{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:52:00Z","timestamp":1791827520292,"version":"4.3.4"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chagas disease (CD) is a leading tropical disease and the most prevalent parasitic infection in Latin America, affecting &amp;gt;7 million people globally and \u223c240 000\u2013350 000 individuals within the United States. Though known to be endemic to Latin America, prevalence in the United States is also increasing with improved recognition of locally acquired cases, especially in Texas. Autochthonous cases occur throughout the Southern United States, but the geographic range is anticipated to shift northwards as a result of climate change. Chagas disease is referred to as a \u201csilent and silenced disease\u201d by the World Health Organization as most people show no signs or symptoms for years following acute infection, and it primarily affects individuals who are socioeconomically disadvantaged. Historically, Chagas disease has been underrecognized. In the absence of treatment, infected individuals progress to a clinically silent or \u201cindeterminate form\u201d of infection that persists for life. While most patients with indeterminate Chagas disease do not have long-term sequelae, \u223c30%\u201340% will develop end-organ cardiac or gastrointestinal disease decades after infection. Due to its protean clinical presentations, diagnosis requires a high clinical index of suspicion and knowledge of the epidemiology. Traditionally, the diagnosis is based on serology, visualization of the parasite in blood, and polymerase chain reaction (PCR), all of which require suspecting the infection. Microbial cell-free DNA (mcfDNA) of blood can serve as a useful tool for detection of Trypanosoma cruzi even when Chagas disease is not suspected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Here we present 7 cases, 3 children and 4 adults, who presented with nonspecific manifestations; CD was not in the initial differential diagnosis in 5 of them. Chagas disease was ultimately diagnosed by Karius Spectrum test. In 1 case, the test was sent to expedite diagnosis in the setting of suspected Chagas reactivation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag584","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:52:11Z","timestamp":1790855531000},"source":"Crossref","is-referenced-by-count":0,"title":["The Utility of Microbial Cell-Free DNA in the Rapid Diagnosis of Chagas Disease: Chagas Disease Case Series"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4667-5028","authenticated-orcid":false,"given":"Anissa","family":"Amilhamja","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Driscoll Children's Hospital , Corpus Christi, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Driscoll Children's Hospital , Corpus Christi, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5278-6162","authenticated-orcid":false,"given":"Kristin","family":"Mondy","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Dell Medical School , Austin, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8240-5209","authenticated-orcid":false,"given":"Michael","family":"Kron","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Froedtert and Medical College of Wisconsin , Milwaukee, Wisconsin ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1956-6699","authenticated-orcid":false,"given":"Niki","family":"Viradia","sequence":"additional","affiliation":[{"name":"4th Year Medical Student, Froedtert and Medical College of Wisconsin , Wauwatosa, Wisconsin ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1093-550X","authenticated-orcid":false,"given":"Omer","family":"Beaird","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, UCLA , Los Angeles, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1111-0892","authenticated-orcid":false,"given":"Jaime","family":"Fergie","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Driscoll Children's Hospital , Corpus Christi, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"2026101213320577200_ofag584-B1","doi-asserted-by":"crossref","DOI":"10.5334\/gh.484","article-title":"WHF IASC roadmap on Chagas disease","volume":"15","author":"Echeverr\u00eda","year":"2020","journal-title":"Glob Heart"},{"key":"2026101213320577200_ofag584-B2","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/S0140-6736(17)31612-4","article-title":"Chagas disease","volume":"391","author":"P\u00e9rez-Molina","year":"2018","journal-title":"Lancet (London, England)"},{"key":"2026101213320577200_ofag584-B3","doi-asserted-by":"crossref","DOI":"10.1111\/ctr.13546","article-title":"Tissue and blood protozoa including toxoplasmosis, Chagas disease, leishmaniasis, Babesia, Acanthamoeba, Balamuthia, and Naegleria in solid organ transplant recipients\u2014Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice","volume":"33","author":"La Hoz","year":"2019","journal-title":"Clin Transplant"},{"key":"2026101213320577200_ofag584-B4","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0140-6736(23)01787-7","article-title":"Chagas disease","volume":"403","author":"de Sousa","year":"2024","journal-title":"Lancet (London, England)"},{"key":"2026101213320577200_ofag584-B5","doi-asserted-by":"crossref","DOI":"10.1016\/S0735-1097(23)03622-7","article-title":"Chagas reactivation during desensitization for orthotopic heart transplantation","volume":"81","author":"David","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2026101213320577200_ofag584-B6","article-title":"Plasma microbial cell-free DNA sequencing from over 15,000 patients identified a broad spectrum of pathogens","volume":"61","author":"Park","year":"2023","journal-title":"J Clin Microbiol"},{"key":"2026101213320577200_ofag584-B7","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2022.975106","article-title":"Central nervous system commitment in Chagas disease","volume":"13","author":"Useche","year":"2022","journal-title":"Front Immunol"},{"key":"2026101213320577200_ofag584-B8","doi-asserted-by":"crossref","first-page":"ITC17","DOI":"10.7326\/AITC202302210","article-title":"Chagas disease","volume":"176","author":"Hochberg","year":"2023","journal-title":"Ann Intern Med"},{"key":"2026101213320577200_ofag584-B9","doi-asserted-by":"crossref","DOI":"10.1016\/j.cpcardiol.2019.100507","article-title":"Chagas disease: chronic Chagas cardiomyopathy","volume":"46","author":"Echavarr\u00eda","year":"2021","journal-title":"Curr Probl Cardiol"},{"key":"2026101213320577200_ofag584-B10","doi-asserted-by":"crossref","DOI":"10.1007\/s11886-018-1077-5","article-title":"Diagnosis and management of Chagas cardiomyopathy in the United States","volume":"20","author":"Benck","year":"2018","journal-title":"Curr Cardiol Rep"},{"key":"2026101213320577200_ofag584-B11","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1038\/nrcardio.2012.109","article-title":"Diagnosis and management of Chagas disease and cardiomyopathy","volume":"9","author":"Ribeiro","year":"2012","journal-title":"Nat Rev Cardiol"},{"key":"2026101213320577200_ofag584-B12","doi-asserted-by":"crossref","first-page":"871","DOI":"10.3201\/eid1605.091440","article-title":"Physician awareness of Chagas disease, USA","volume":"16","author":"Stimpert","year":"2010","journal-title":"Emerg Infect Dis"},{"key":"2026101213320577200_ofag584-B13","doi-asserted-by":"crossref","first-page":"857","DOI":"10.4269\/ajtmh.25-0559","article-title":"Barriers to Chagas disease screening among primary care providers in the United States","volume":"114","author":"Carrion","year":"2026","journal-title":"Am J Trop Med Hyg"},{"key":"2026101213320577200_ofag584-B14","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1038\/s41564-018-0349-6","article-title":"Analytical and clinical validation of a microbial cell-free DNA sequencing test for infectious disease","volume":"4","author":"Blauwkamp","year":"2019","journal-title":"Nat Microbiol"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofag584\/71716017\/ofag584.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/10\/ofag584\/71716017\/ofag584.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/10\/ofag584\/71716017\/ofag584.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:32:13Z","timestamp":1791826333000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofag584\/8884982"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":14,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,9,29]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofag584","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,9,29]]},"article-number":"ofag584"}}