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Parasitic Diseases Research and Treatment · Review
Frontiers in Public Health · September 8, 2026
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This systematic review synthesizes 114 food-borne Chagas disease outbreaks (1,293 cases, 77 deaths) reported between 1965 and 2024 across six Latin American countries. The outbreaks are characterized by acute febrile presentation (83.6%), significant cardiac involvement (pericardial effusion 29.3%, repolarization disorders 26.3%), and substantial burden of cardiac abnormalities on follow-up despite treatment, though microbiological confirmation of food sources is rare and diagnostic and follow-up practices are highly inconsistent.
Systematic review following PRISMA-2020 guidelines of food-borne Chagas disease outbreak reports. Food-borne Chagas disease outbreaks reported in the scientific literature; studies describing outbreaks in six countries (primarily Brazil and other Amazonian/tropical regions of South America).. n = 1,293. Six countries in South America, with predominance of cases in Amazonian and tropical regions; Brazil accounted for majority of outbreaks (64 of 114)..
114 outbreaks identified across 6 countries comprising 1,293 cases and 77 deaths (case fatality rate 5.95%) Reported outbreaks increased 7.1-fold during the second half of the study period (1965–2024) Food sources microbiologically confirmed in only 1 of 114 outbreaks; 82 outbreaks had suspected food vehicle based on epidemiological evidence
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Clinicians managing suspected or confirmed food-borne Chagas disease should anticipate acute febrile presentation with high rates of cardiac involvement, including arrhythmias and pericardial effusion. The persistence of cardiac abnormalities despite treatment and low rates of serological clearance indicate need for long-term cardiac and parasitological follow-up, though current evidence is limited by inconsistent diagnostic practices and sparse long-term outcome data.
Systematic review of outbreak data from heterogeneous sources with substantial methodological limitations, underreporting, and inconsistent diagnostic practices; descriptive findings without controlled comparisons or intervention trials.
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Clinicians managing suspected or confirmed food-borne Chagas disease should anticipate acute febrile presentation with high rates of cardiac involvement, including arrhythmias and pericardial effusion. The persistence of cardiac abnormalities despite treatment and low rates of serological clearance indicate need for long-term cardiac and parasitological follow-up, though current evidence is limited by inconsistent diagnostic practices and sparse long-term outcome data.
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Objective Food-borne Chagas disease is an emerging public health concern in South America, yet key aspects of its epidemiology and clinical impact remain poorly characterized. This systematic review aimed to systematically synthesize the available evidence on food-borne Chagas disease outbreaks in order to characterize their epidemiological, clinical, laboratory, treatment, and follow-up features, and to identify major knowledge gaps. Methods A systematic review of food-borne Chagas disease outbreaks reported between 1965 and 2024 was conducted following PRISMA-2020 guidelines (PROSPERO-CRD42024542461). Independent reviewers screened studies and extracted data on epidemiology, food sources, diagnostics, clinical presentation, treatment, follow-up, seasonality, vectors, and parasite lineages. Results Among 835 records identified, 111 studies met the inclusion criteria, describing 114 outbreaks in six countries, comprising 1,293 cases and 77 deaths (case fatality rate: 5.95%). Reported outbreaks increased 7.1-fold during the second half of the study period. Food sources were epidemiologically identified in only 12 outbreaks, with microbiological confirmation achieved in just one of them. In a further 82 outbreaks, the implicated food vehicle was classified as suspected based on epidemiological evidence, while no food source was identified in the remaining 20 outbreaks. Açaí was the most frequently implicated food in Brazil (32/64 outbreaks), whereas fruit-based beverages predominated elsewhere. Outbreaks clustered in Amazonian and tropical regions and occurred mainly during warm and rainy seasons, with predominance of sylvatic TcI/TcIV lineages and frequent involvement of Rhodnius spp. vectors. The median incubation period was 16 days. Clinical information was available for 941 patients, revealing a predominantly acute febrile syndrome (83.6%), followed by headache (37.1%), myalgia (36.4%), and facial edema (25.4%). Cardiac evaluation in 501 patients showed a substantial burden of abnormalities, including pericardial effusion (29.3%), repolarization disorders (26.3%), tachycardia (18.5%), bundle branch blocks (8.4%), and heart failure (7.2%). Follow-up data suggested persistence of cardiac alterations despite treatment, while long-term serological and molecular outcomes indicated low seronegativization and possible parasite persistence even after 10 years. Conclusion Food-borne Chagas disease remains an important mode of T. cruzi transmission, particularly in Amazonian and sylvatic settings. However, substantial heterogeneity, underreporting, and inconsistent diagnostic and follow-up practices limit current understanding. Standardized outbreak investigations, long-term cohort studies, and strengthened surveillance systems are urgently needed. Systematic review registration PROSPERO 2024 CRD42024542461. Available online at: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024542461.
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