Chagas disease and systemic autoimmune diseases among Bolivian patients in Switzerland

Abstract

BACKGROUNDChronic cardiomyopathy occurs in 20-40% of the patients with Chagas disease. Autoimmune mechanisms may contribute to its pathogenesis. We diagnosed several cases of systemic autoimmune diseases among Bolivian migrants in Geneva with a high prevalence of Chagas disease.OBJECTIVESWe tested the hypothesis of a clinical association between systemic autoimmune diseases and Chagas disease, particularly with the development of cardiomyopathy.METHODSWe retrospectively searched the medical records of all Bolivian patients visiting Geneva University Hospitals between 2012 and 2015 for diagnosis of Chagas disease or systemic autoimmune diseases.FINDINGSOf the 2,189 eligible patients, 28 [1.3%; 95% confidence interval (CI) = 0.9-1.9%] presented with systemic autoimmune disease. The Chagas status was known in 903 (41.3%) patient, of whom 244 (27.0%; 95% CI = 24.2-30.0%) were positive. Eight (28.6%; 95% CI = 15.3-47.1%) of the 28 cases of systemic autoimmune disease had Chagas disease. We found no association between both entities (p = 1.000) or with Chagasic cardiomyopathy (p = 0.729). Moreover, there was no evidence of a temporal relationship between antiparasitic chemotherapy and the development of systemic autoimmune diseases.CONCLUSIONSOur results do not support a clinical association between chronic Chagas disease and systemic autoimmune diseases. However, prospective studies in areas endemic for Chagas disease should better assess the prevalence of systemic autoimmune diseases and thus a possible relationship with this infection.

Clinical and epidemiological aspects of chronic Chagas disease from Southern Brazil

“…Since immunosuppression may modify the natural progression of T. cruzi infection, some immunosuppressive conditions have previously been studied in CD patients. Systemic autoimmune diseases (SAD) are underreported in patients with T. cruzi infection, and the few studies that observed this association have focused on lupus erythematosus or rheumatoid arthritis possibly due to the underreporting of these conditions in low-income areas/countries 59,60 . Our SAD prevalence in patients with chronic CD of 2% was similar to the 3% recently reported by Jackson et al 59 .…”

“…Systemic autoimmune diseases (SAD) are underreported in patients with T. cruzi infection, and the few studies that observed this association have focused on lupus erythematosus or rheumatoid arthritis possibly due to the underreporting of these conditions in low-income areas/countries 59,60 . Our SAD prevalence in patients with chronic CD of 2% was similar to the 3% recently reported by Jackson et al 59 . A progressive increase of elderly individuals among chronic CD patients has also been observed in several endemic countries, including Brazil 6,7,61,62 .…”

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

“…As of 2013, approximately 36.7 million people migrated out of Latin America and the Caribbean and were residing elsewhere in the world, predominantly in North America [3], bringing Chagas disease to urban environments [4]. Moreover, there have been reported cases of positive Trypanosoma infection in Italy [5] and Switzerland [6].…”

Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature

“…One such study described 2 of 13 patients with ARD who developed symptomatic reactivation on immunosuppressive therapies over a 2-year period, and another 5 patients who developed possible CD reactivation detected by a single positive T. cruzi blood PCR test ( Table 1 ) [ 30 ]. In other case series, the majority of immunosuppressed patients with ARD and CD were treated for chronic CD before the development of any evidence of CD reactivation, and only a small minority of these patients subsequently developed CD reactivation while receiving immunosuppression [ 25 , 36 , 37 ]. In 1 such study, 6 of 8 patients with ARD and CD were treated in this manner with varying regimens of benznidazole and nifurtimox.…”

“…Three patients were treated for CD before a diagnosis of an ARD was made. Only 1 of the patients who received such treatment subsequently developed CD reactivation while receiving immunosuppression (further patient details not specified) [ 36 ]. In another study, 11 of 14 patients with chronic CD and ARD were treated for chronic CD with benznidazole for 60 days at the time of study enrollment, and none of the 14 patients experienced CD reactivation while receiving immunosuppression during follow-up [ 25 ].…”