According to recent survey results published in the October issue of The American Journal of Tropical Medicine and Hygiene, obstetricians and gynecologists in the United States are unfamiliar with Chagas' disease, a condition that affects an estimated 300,000 people in the United States and can cause serious cardiovascular and digestive complications. The disease can be transmitted from mother to her unborn child, and as many as 300 congenital infections are estimated to occur annually in the United States. However, the survey revealed that knowledge and understanding of this condition among obstetrician-gynecologists, is low. The survey of U.S. physician members of the American College of Obstetricians and Gynecologists was developed by ACOG, with technical input provided by the CDC.
"There are potentially 100,000 women living in the U.S. who are at risk of infecting their unborn babies," said Edward T. Ryan, MD, President, American Society of Tropical Medicine and Hygiene. "We need to educate obstetricians, family practitioners, nurse midwives, and pediatricians about Chagas', especially those who care for families from Latin America."
For obstetricians/gynecologists in the United States, increased awareness around Chagas' disease is important because many newly diagnosed patients are identified among blood donors who are women of child-bearing age and at risk of transmitting the infection to their newborns. Many of these women in the United States are from Mexico, Central or South America where they acquired the infection; most have no symptoms and are unaware of the danger to their baby should they decide to become pregnant.
Chagas' disease is endemic in Latin America, and affects an estimated 8-11 million people in Mexico, Central and South America. Many people infected with Chagas' disease, caused by a parasite, are undiagnosed and unaware of the potential seriousness of the condition. The disease is transmitted primarily through triatomine bugs, more commonly known as "kissing bugs." Infection can also occur through blood transfusions, ingestion of contaminated food or drink, organ transplants, and from an infected mother to her unborn child.
If left untreated, Chagas' disease can cause complications such as cardiomyopathy (an enlarged heart that no longer pumps effectively), heart disease, heart failure, enlargement of the colon, enlargement of the esophagus (which can make swallowing difficult), and malnutrition. An estimated 20 to 30 percent of patients will develop the cardiovascular/digestive complications, decades after the initial infection. For those with the infection, there are two approaches to treatment: treatment to kill the parasite, and treatment to manage the symptoms and signs of infection. There is currently no vaccine against Chagas' disease.
"The good news about the survey results is that the majority of physicians respondents were not misinformed, they just did not have information about Chagas' disease," said Jennifer R. Verani, MD, from the Centers for Disease Control and Prevention (CDC). "Now that we know this, we can educate clinicians who regularly see patients who are at risk."
Although congenital Chagas' disease is relatively rare in the United States, the estimated number of annual cases is similar to other rare diseases for which all newborns in the United States are routinely screened at birth. The majority of obstetricians/gynecologists were unaware of the testing recommendations for newborn babies of infected mothers, which indicate that the babies should be tested at birth, at 4 to 6 weeks and at 9 to 12 months.
The survey results found that only three percent of the physicians surveyed considered their knowledge about Chagas' disease "excellent" or "good," compared to a large majority (88 percent) who described their knowledge as "limited" or "very limited"; almost ten percent of those surveyed reported never having heard of the disease at all. One-third of survey respondents "did not know" what causes the disease and only 58 percent were able to correctly identify it as a parasitic infection.