03105nas a2200193 4500000000100000008004100001653003100042653001900073100001500092700001700107700001400124700001300138700001500151245007200166856009200238300000900330490000600339520256600345 2007 d10aNeglected tropical disease10aChagas disease1 aTarleton R1 aReithinger R1 aUrbina JA1 aKitron U1 aürtler RE00aThe challenges of Chagas disease - Grim outlook or glimmer of hope? uhttp://journals.plos.org/plosmedicine/article/asset?id=10.1371/journal.pmed.0040332.PDF ae3320 v43 a

Through its impact on worker productivity, premature disability, and death, Chagas disease accounts for 670,000 disability-adjusted life years per annum [1]. This makes it the most important parasitic disease of the Americas. It is both a disease of poverty (Figures 1 and 2) and, like other neglected tropical diseases, also “poverty promoting” [2]. Traditionally confined to Latin America, Chagas disease is becoming an important health issue in the United States and Europe. First, due to the continuous influx of immigrants from disease-endemic countries in Latin America, a proportion of whom are infected with Trypanosoma cruzi, an increasing number of infected subjects are seen in clinical practice, whether, for example, through routine screening of US blood and organ banks [3] or physicians' offices in Europe [4]. The appearance of T. cruzi in US blood banks led to the implementation of the first Food and Drug Administration–approved diagnostic blood screening test for Chagas disease earlier this year [5]. Second, an increasing number of autochthonous Chagas disease cases have been reported in the US [6,7], which may mirror the increased reporting of T. cruzi infection in domestic animals and wildlife. Recognizing that Chagas disease can no longer be considered an “exotic” disease in the US, the American Society of Tropical Medicine and Hygiene held a clinical course in Chagas disease prior to its 2007 annual meeting