Reactivation of Chagas disease after a bone marrow transplant in Italy: first case report.

Abstract

Chagas disease is a protozoan zoonosis caused by the haemoflagellate Trypanosoma cruzi (T. cruzi). In continental Latin America, it is transmitted to humans mainly by insect vectors (Triatominae). Transmission can also occur by blood transfusion1,2, transplantation of infected organs, tissues or cells1–3 or from mother to child1, even in countries in which the disease is not endemic. In Latin America about 8–10 million people are affected4 and it has been calculated that 667,000 disability-adjusted life years are lost annually5. Most of the infected people are not aware of their status because the disease frequently causes few or no symptoms during the acute phase and evolves commonly to a clinically silent (indeterminate) phase; only in 20–30% of patients is there progression to a chronic disease, affecting mainly the heart and digestive system. Given the growing amount of international travel and the overall increase in migratory flows, a not negligible number of imported cases are registered also in non-endemic areas6. Immunosuppression and immune deficiency states (e.g. a patient with human immunodeficiency virus infection or acquired immunodeficiency syndrome) can lead to reactivation of latent infection which, in some circumstances, may give rise to severe manifestations1. We report the first case of Chagas disease reactivation after a bone marrow transplant (BMT) recorded in Italy and the first ever in Europe in a patient of paediatric age.