Recognizing and Reducing the Risks of Chagas Disease in Travelers

Extract

To the Editor in Chief:

We are writing to correct misconceptions in the above‐mentioned article of Dr James H. Diaz. ¹ Some are minor: for example, current estimated Trypanosoma cruzi infection prevalence is 8 to 10 million, not 20 million. The Southern Cone is not the only part of South America with endemic T cruzi transmission, as implied on page 185, and there are control initiatives in the Andean, Amazon, and Central American regions in addition to INCOSUR. ² Despite the statement on page 186, Triatoma sanguisuga is not a vector species found in the Yucátan.

However, some statements in this article may mislead clinicians caring for patients with suspected or proven T cruzi infection. The author states on page 188 that the World Health Organization (WHO) recommends diagnosis of chronic T cruzi infection by a sensitive serologic screening assay followed by “a subsequent specific confirmatory test, such as hemoculture or detection of amplified T cruzi DNA or RNA by polymerase chain reaction (PCR).” The WHO actually recommends two or more serologic assays using different techniques. ³ Hemoculture and PCR sensitivity are low in this setting, and negative results do not necessarily indicate absence of infection.