Febrile 129: Cruzi'n USA
Feb 16, 2026
Norman Beattie, infectious diseases clinician and epidemiologist; Akanksha Alok, ID fellow focusing on Chagas; Jacob Ricci, MD‑PhD student studying myocarditis. They discuss clinical cases, transmission routes, serologic testing challenges, cardiac imaging and MRI findings, arrhythmia risk and device decisions, blood-donor screening follow-up, treatment choices, and local research directions in Florida.
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Always Send Multiple Chagas Serologies
- Do send multiple serologic assays when suspecting Chagas because different FDA-approved tests vary by antigen and regional parasite strains.
- Norman Beattie recommends at least two assays and preferably more (ELISA, TESA immunoblot, MultiCruzi, rapid lateral flow) to confirm infection.
Cardiac MRI Reveals Early Chagas Heart Damage
- Cardiac MRI with late gadolinium enhancement can detect myocardial fibrosis and apical aneurysms even when ECG and echo look normal.
- Akanksha Alok used CMR showing extensive mid‑myocardial LGE and elevated T1 with normal T2, supporting Chagas cardiomyopathy.
Consider ICD For Primary Prevention In Chagas
- Do involve electrophysiology early and consider ICD for primary prevention in Chagas cardiomyopathy due to high sudden death risk.
- In the case presented, the team placed an ICD while managing heart failure and not giving antiparasitics at stage C.