Pediatric Chagas disease in the non-endemic area of Madrid: A fifteen-year review (2004–2018)

Abstract

Background Chagas disease (CD) has become an emerging global health problem in association with the immigration of individuals from endemic areas (in LatinAmerica) to other countries.Spain is the country in Europe with the highest number of CD cases. Concerning pediatric CD, treatment is not only better tolerated by younger children but also has greater cure possibilities. The aim of this study was to describe clinical and epidemiological aspects of CD in a pediatric population diagnosed of 10 hospitals in the Community of Madrid during the 2004–2018 period, as well as the safety and efficacy of CD treatment on this population. Methodology/Principal findings A multicenter, retrospective, descriptive study was conducted. The studied population included all identified children under the age of 18 with a diagnosis of CD. Diagnosis was performed with a positive parasitological test (with subsequent confirmation) or confirmed persistence of positive serology beyond 9 months, for children younger than one year-old, and with two different positive serological tests, for children older than one. Fifty-one children were included (59% male; 50.9% born in Spain). All mothers were from Latin America. The median age at diagnosis was 0.7 months for those under one year of age, and 11.08 years for those older than one year-old. Only one case presented a symptomatic course (hydrops faetalis, haemodynamic instability at birth, ascites, anaemia). For 94% treatment was completed. Considering patients who received benznidazole (47), AE were recorded in 48,9%. Among the 32 patients older than one year-old treated with benznidazole, 18 (56.25%) had adverse events whereas in the 15 under one year, 5(33,3%) did. Eigtheen (78.2%) of the patients with benznidazole AE were older than one year-old(median age 11.4 years). Of the patients treated with nifurtimox (9), AE were reported in 3 cases (33,3%). Cure was confirmed in 80% of the children under one year-old vs 4.3% in those older (p<0.001). Loss to follow- up occurred in 35.3% of patients. Conclusions/Significances Screening programs of CD since birth allow early diagnosis and treatment, with a significantly higher cure rate in children treated before one year of age, with lower incidence of adverse events. The high proportion of patients lost to follow-up in this vulnerable population is of concern.

Chagas Disease in Europe

“…Few series based on pediatric cases of CD in Europe have been published. The largest included 51 cases of CD in children, 50.9% of whom were born in Spain and all of whom had Latin American mothers [ 50 ]. Another study reported 45 pediatric T. cruzi cases diagnosed in Spain and Switzerland and all were children of Latin American origin.…”

“…PCR for T. cruzi was performed in 20 of the 22 cases diagnosed by serological screening and was positive in 12 cases (60%) [ 52 ]. For children born in Latin America, Bolivia was the most frequent area of origin [ 50 , 51 , 52 ].…”

“…Pediatric cases have been reported to be asymptomatic in 60–90% of cases [ 50 , 51 , 52 ]. If left untreated, most children enter a prolonged asymptomatic chronic phase in which about one third of patients may develop late complications [ 53 ].…”

“…Therefore, the efficacy in children is much higher than in adults and the earlier the treatment is administered, the better the response. Published data have reported cure rates of 80% in children aged less than 1 year compared to 4.3% in older children [ 50 ]. Moreover, children show better tolerance to treatment with fewer adverse effects than adults [ 57 ], especially when treatment is administered in patients younger than 7 years of age [ 50 ].…”

Alternative Approaches for the Treatment of Chagas Disease

“…[10] Chagas disease (CD), resulting from infection by the T. cruzi parasite, remains a significant community and individual health concern in Latin America. The WHO classifies [11] it as an NTD, highlighting the association of the disease with poverty and disadvantage, affecting communities with limited visibility and political influence. It leads to stigmatization and discrimination, receives less attention from researchers, and has a substantial impact on both illness and death rates.…”