Chagas disease, caused by the parasite Trypanosoma cruzi, is a major cause of morbidity and mortality in Central and South America. Initial infection and ensuing chronic infection often go undetected in the human host. High seroprevalence of T. cruzi infection is well documented in endemic areas. Designated as “a neglected tropical disease” by the World Health Organization, rural economically disadvantaged and marginalized populations in endemic countries traditionally have the highest rates of infection. As economic hardship, political instability, and the search for opportunity spur migration of infected humans from endemic to non-endemic areas of the world, blood bank data have documented rising seroprevalence of T. cruzi in traditionally nonendemic areas. In these areas, T. cruzi is transmitted through blood transfusion, organ transplantation, and maternal-fetal mechanisms. Increasing awareness of large numbers of infected immigrants in nonendemic countries, and the medical care they require, has focused attention on the need for strategic programs for screening affected populations, education of healthcare providers, and provision of necessary medical services for those infected. Physicians in nonendemic countries should be able to recognize signs and symptoms of acute and chronic Chagas disease as migration and globalization increase the burden of disease in non-endemic areas. 1. Introduction In 1909 a Brazilian physician, Dr. Carlos Chagas, described a parasite found in the hindgut of “vinchucas” (Triatoma infestans) as being responsible for an outbreak of acute febrile illness in workers of the Central Railroad of Brazil. He named this parasite Trypanosoma cruzi and went on to describe the lifecycle of the parasite, modes of transmission to human hosts, and both acute and chronic phases of human illness. The disease became known as American trypanosomiasis or Chagas disease. Triatomine bugs (Triatoma, Panstrongylus, Rhodnius, and other genera), the vectors of the parasite Trypanosoma cruzi, thrive in rural areas from the southern United States to the southern tip of Argentina. In endemic areas, these insects infest traditional mud-walled human dwellings. At night they bite humans sleeping inside, defecating into the fresh bite wounds and releasing feces infected with the parasites into the human host. The incubation period of disease acquired by autochthonous transmission in the immunocompetent human host ranges from 5 to 15 days. However, incubation periods as long as 21 days have been documented with oral transmission of disease (ingestion of
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