Table 16.

Clinical and laboratory monitoring for Trypanosoma cruzi infection after accidental exposures

General comments
 Monitoring should be done irrespective of whether the person is treated presumptively, before infection is documented.
 For persons treated presumptively with short-course therapy (see the text), this protocol should be adapted to include more intensive monitoring after therapy, because therapy could be suppressive (i.e., early test results could be negative and later results could be positive).
Monitor clinically
 Any rash, swelling, or erythema that develops near the site of exposure should be evaluated. Temperature should be monitored daily for 4 weeks, and febrile illnesses that develop during the next 6 months should be evaluated.
Monitor for development of antibody to the parasite
 A suggested approach is to test serum weekly for 8 weeks or until seroconversion is noted, monthly for the next 4 months, and whenever clinical manifestations suggestive of Chagas' disease are noted. Preemployment serum and/or serum obtained immediately after the exposure should be tested in parallel with subsequent specimens, especially if the latter specimens are positive.
Monitor for parasitemia
 A suggested approach is to monitor blood for parasitemia at least twice weekly for at least 4 weeks and whenever manifestations suggestive of Chagas' disease are noted. See Table 17for details about examination of whole blood and buffy coat for motile trypomastigotes. PCR, an investigational technique, may facilitate early detection of infection (97, 99). Other conventional means of parasitologic confirmation of infection include tissue examination, hemoculture, animal inoculation, and xenodiagnosis.