Disclosures: The authors report no relevant financial disclosures.
October 19, 2021
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US hospitalizations for Chagas heart disease, caused by ‘kissing bugs,’ on the rise

Disclosures: The authors report no relevant financial disclosures.
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The incidence of Chagas cardiomyopathy in the U.S. increased from 2002 to 2017, particularly among individuals who emigrated from Central and South America, and was associated with risk for arrhythmia and HF, researchers reported.

According to a prior report published in Circulation in 2016, Chagas disease is caused by a parasite called Trypanosoma cruzi, which is transmitted by biting insects called triatomine bugs or “kissing bugs.”

Photo of a kissing bug
Source: Adobe Stock

According to the CDC, kissing bugs are nocturnal insects typically found in the southern U.S., Mexico, Central America and South America that feed on the blood of mammals.

In the Circulation report, researchers at one Los Angeles hospital estimated that approximately one in five patients with cardiomyopathy who lived in Latin American countries for at least 1 year had Chagas disease-related cardiomyopathy.

According to WHO, Chagas disease is labeled as an endemic in areas of 21 Latin American countries, with an estimated 6 million to 7 million people worldwide infected with T. cruzi.

For this cross-sectional study published in JAMA Network Open, researchers utilized data from the Healthcare Cost and Utilization Project National Inpatient Sample to identify patients discharged with the diagnosis of Chagas cardiomyopathy in the U.S. from 2002 to 2017. Researchers evaluated patient characteristics and outcomes associated with Chagas cardiomyopathy and trends in the percentage of hospital discharges for the disease. Patient ethnicity was self-reported or determined by clerk at hospital admission.

Trends in Chagas cardiomyopathy

Of the approximately 482 million inpatient discharges recorded in the database, Chagas cardiomyopathy was the primary or a coexisting diagnosis in 2,037 discharges (mean age, 52 years; 51% men).

Of the discharges in which a hospital region was indicated, 35.9% of Chagas cardiomyopathy cases were in the western U.S. and 32.3% were from the southern U.S.

According to the study, Hispanic patients made up 12.8% of the overall hospital discharges; however, Hispanic patients represented 74.2% of discharges with Chagas cardiomyopathy.

Following the Cochran-Armitage trend test, researchers reported there was a significant uptrend in Chaga cardiomyopathy hospitalizations from 2002 to 2017 (P < .001).

“Previous reports based on patterns of emigration from South America have estimated a prevalence of Chagas as 300,000 cases in the U.S., 3,000 cases in Canada and 123,000 cases in Europe,” Neiberg de Alcantara Lima, MD, of the department of internal medicine at Western Michigan University Homer Stryker M.D. School of Medicine, and colleagues wrote. “Our findings suggest that hospitalizations for Chagas heart disease have increased every year of our study and that Chagas heart disease is more prevalent in the West and South regions of the U.S., where migration from South America is higher.”

Complications of Chagas heart disease

The following codes were recorded among patients discharged with Chagas cardiomyopathy:

  • sinoatrial node dysfunction in 4.8% of patients;
  • atrial tachyarrhythmias were coded in 27.1% of patients;
  • ventricular arrhythmias were coded in 25% of patients;
  • atrioventricular and intraventricular conduction anomalies in 14.5% of patients; and
  • HF in 64.6% of patients.

In addition, procedure codes for pacemaker implantation were reported in 2.5% of discharges; implantable defibrillator procedure codes in 10.7% and cardiac resynchronization procedure codes in 2.9%.

“As opposed to COVID-19 infection that can cause acute myocarditis and heart failure, the T. cruzi usually affects the heart after 5 to 25 years of the initial transmission,” de Alcantara Lima told Healio. “Chagas heart disease should be suspected in individuals who have lived in endemic countries of Latin America and have no apparent cause for their heart disease. As the triatomine vector is not commonly found in the United States, CDC recommends that control strategies need to be focused on preventing transmission from blood transfusion, organ transplantation and mother-to-baby.”

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