Chagas in Children Unmasked With Multimodality Imaging.

backgroundChagas disease is typically acquired during childhood but evolves into chronic cardiomyopathy over decades in 30% to 40% of infected individuals. Among Latin America-born patients with newly diagnosed nonischemic cardiomyopathy in the United States, 13% to 19% have Chagas disease as the underlying etiology. CASE SUMMARY: We present 3 pediatric cases illustrating the mechanistic connection between childhood infection and lifetime cardiomyopathy risk: 1) acute myocarditis with cardiac arrest and complete recovery after early benznidazole treatment; 2) fulminant myocarditis requiring venoarterial extracorporeal membrane oxygenation with severely reduced global longitudinal strain and left ventricular apical thrombus; and 3) chronic cardiomyopathy with myocardial fibrosis on cardiac magnetic resonance and regional strain abnormalities. Speckle-tracking echocardiography and cardiac magnetic resonance revealed the mechanistic substrate for disease progression. DISCUSSION: These cases demonstrate the spectrum of pediatric Chagas cardiomyopathy from reversible acute myocarditis to established fibrosis. Speckle-tracking echocardiography and cardiac MRI revealed the mechanistic substrate for disease progression, detecting subclinical dysfunction and fibrosis that predict progression to overt cardiomyopathy. TAKE-HOME MESSAGES: Early recognition and treatment of pediatric Chagas disease prevents adult cardiomyopathy by interrupting persistent parasitemia. Speckle-tracking echocardiography and cardiac magnetic resonance detect subclinical dysfunction and fibrosis predicting disease progression.