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Diagnosis of Acute Chagas Disease in a Belizean Child with Evidence of a Multiclonal Trypanosoma cruzi Infection

Kristy O. MurrayDivision of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas;
William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas;
National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;

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Miguel A. SaldañaDivision of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas;
William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas;

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Sarah M. GunterDivision of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas;
William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas;
National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;

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Russell ManzaneroBelize Ministry of Health and Wellness, Belmopan, Belize;

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Emily Zielinski-GutierrezU.S. Centers for Disease Control and Prevention—Central America Region, Guatemala City, Guatemala;

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Claudia HerreraDepartment of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana;

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Julie M. ThompsonDepartment of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana;
Department of Biomedical Science, School of Medicine, Tulane University, New Orleans, Louisiana

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Adrianna MaligaDivision of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas;

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Kim BautistaBelize Ministry of Health and Wellness, Belmopan, Belize;

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Allison LinoDivision of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas;
William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas;

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Ella HawesDivision of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas;
William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas;

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Shannon E. RoncaDivision of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas;
William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas;
National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;

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Francis MoreyBelize Ministry of Health and Wellness, Belmopan, Belize;

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Rafael Chacon FuentesU.S. Centers for Disease Control and Prevention—Central America Region, Guatemala City, Guatemala;

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Beatriz LopezU.S. Centers for Disease Control and Prevention—Central America Region, Guatemala City, Guatemala;

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Eric DumonteilDepartment of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana;

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Gerhaldine H. MorazanDivision of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas;
Belize Ministry of Health and Wellness, Belmopan, Belize;

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ABSTRACT.

In January 2020, we instituted acute febrile illness surveillance in 11 hospitals and clinics across Belize. Within 3 months, we diagnosed an acute case of Chagas disease by polymerase chain reaction in a 7-year-old child in the northern part of the country. Phylogenetic analyses of the parasite from the acute blood specimen revealed a multiclonal Trypanosoma cruzi infection, including parasites from the TcII (25.0% of haplotypes), TcIV (2.5% of haplotypes), and TcV (72.5% of haplotypes) discrete typing units. The family reported no history of travel, and three Triatoma species vectors were found within the home. The child’s mother was seronegative for antibodies to T. cruzi, ruling out congenital transmission. Convalescent blood samples documented seroconversion and confirmed acute infection. The child was successfully treated with nifurtimox. This is the first known diagnosed case of acute Chagas infection in Belize, highlighting the need for further investigation and public health prevention measures.

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Author Notes

Address correspondence to Kristy Murray, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates St., FC 550.07, Houston, TX 77030. E-mail: kmurray@bcm.edu

Financial support: This study was generously funded, in part, by CDC U01 GH002235 (to K. O. M.). The genotyping and genomic analysis was funded in part by the Tulane ByWater Institute–Faculty Fellowships in Interdisciplinary Collaboration 2020 to C. P. H.

Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services. Use of trade names is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry, the Public Health Service, or the U.S. Department of Health and Human Services.

Authors’ addresses: Kristy O. Murray, Sarah M. Gunter, and Shannon E. Ronca, Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas; and National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, E-mails: kmurray@bcm.edu, sm22@bcm.edu, and shannon.ronca@bcm.edu. Miguel A. Saldaña, Allison Lino, and Ella Hawes, Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, and William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, E-mails: Miguel.Saldana@phs.hctx.net, Allison.lino@bcm.edu, and ella.hawes@bcm.edu. Russell Manzanero, Kim Bautista, and Francis Morey, Belize Ministry of Health and Wellness, Belmopan, Belize, E-mails: rmanzanero@health.gov.bz, kbautista@health.gov.bz, and fmorey@health.gov.bz. Emily Zielinski-Gutierrez, Rafael Chacon Fuentes, and Beatriz Lopez, U.S. Centers for Disease Control and Prevention—Central America Region, Guatemala City, Guatemala, E-mails: ebz0@cdc.gov, qin8@cdc.gov, and fdx8@cdc.gov. Claudia Herrera and Eric Dumonteil, Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, E-mails: cherrera@tulane.edu and edumonte@tulane.edu. Julie M. Thompson, Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, and Department of Biomedical Science, School of Medicine, Tulane University, New Orleans, Louisiana, E-mail: jthompson4@tulane.edu. Adrianna Maliga, Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, E-mail: Adrianna.maliga@bcm.edu. Gerhaldine H. Morazan, Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, and Belize Ministry of Health and Wellness, Belmopan, Belize, E-mail: gerhaldine.morazan@bcm.edu.

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