Update on Chagas disease in Germany: retrospective analysis of Trypanosoma cruzi testing from 2019 to 2025

BACKGROUND: Chagas disease (CD), caused by Trypanosoma cruzi (T. cruzi), is a global concern due to international migration and the occurrence of non-vectorial transmission in non-endemic countries. In Germany, previous studies suggest substantial underdiagnosis. This study aimed to provide an updated analysis of T. cruzi testing in Germany between 2019 and 2025, to compare it with the period 2000-2018, and to examine whether testing activity changed following the 2022 national recommendations. METHODS: Retrospective descriptive study of T. cruzi diagnostic testing between January 2019 and December 2025 in Germany. Participating laboratories provided information on diagnostic procedures, demographic, and test results. Individuals with confirmed CD as well as their clinical management were further characterized using a questionnaire completed by attending physicians. RESULTS: Five laboratories that perform T. cruzi testing in Germany, performed 8,093 T. cruzi diagnostic tests in 3,874 individuals between 2019 and 2025. Of all tests performed, 169 (2.1%) were positive. After deduplication and application of the case definition, 33 CD cases were found. Among confirmed cases, the largest subgroup was women aged ≥ 50 years. Clinical data were available for 20/33 patients, most of whom had the indeterminate form of CD. Only 5/14 (35.7%) had received antiparasitic treatment. Most responding physicians reported having read the national recommendations introduced in 2022. CONCLUSIONS: CD remains underdiagnosed in Germany despite the availability of national recommendations. Expanding targeted screening, increasing healthcare professional awareness, preventing non-vectorial transmission and improving health insurance coverage are essential to reduce the burden of CD.