Outbreaks of orally transmitted Chagas disease in Latin America: A comprehensive systematic review

BackgroundThe rising burden of orally transmitted Chagas disease in South America underscores the need for a deeper understanding of this food-borne transmission route. Despite its relevance, key aspects such as transmission dynamics, epidemiology, and clinical outcomes remain insufficiently explored, limiting prevention and treatment strategies. MethodsA systematic review (PROSPERO 2024-CRD42024542461) of reported outbreaks from 1965 to 2023 was conducted. Three reviewers independently screened and selected studies using predefined criteria. Data on epidemiology, contamination sources, clinical findings, diagnostics (cardiac, serological, molecular), vector species, and parasite lineages were extracted. FindingsWe compiled data from 111 outbreaks involving 1187 cases (55% males), 77 deaths, in 6 countries. Contaminated food sources were identified in 63 outbreaks (56{middle dot}7%), with reliable confirmation in 8 (7{middle dot}2%), acai fruit being the most common source (28%). Outbreaks occurred mainly in sylvatic and tropical regions, coinciding with warm seasons and crop harvest periods. Selvatic parasite lineages predominated (98%), with Rhodnius spp. triatomines being implicated in 28%. The median incubation period was 22 days. Case fatality ratio was 6{middle dot}5%. Acute infection presented with fever (80%), facial edema (20%), altered ECG (39{middle dot}2%) and Echo (28{middle dot}9%). Despite antiparasitic treatment, cardiac alterations persisted after 1 and 4 years. A ten-year follow-up showed no chronic Chagasic cardiomyopathy, though risk markers and persistent T. cruzi-specific IgG were reported. Data reinforces gaps mainly in long-term clinical, serological and molecular follow-up. InterpretationMore integrated strategies are needed to enhance outbreak detection and management. FundingFiocruz, CNPq and Faperj (Brazil) and FOCEM/Mercosur.