in october 2012 , a 13-year - old boy in japan was admitted to the national defense medical college hospital in saitama , japan , for chronic constipation . his parents and grandparents were bolivian nationals of japanese descent who had lived in chagas disease endemic areas in bolivia until 1992 . in 1999 , the boy was delivered full - term after an uncomplicated pregnancy in japan but had a low birthweight . he was in excellent health and showed no signs of disease until 2 years before his admission , when he began to report chronic constipation . at that time , he had a medical examination at a catholic church because most hospitals in japan could not make a definitive diagnosis of chagas disease . after admission , he reported extreme constipation and explained that he defecated only once per week . results of laboratory tests at admission , including those for serum brain natriuretic peptide , were generally within reference ranges . however , abdominal radiography showed major distension of the colon that extended 65 mm ( figure ) . abdominal radiograph of a 13-year - old boy with congenital chagas disease , japan , showing megacolon and marked dilatation at the splenic flexure . the definitive diagnosis , including effectiveness of antiparasitic treatment , was confirmed by using serologic , genomic , and parasitologic methods ( table 2 ) . an elisa ( ortho t. cruzi elisa test system ; ortho - clinical diagnostics , raritan , nj , usa ) was performed according to the manufacturer s protocol . a nested pcr that amplifies a dna fragment of a repetitive tcz sequence was performed as described ( 5 ) . the parasite was also isolated by blood culture on novy , mcneal , and nicolle agar ( 6 ) and examined by light microscopy and real - time pcr . it was later determined that the boy s mother was also seropositive for chagas disease . the patient was treated with oral benznidazole ( 5 mg / kg / d for 60 days ) and showed no adverse effects . parasitemia and dna of t. cruzi in peripheral blood could not be detected by the end of treatment . to ensure successful treatment and cure , we intend to clinically follow up the patient for several decades until serologic results eventually become negative ( 7 ) . chagas disease is usually regarded as one of the most serious health problems in rural areas of central and south america . however , recent successful vector control programs to reduce vector - borne transmission have dramatically changed the epidemiology of this disease ( 8) . mass migration of chronically infected and asymptomatic persons has caused globalization of chagas disease , and has made nonvectorial infection , including vertical and blood - borne transmission , more of a threat to human communities than vectorial infection ( 9 ) . on the basis of local and limited serologic surveys , the presumptive number of chagasic patients living in japan is currently 4,500 , compared with > 100,000 in the united states and > 6,000 in spain ( 2 ) . sporadic imported cases have been recognized and reported in japan in the past decade , but the exact incidence is unknown . most cases were diagnosed only after patients had critical complications , including severe cardiac involvement ( 10 ) . it is also conceivable that chagasic patients with less severe cardiac symptoms or gastrointestinal involvement have sought treatment at local hospitals in japan , where the potential for missing or misdiagnosing the disease would likely be high . the difficulty in making a correct diagnosis of chagas disease is compounded in japan by low awareness and recognition of the disease by medical staff ; scarcity of epidemiologic or statistical data ; and lack of diagnostic tools , resources , and facilities available to help with the differential diagnosis . there is currently no laboratory test  based screening system for donated blood to detect chagas disease in japan . instead , a questionnaire is used to determine if donors have any connections with disease - endemic regions . as of october 2012 , to avoid transmission through transfusions , japanese red cross blood centers no longer use donated blood for transfusions or producing blood products if the donor or donor s mother has spent 4 weeks in latin america . therefore , before 2012 , it is difficult to estimate how many contaminated blood donations were overlooked in japan . the estimated vertical transmission rate from an infected mother to her newborn is 5% in bolivia ( 11 ) . if one considers that 34,000 children were born to latin american women during the past decade in japan and that the seroprevalence of t. cruzi is estimated to be 1.8% , the number of infected newborns in the past decade is 30 . however , there are no current screening programs for chagas disease in japan to detect chronically infected persons , including pregnant women and newborns . the patient in this study had congenital chagasic infection , accompanied by advanced gastrointestinal complications . the delay in diagnosis for this patient case was caused by the absence of a screening program in japan , a problem which also makes it impossible to determine the precise number of pregnant women and newborns with t. cruzi infection in this country . in spain , the most affected country in europe , a specific program was developed to focus on migrants from latin american woman of childbearing age . since its introduction , the program has contributed not only to the early diagnosis of chagas disease but also to improvements in the quality of life and prognosis for patients ( 12 ) . because the therapeutic efficacy of treatment , including benznidazole , for infection with t. cruzi is > 90% in infants with congenitally transmitted chagas disease if treated during the first year of life ( 13 ) , it would be ideal for all pregnant women entering japan from disease - endemic countries to be screened for the presence of serum antibody against t. cruzi . this report indicates the urgent need for implementing proper measures to prevent the vertical transmission of t. cruzi in non  chagas disease
we report a patient with congenital chagas disease in japan . 
 this report reemphasizes the role of neglected and emerging tropical diseases in the era of globalization 
 . it also indicates the need for increased vigilance for detecting chagas disease in non  disease - endemic countries .