Adaptation of Chagas Disease Screening Recommendations for a Community of At-risk HIV in the United States.

Chagas disease (CD), caused by Trypanosoma cruzi, is underdiagnosed in the United States. Improved screening strategies are needed, particularly for people at risk for life-threatening sequelae of CD, including people with human immunodeficiency virus (HIV, PWH). Here we report results of a CD screening strategy applied at a large HIV clinic serving an at-risk population.

Chagas Disease Diagnostic Practices at Four Major Hospital Systems in California and Texas.

BACKGROUND: Chagas disease (CD) is a parasitic disease that affects ∼300 000 people living in the United States. CD leads to cardiac and/or gastrointestinal disease in up to 30% of untreated people. However, end-organ damage can be prevented with early diagnosis and antiparasitic therapy. METHODS: We reviewed electronic health records of patients who underwent testing for CD at four hospital systems in California and Texas between 2016 and 2020. Descriptive analyses were performed as a needs assessment for improving CD diagnosis. RESULTS: In total, 470 patients were tested for CD. Cardiac indications made up more than half (60%) of all testing, and the most frequently cited cardiac condition was heart failure. Fewer than 1% of tests were ordered by obstetric and gynecologic services. Fewer than half (47%) of patients had confirmatory testing performed at the Centers for Disease Control and Prevention. DISCUSSION: Four major hospitals systems in California and Texas demonstrated low overall rates of CD diagnostic testing, testing primarily among older patients with end-organ damage, and incomplete confirmatory testing. This suggests missed opportunities to diagnose CD in at-risk individuals early in the course of infection when antiparasitic treatment can reduce the risk of disease progression and prevent vertical transmission.

Impact of gastrointestinal polymerase chain reaction panels on antibiotic utilization in hospitalized adult patients.

Multiplex stool polymerase chain reaction (PCR) panels offer rapid comprehensive testing for patients with infectious diarrhea. We compared antibiotic utilization among hospitalized patients with suspected infectious diarrhea who underwent diagnostic testing with either a stool culture or stool PCR panel. No significant differences in antibiotic utilization were identified.

Reviewing a Decade of Outpatient Tropical Medicine in Houston, Texas.

Tropical diseases cause significant morbidity among the world's poorest populations. Although more common in low- and middle-income countries, tropical diseases are also found among underserved populations living in high-income countries such as the United States. The National School of Tropical Medicine at Baylor College of Medicine and the Harris Health System founded a tropical medicine clinic-the Harris Health Tropical Medicine Clinic (HHTMC)-in Houston in 2011 in response to tropical disease-related morbidity in Texas. We conducted a retrospective chart review of a sample of patients older than 18 years of age who were referred to the HHTMC between October 2011 and January 2020. Of the 523 patients reviewed, 185 (35.4%) had mycobacterial infections, 184 (35.2%) had parasitic infections, 38 (7.3%) had fungal infections, 16 (3.1%) had eosinophilia without a confirmed clinical diagnosis, 28 (5.4%) had bacterial infections, and 13 (2.5%) had viral infections. The most common infections overall were extrapulmonary and latent tuberculosis (n = 169), neurocysticercosis (n = 78), strongyloidiasis (n = 28), Chagas disease (n = 25), and schistosomiasis (n = 12). The epidemiology of tropical diseases in the United States is understudied at national and regional levels. This 10-year retrospective study contributes to bridging this knowledge gap by detailing the frequencies of tropical disease diagnoses made at the HHTMC in Houston, TX. These data highlight areas for advancement in the field of tropical medicine within the United States, such as improving front-line health-care provider education; establishing tropical medicine clinics in areas of high prevalence such as the Gulf Coast, Appalachia, and urban areas; and developing comprehensive, systematic national tropical disease screening programs and patient registries.

Advances in vaccine development for human trichuriasis.

Trichuriasis known as whipworm infection caused by Trichuris trichiura, is a highly prevalent soil-transmitted helminthiasis in low- and middle-income countries located in tropical and subtropical areas and affecting approximately 360 million people. Children typically harbour the largest burden of T. trichiura and they are usually co-infected with other soil-transmitted helminth (STH), including Ascaris lumbricoides and hookworm. The consequences of trichuriasis, such as malnutrition and physical and cognitive growth restriction, lead to a massive health burden in endemic regions. Despite the implementation of mass drug administration of anthelminthic treatment to school-age children, T. trichiura infection remains challenging to control due to the low efficacy of current drugs as well as high rates of post-treatment re-infection. Thus, the development of a vaccine that would induce protective immunity and reduce infection rate or community faecal egg output is essential. Hurdles for human whipworm vaccine development include the lack of suitable vaccine antigen targets and animal models for human T. trichiura infection. Instead, rodent whipworm T. muris infected mouse models serve as a major surrogate for testing immunogenicity and efficacy of vaccine candidates. In this review, we summarize recent advances in animal models for T. trichiura antigen discovery and testing of vaccine candidates, while providing an overall view of the current status of T. trichiura vaccine development.