CLINICAL MICROBIOLOGY REVIEWS, Oct. 2011, p. 655–681 Vol. 24, No. 4 0893-8512/11/$12.00 doi:10.1128/CMR.00005-11 Copyright © 2011, American Society for Microbiology. All Rights Reserved. Trypanosoma cruzi and Chagas’ Disease in the United States Caryn Bern,1* Sonia Kjos,2 Michael J. Yabsley,3 and Susan P. Montgomery1 Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia1; Marshfield Clinic Research Foundation, Marshfield, Wisconsin2; and Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, Georgia3 INTRODUCTION .......................................................................................................................................................656 TRYPANOSOMA CRUZI LIFE CYCLE AND TRANSMISSION..........................................................................656 Life Cycle .................................................................................................................................................................656 Transmission Routes..............................................................................................................................................657 Vector-borne transmission.................................................................................................................................657 Congenital transmission ....................................................................................................................................657 Blood-borne transmission..................................................................................................................................657 Organ-derived transmission..............................................................................................................................657 Oral transmission...............................................................................................................................................657 TRIATOMINE VECTOR BIOLOGY AND ECOLOGY ........................................................................................657 Background..............................................................................................................................................................657 Triatomine Distribution in the United States ....................................................................................................658 Description of U.S. Triatomine Species...............................................................................................................659 Triatoma gerstaeckeri (Stål)................................................................................................................................659 Triatoma incrassata Usinger...............................................................................................................................660 Triatoma indictiva Neiva .....................................................................................................................................660 Triatoma lecticularia (Stål).................................................................................................................................660 Triatoma neotomae Neiva....................................................................................................................................661 Triatoma protracta (Uhler) .................................................................................................................................661 Triatoma recurva (Stål).......................................................................................................................................661 Triatoma rubida (Uhler) .....................................................................................................................................661 Triatoma rubrofasciata (DeGeer) .......................................................................................................................661 Triatoma sanguisuga (Leconte) ..........................................................................................................................662 Paratriatoma hirsuta Barber...............................................................................................................................662 Human-Vector Interactions and T. cruzi Transmission Potential in the United States...............................662 ANIMAL RESERVOIRS OF TRYPANOSOMA CRUZI..........................................................................................663 Background..............................................................................................................................................................663 Wildlife Reservoirs of T. cruzi in the United States ..........................................................................................663 Domestic and Exotic Animal Infections in the United States..........................................................................665 Canine Chagas’ disease......................................................................................................................................665 Primates and other exotic animals...................................................................................................................666 MOLECULAR EPIDEMIOLOGY OF T. CRUZI...................................................................................................666 General Molecular Epidemiology .........................................................................................................................666 T. cruzi Genotypes in the United States ..............................................................................................................667 CLINICAL ASPECTS OF CHAGAS’ DISEASE.....................................................................................................668 Acute T. cruzi Infection ..........................................................................................................................................668 Congenital T. cruzi Infection .................................................................................................................................668 Chronic T. cruzi Infection......................................................................................................................................668 Indeterminate form of chronic T. cruzi infection ...........................................................................................668 Cardiac Chagas’ disease ....................................................................................................................................668 Digestive Chagas’ disease ..................................................................................................................................668 T. cruzi Infection in the Immunocompromised Host .........................................................................................669 Acute T. cruzi infection in organ transplantation recipients........................................................................669 Reactivation of chronic T. cruzi infection in organ recipients......................................................................669 Reactivation Chagas’ disease in HIV/AIDS patients .....................................................................................669 DIAGNOSIS ................................................................................................................................................................669 Diagnosis of Acute T. cruzi Infection ...................................................................................................................669 Diagnosis of Congenital T. cruzi Infection ..........................................................................................................669 Diagnosis of Chronic T. cruzi infection ...............................................................................................................670 * Corresponding author. Mailing address: Division of Parasitic Dis- eases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Rd. N.E., Atlanta, GA 30333. Phone: (404) 718-4726. Fax: (404) 718-4816. E-mail: [email protected]. 655 656 BERN ET AL. CLIN.MICROBIOL.REV. Utility of PCR for Diagnosis or Monitoring .......................................................................................................670 TREATMENT..............................................................................................................................................................670 Antitrypanosomal Drugs........................................................................................................................................670 Treatment of Acute and Congenital T. cruzi infection.......................................................................................670 Treatment of Chronic T. cruzi Infection..............................................................................................................670 Management of the Immunocompromised Host ................................................................................................671 EPIDEMIOLOGY OF CHAGAS’ DISEASE...........................................................................................................671 HUMAN CHAGAS’ DISEASE IN THE UNITED STATES..................................................................................671