, serology Detect asymptomatic infected individuals Refer family members at risk Treatment of infected individuals; effectiveness high in children, uncertain in adults 0.5 to 4% in high-risk populations; many of those detected were >50 in whom treatment not generally recommended[4-6]
Patients from Latin America with immunosuppressive conditions (HIV, transplant candidates, transplant recipients) Serology; molecular testing if high index of suspicion Detect infected individuals before reactivation occurs   Treatment of Trypanosoma cruzi reactivation can be life-saving; prospective monitoring for reactivation improves prognosis No systematic data on prevalence of T. cruzi in these populations in the United States

* Risk factors include being born or having lived ≥6 months in an endemic country of Latin America, persons born to a mother with confirmed T. cruzi infection, or persons with evidence of a bite or other exposure to a triatomine bug in Latin America or regions of United States with known enzootic cycles.

¶ Polymerase chain reaction (plus microscopy if available) twice in the first 3 months of life, followed by immunoglobulin G serology at 9 months or later.

Δ Highest priority for children, young adults, and females of childbearing age due to considerations of antitrypanosomal treatment effectiveness[7].

◊ Family members of infected individuals should also be tested if they share the same risk factors, such as residence in an endemic country[8].
References:
  1. Dodd RY, Groves JA, Townsend RL, et al. Impact of one‐time testing for Trypanosoma cruzi antibodies among blood donors in the United States Transfusion 2019; 59:1016.
  2. Schwartz BS, Paster M, Ison MG, Chin-Hong PV. Organ donor screening practices for Trypanosoma cruzi infection among US Organ Procurement Organizations. Am J Transplant 2011; 11:848.
  3. Edwards MS, Rench MA, Todd CW, et al. Perinatal Screening for Chagas Disease in Southern Texas. Journal of the Pediatric Infectious Diseases Society 2015; 4:67.
  4. Manne-Goehler J, Davis J, Perez JH, et al. The results of a primary care-based screening program for Trypanosoma cruzi in East Boston, Massachusetts. In: IDWeek. San Francisco, CA:2018. Available at: https://doi.org/10.4269/ajtmh.abstract2018.
  5. Meymandi SK, Forsyth CJ, Soverow J, et al. Prevalence of Chagas Disease in the Latin American-born Population of Los Angeles. Clin Infect Dis 2017; 64:1182.
  6. Castro-Sesquen YE, Saldana A, Patino Nava D, et al. Use of a Latent Class Analysis in the Diagnosis of Chronic Chagas Disease in the Washington Metropolitan Area. Clin Infect Dis 2021; 72:e303.
  7. Forsyth CJ, Manne-Goehler J, Bern C, et al. Recommendations for Screening and Diagnosis of Chagas Disease in the United States. J Infect Dis 2021; jiab513.
  8. Hernandez S, Forsyth CJ, Flores CA, Meymandi SK. Prevalence of Chagas Disease Among Family Members of Previously Diagnosed Patients in Los Angeles, California. Clin Infect Dis 2019; 69:1226.
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