Chagas Disease in the 21st Century: Global Spread, Ecological Shifts, and Research Frontiers.

Chagas disease (CD), caused by the parasite Trypanosoma cruzi, remains one of the most important neglected tropical diseases. Historically confined to rural areas of Latin America, the disease has now become a global health challenge due to increased migration, urbanization, and ecological changes. This review explores how patterns of transmission and endemicity have evolved, emphasizing the emergence of new geographic hotspots and non-traditional routes of transmission, such as congenital and oral infections. We integrate evidence from ecological studies showing how deforestation, urban sprawl, and climate change are reshaping vector habitats and influencing the spread of triatomine insects. Furthermore, we highlight advances made between 2020 and 2025 in key research areas, including vector genomics and climate-based predictive mapping, as well as digital surveillance strategies that leverage machine learning and citizen science. These innovations provide valuable insights for predicting future risks and improving disease control. By linking global epidemiological trends, ecological drivers, and cutting-edge scientific advances, this review underscores the urgent need for integrated, collaborative strategies to prevent further spread and to protect vulnerable populations worldwide.