The CDC’s New Initiative on Parasitic Infections

This week the Centers for Disease Control and Prevention (CDC) announced a new initiative that targets parasitic diseases in the United States. Coinciding with the publication of a series of articles in the American Journal of Tropical Medicine and Hygiene (AJTMH), the new CDC initiative will prioritize five major parasitic diseases — Chagas disease, cysticercosis, toxocariasis, toxoplasmosis and trichomoniasis — which are considered neglected because they mainly impact Americans who live in extreme poverty, especially in the southern United States and in degraded urban areas of major U.S. cities. CDC’s renewed commitment to these diseases is extremely welcome, and I especially want to congratulate the dynamic leadership of their Division of Parasitic Diseases and Malaria including Drs. Monica Parise and Larry Slutsker, who lead these activities.

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Chagas Disease: Urgent Measures Are Needed

Global health topics are typically presented in the context of extreme poverty in sub-Saharan Africa or Asia. However, today approximately 100 million people in the Western Hemisphere also live on less than $2 per day. About 10 percent of these “bottom 100 million” currently live with a serious and life-threatening neglected disease known as Chagas disease or American trypanosomiasis.

Humans acquire Chagas disease microscopic parasites — trypanosomes — through contact with kissing bugs that thrive in poor quality and substandard housing. Trypanosomes selectively attack the heart so that up to one-third of people who acquire them progress and develop a form of heart disease known as a cardiomyopathy associated with heart aneurysms, arrhythmias, and even sudden death.

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An Unfolding Tragedy of Chagas Disease in North America

In North America, Chagas disease (American trypanosomiasis caused by Trypanosoma cruzi) was first reported in Mexico in 1940 [1] and in the United States in Texas in 1955 [2]. However, based on ancient mummified remains discovered in the Rio Grande Valley, human T. cruzi infection has been present in North America since prehistoric times [3].

T. cruzi is a protozoan hemoflagellate that is most commonly transmitted to humans by blood-feeding triatomine bugs followed by autoinoculation [2]. Chagas disease can also be transmitted to man by non-vectorial mechanisms, namely mother-to-child-transmission [4], blood transfusion, and orally through food-borne transmission. When untreated in the acute stage, the disease becomes chronic and up to 30% or more of infected individuals will progress to Chagasic cardiomyopathy or megavisceral disease associated with debilitating morbidity or death. Today, Chagas disease is a leading cause of heart disease among people living in extreme poverty in the Western Hemisphere, especially in Latin America, where it is a major parasitic killer [2].

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Neglected Tropical Diseases as Hidden Causes of Cardiovascular Disease

There is a growing awareness of the importance of chronic non-communicable diseases (CNCDs) in the world’s low- and middle-income countries (LMICs). Beginning in the 1990s, Murray and Lopez predicted a doubling of death rates due to cardiovascular disease in developing countries by 2020, while a substantial rise was also predicted by Leeder et al. Based on World Health Organization (WHO) predictions, 75% of the burden of cardiovascular disease is found in LMICs. Alarming increases have also been noted for other CNCDs in LMICs including cancer, chronic respiratory diseases, and diabetes. In September 2011, a report by the World Economic Forum and the Harvard School of Public Health estimated the global economic burden of CNCDs over the next two decades to be US$47 trillion.

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Chagas Disease: “The New HIV/AIDS of the Americas”

Endemic Chagas disease has emerged as an important health disparity in the Americas. As a result, we face a situation in both Latin America and the US that bears a resemblance to the early years of the HIV/AIDS pandemic. With approximately 10 million people living with Chagas disease, this condition is one of the most common NTDs affecting the bottom 100 million in the region, a prevalence exceeded only by hookworm and other soil-transmitted helminth infections. Moreover, among the NTDs in the Americas, Chagas disease ranks near the top in terms of annual deaths and DALYs lost.

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For Expectant Mothers, Chagas Disease Is Cause for Concern

Chagas disease — a parasitic infection transmitted through an insect commonly known as the “kissing bug” — is one of the most common infections among pregnant women in the Western Hemisphere. It can be found all over Latin American, from Mexico and Central America to Paraguay and Argentina. Cases of Chagas disease are now widely prevalent throughout south Texas and may be spreading to other areas of the U.S. Read the rest here