Chagas' disease in northern California. No longer an endemic diagnosis.

Chagas' disease has long been considered a diagnosis endemic to South and Central America, with over 10 million seropositive cases in Brazil alone, and over 25 percent of infants in rural Brazil with demonstrable parasitemia. In northern California, progressive biventricular heart failure developed in a 75-year-old woman with a history of right bundle branch block, sinus bradycardia, and ventricular dysrhythmias. Echocardiography showed a characteristic pattern of inferoposterior hypokinesis with relatively intact septal motion. Complement fixation titers for Trypanosoma cruzi were diagnostic. The chronic forms of Chagas' disease may not be manifest until 30 years after the insect bite. It is this factor of prolonged latency, in relation to modern migration and relocations, that makes Chagas' disease no longer an endemic diagnosis.