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Chagas=E2=80=99 disease (Trypanosoma cruzi)
Recipient
A past history of Chagas=E2=80=99 disease should trigger permanent exclu= sion.
A history of being born or transfused with blood in a Chagas=E2=80=99 en= demic area should trigger serological testing to quantify risk.
A past history of Chagas=E2=80=99 disease may be acceptable if no eviden= ce of acute or chronic infection, at the discretion of the requesting trans= plant centre.
A history of being born or transfused with blood in a Chagas=E2=80=99 en= demic area should trigger serological testing to quantify risk.
A history of being transfused with blood in a Chagas=E2=80=99 endemic ar= ea should trigger serological testing to quantify risk.
The causative organism of Chagas=E2=80=99 disease is the protozoan Trypa= nosoma cruzi. The infection is a zoonosis that is transmitted to humans by = bloodsucking insects of the Reduviidae family (kissing bugs), triatomine su= bfamily. The animal reservoir includes over 150 species of both wild and do= mestic mammals. Infection is life-long, but approximately 70% of infected i= ndividuals will remain asymptomatic. Furthermore, parasitaemia occurs not o= nly during the acute phase of infection, but also during asymptomatic chron= ic phases (albeit intermittently and at low levels).
Accordingly, Chagas=E2=80=99 is well-known to be transfusion-transmissible=
and asymptomatic parasitaemia has been detected in blood donors. Cases of =
transmission via solid organ transplantation have also been reported. Thoug=
h platelet concentrates are the most frequently reported means of transmiss=
ion, T. cruzi is able to survive refrigeration, freezing and thawing.
Chagas=E2=80=99 is endemic to mainland Latin America; however, the common =
modes of transmission are such that the risk to travellers is minimal. Inst=
ead, the people most at risk are those who spend early childhood in an ende=
mic area in certain types of dwelling, those who receive blood transfusions=
in endemic areas, and children whose mothers grew up at risk of Chagas=E2=
=80=99 disease. Most of this risk can be captured by asking donors their co=
untry of birth and whether they have ever received a blood transfusion in a=
Chagas=E2=80=99-endemic country. The former can be definitively captured a=
t recruitment, while the latter could occur at any time up to work-up.
The detection of antibodies to T. cruzi is an established strategy to prev=
ent transmission of infection through blood transfusion. Where available, t=
his strategy can be adapted to assess the risk of prospective HPC donors wi=
th identified risk factors for chronic, asymptomatic Chagas=E2=80=99 diseas=
e. Because the prevalence of Chagas=E2=80=99 disease varies widely within t=
he populations of endemic areas, it is likely that most donors with identif=
ied risk factors =E2=80=93 especially those residing in non-endemic countri=
es =E2=80=93 will test negative for T. cruzi antibodies.
The most commonly used format for serological assays is the enzyme-linked =
immunosorbent assay (ELISA). A number of commercially available ELISAs are =
available and two have been licensed by the Food and Drug Administration (F=
DA) in the US. Other serological assay formats include particle agglutinati=
on (PA) and indirect haemagglutination assay (IHA). The Abbott Diagnostics =
ESA Chagas, an enzyme strip assay, is the only confirmatory assay to be app=
roved by the FDA.
1 Kirchhoff LV. Trypanosoma Species (American Trypanosomiasis, Chagas=E2= =80=99 Disease): Biology of Trypanosomes. In Mandell GL, Bennett JE and Dol= in R, editors. Mandell, Douglas, and Bennett's Principles and Practice of I= nfectious Diseases. 6th ed, 2005:2622-2630.
2 Moncayo A and Silveira AC. Current epidemiological trends for Chagas d= isease in Latin America and future challenges in epidemiology, surveillance= and health policy. Mem Inst Oswaldo Cruz 2009; 104 (Suppl. 1):17-30.
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5 Stramer SL, Hollinger, FB, Katz, LM, Kleinman, S, Metzel PS, Gregory K= R, Dodd, R. Emerging infectious disease agents and their potential threat t= o transfusion safety. Transfusion. 49. August 2009. Supplement.
6 Schmunis GA. Epidemiology of Chagas disease in non-endemic countries: = the role of international migration. Mem Inst Oswaldo Cruz 2007; 102 (Suppl= .I):75-85.
7 Albajar-Vinas P. The hidden Chagas disease burden in Europe. Euro Surv= eill.2011;16(38):pii=3D19975.
8 Castro E. Chagas=E2=80=99 disease: lessons from routine donation testi= ng. Transfusion Med 2009; 19:16-23.
9 Leiby DA, Herron RM Jr, Garratty G and Herwaldt BL. Trypanosoma cruzi = parasitaemia in US blood donors with serologic evidence of infection. J Inf= ect Dis 2008; 198:609-613.
10 CDC. Chagas disease after organ transplantation =E2=80=93 Los Angeles= , California, 2006. MMWR 2006; 55:798-800.
11 Bern C, Montgomery SP, Katz L, Caglioti S and Stramer SL. Chagas dise= ase and the US blood supply. Curr Opin Infect Dis 2008; 21:476-482.
12 Primavera KS, Umezawa ES, Peres BA, Camargo ME, Hoshino-Shimizu S. Ch= agas'disease: IgA, IgM and IgG antibodies to T. cruzi amastigote, trypomast= igote and epimastigote antigens in acute and in different chronic forms of = the disease. Rev Inst Med Trop Sao Paulo. 1990 May-Jun;32(3):172-80.
13 Young C, Losikoff P, Chawla A, Glasser L and Forman E. Transfusion-ac= quired Trypanosoma cruzi infection. Transfusion 2007; 47:540-544.