Screening for Trypanosoma cruzi infection in immigrants and refugees: Systematic review and recommendations from the Spanish Society of Infectious Diseases and Clinical Microbiology

Abstract

Background: Chagas disease has spread beyond its original borders on the American continent with migration. It can be transmitted from mother to child, through organ transplantation and transfusion of blood and blood products. It is necessary to determine when to screen for this infection. Aim: Our objective was to evaluate the appropriateness of screening for Trypanosoma cruzi infection in Latin American migrants and their descendants. Methods: We reviewed the literature using rigorous criteria. The quality of evidence was ranked according to the GRADE classification. An evidence to decision framework was adopted to provide information on the most relevant aspects necessary to formulate recommendations. Results: The 33 studies evaluated revealed a prevalence of T. cruzi infection among Latin American migrants in Europe of 6.08% (95% confidence interval (CI): 3.24-9.69; 28 studies). Vertical transmission occurred in three of 100 live births (95% CI: 1-6; 13 studies). The prevalence of cardiovascular disease was 19% (95% CI: 13-27; nine studies), including only 1% severe cardiac events (95% CI: 0-2; 11 studies). The overall quality of evidence was low because of risk of bias in the studies and considerable heterogeneity of the evaluated populations. The recommendations took into account economic studies on the value of screening strategies and studies on acceptability of screening and knowledge of the disease in the affected population. Conclusions: We identified five situations in which screening for T. cruzi infection is indicated. We recommend screening persons from endemic areas and children of mothers from these areas.

Key Chagas disease missing knowledge among at-risk population in Spain affecting diagnosis and treatment

“…Bolivians associated CD with poor people living in the rural areas of their country, but, at the same time, they did not believe that people with CD are rejected in Spain, mainly because it is not a contagious disease and almost nobody knows about the disease here. Although this might indicate that the perception of stigma has decreased in relation to the findings in other studies [ 27 , 29 , 31 ], almost none of the Bolivians mentioned their boss or colleagues when asked about whom they would tell if they had CD.…”

“…Chagas disease is a silent disease, one that is mostly asymptomatic during the indeterminate chronic phase, which makes it difficult to identify signs and later complications. The long period without symptoms that might affect everyday activities, added to the normalization of CD, often keeps patients from being diagnosed and treated [ 26 , 27 ].…”

“…This widespread perception amongst the population at risk reinforces the idea that there is little point in diagnosing and treating the disease [ 23 ]. However, although there is confusion regarding treatment, they at least know that treatment is available [ 12 , 27 ]. What is more, most of the Bolivians interviewed had a positive attitude towards being treated and towards treat their children.…”

Chagas disease screening in pregnant Latin American women: Adherence to a systematic screening protocol in a non-endemic country

“…Serological screening in pregnant women and examination of babies born from seropositive mothers is a suitable strategy to detect and prevent congenital Chagas disease in non-endemic areas of both endemic and non-endemic countries[ 10 , 15 , 17 , 18 ]. In Spain, experts recommend prenatal serological screening followed by microscopic examination or polymerase chain reaction (PCR) of cord blood from infants of seropositive mothers at birth and by one month of age.…”

A new patient registry for Chagas disease

“…A Chagas disease patient registry could be paired with serum chemistries in order to aid the development of biomarkers to predict downstream treatment successes versus progression of disease [16]. As in others NTDs, there are limitations in the availability of evidence-based guidelines for Chagas disease or, in some cases, insufficient evidence to support some of the guidelines even when they are available [17,18]. In some cases, there is also a lack of minimum standardization between and within the different countries, which created even greater obstacles for an integrated global response [19].…”