A family cluster of Chagas disease detected through selective screening of blood donors: A case report and brief review.
Bottom Line: Screening of the rest of the family revealed two other seropositive family members (the mother and sister).With blood donor screening, Canadian physicians will increasingly see patients with CD and should know how to manage them appropriately.Abstract available from the publisher.
Affiliation: JD MacLean Tropical Diseases Centre, Montreal;
Chagas disease (CD) is a protozoan infection caused by Trypanosoma cruzi, which is transmitted by triatomine insect vectors in parts of Latin America. In a nonendemic country, such as Canada, spread can still occur via vertical transmission, and infected blood or organ donations. The Canadian Blood Services and Héma-Québec have both implemented selective screening of blood donors for CD based on risk factors. In 2011, Héma-Québec identified two seropositive 'at-risk' Chilean siblings who had donated blood in Montreal, Quebec. They were referred to the JD MacLean Centre for Tropical Diseases (Montreal, Quebec) for confirmatory testing (T cruzi excreted-secreted antigen ELISA, polymerase chain reaction and/or radioimmunoprecipitation assay) and follow-up. Screening of the rest of the family revealed two other seropositive family members (the mother and sister). While their geographical history in Chile suggests vectorial transmission, this family cluster of CD raises the possibility of vertical transmission. Congenital infection should always be considered among CD-positive mothers and pregnant women. With blood donor screening, Canadian physicians will increasingly see patients with CD and should know how to manage them appropriately. In addition to the case presentation, the authors review the transmission, screening and clinical management of CD in a nonendemic context.
No MeSH data available.
Related in: MedlinePlus
Mentions: In 2011, the two siblings, II:3 and II:6 (48 and 46 years of age, respectively [Figure 1]), donated blood at a Héma-Québec clinic. On their donor questionnaires, they both answered affirmatively to all three of the CD ‘at-risk’ questions: they were born in Chile to a Chilean mother and had lived in Chile for many years (17 and 15 years, respectively, before emigrating to Canada). Initial screening by Héma-Québec (PRISM Chagas Assay, Abbott) suggested that they were both seropositive, and their status was confirmed by repeat testing using the same assay. They were referred to the JD MacLean Centre for Tropical Diseases at the McGill University Health Centre (Montreal, Quebec) for assessment. Blood was drawn for confirmatory serological testing using a T cruzi excreted-secreted antigen ELISA (TESA-ELISA) (14,15) and PCR by the National Reference Centre for Parasitology (NRCP) in Montreal. Some samples were also tested using RIPA by Quest Diagnostics (USA). Neither had any cardiac nor GI symptoms, and physical examinations were normal. The brother’s (II:3) electrocardiogram (ECG) showed sinus bradycardia, but was otherwise normal. His sister (II:6) had an abnormal ECG with sinus bradycardia and nonspecific T wave changes. Their echocardiograms were both normal. They were asked to bring their parents (I:1, I:2) and their two other sisters (II:2, II:7) to the clinic to be tested for CD.
No MeSH data available.