Recognizing and Reducing the Risks of Chagas Disease (American Trypanosomiasis) in Travelers

C hagas disease, or American trypanosomiasis, is an arthropod-borne protozoan infectious disease endemic throughout most of the Americas, caused by the trypanosome, Trypanosoma cruzi , and transmitted to humans by reduviid, or kissing, bugs. Reduviid bugs (phylum: Insecta, order: Hemiptera, family: Reduviidae, subfamily: Triatominae) transmit several zoonotic strains of T cruzi among many mammalian reservoir hosts throughout the Americas. Chagas disease is most commonly transmitted to humans via T cruzi -infected reduviid bug defecations near bite wounds or exposed mucosal surfaces. Chagas disease may also be transmitted congenitally, by ingestion of T cruzi -infected reduviids or their feces, by blood product transfusions, and by organ transplants. Indeterminate and chronic infections may be reactivated by immunosuppression, particularly human immunodefi ciency virus (HIV) infection or acquired immunodefi ciency syndrome (AIDS), and by pregnancy. Characterized by an infl uenza-like illness acutely in adults, Chagas disease may result in chronic heart disease or gastrointestinal megasyndromes following a prolonged, indeterminate stage of subclinical infection.