  Citation: Gual-Gonzalez, L.; Arango-Ferreira, C.; Lopera-Restrepo, L.C.; Cantillo-Barraza, O.; Marín, D.V.; Bustamante, N.R.; Triana- Chavez, O.; Nolan, M.S. Acute Pediatric Chagas Disease in Antioquia, Colombia: A Geographic Location of Suspected Oral Transmission. Microorganisms 2022, 10, 8. https://doi.org/10.3390/ microorganisms10010008 Academic Editor: Sonia Almeria Received: 8 November 2021 Accepted: 18 December 2021 Published: 22 December 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). microorganisms Case Report Acute Pediatric Chagas Disease in Antioquia, Colombia: A Geographic Location of Suspected Oral Transmission Lídia Gual-Gonzalez 1, * ,† , Catalina Arango-Ferreira 2,3 , Laura Camila Lopera-Restrepo 4,† , Omar Cantillo-Barraza 5 , Daniela Velásquez Marín 3 , Natalia Restrepo Bustamante 3 , Omar Triana-Chavez 5 and Melissa S. Nolan 1, * 1 Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA 2 Departamento de Pediatría Hospital San Vicente Fundación, Medellin 050010, Colombia; catalina.arango@sanvicentefundacion.com 3 Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Medellin 050010, Colombia; daniela.velasquez5@udea.edu.co (D.V.M.); natalia.restrepob@udea.edu.co (N.R.B.) 4 Grupo de Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Medellin 050010, Colombia; lcamila.lopera@udea.edu.co 5 Grupo Biología y Control de Enfermedades Infecciosas, Universidad de Antioquia, Medellin 050010, Colombia; omarcantillo@gmail.com (O.C.-B.); omar.triana@udea.edu.co (O.T.-C.) * Correspondence: lidiag@email.sc.edu (L.G.-G.); msnolan@mailbox.sc.edu (M.S.N.) † These authors contributed equally to this work. Abstract: Chagas disease, Trypanosoma cruzi infection, is an insidious cause of heart failure in Latin America. Early diagnosis and treatment are critical to prevent irreversible myocardial damage that progressively accumulates over decades. Several structural barriers account for the less than 1% of cases in Colombia being treated, including poor physician knowledge, especially considering that some regions are considered non-endemic. The two cases reported here represent an emerging epidemiologic scenario associated with pediatric Chagas disease. Both cases are suspected oral transmitted parasitic infection in a geographic region of Colombia (Andean region of Antioquia) where no previous oral transmission of Chagas disease had been reported. Their clinical histories and course of disease are presented here to increase physician awareness of the epidemiologic risk factors and clinical manifestations associated with pediatric oral Chagas disease in Antioquia department, Colombia. Keywords: Trypanosoma cruzi; oral transmission; pediatric Chagas disease; Colombia; Antioquia 1. Introduction Chagas disease is a parasitic infection that if untreated can lead to insidious organomegaly in a subset of chronically infected patients. This neglected tropical disease affects 7 million Latin Americans and another 75 million live at risk of acquiring incident disease [1]. Vector- borne transmission is the most common infection route; however, oral transmission via contaminated beverages or food products is becoming a greater public health concern [2]. Further, infected patients that acquire disease orally present with greater acute disease symptomology and occur in communal outbreaks [3–5]. Children are particularly vul- nerable to severe disease and death from orally transmitted Chagas disease [6–8]. The geographic location of triatomine species associated with food/beverage product is largely unknown but has been reported in the Amazonian region of Venezuela-Brazil, Peru, and Colombia [2]. The identification of new geographic areas of oral transmission risk is im- portant to both provide prompt treatment to those affected and perform interventions to prevent continued transmission to other local residents. The two case reports presented here highlight the clinical manifestations and epidemiologic risk factors for two children suspected of oral Trypanosoma cruzi infection in a new geographic area in Colombia. Microorganisms 2022, 10, 8. https://doi.org/10.3390/microorganisms10010008 https://www.mdpi.com/journal/microorganisms