Trypanosoma cruzi infection in a non-endemic country: epidemiological and clinical profile

Abstract

Chagas disease has been increasingly diagnosed in non-endemic countries. This is a prospective observational study performed at the Tropical Medicine Units of the International Health Program of the Catalan Health Institute, Barcelona (PROgrama de Salud Internacional del Instituto Catalán de la Salud, PROSICS Barcelona, Spain), that includes all patients with Chagas disease who attended from June 2007 to May 2012. Clinical and epidemiological data were collected. Overall, 1274 patients were included, the mean age of the patients was 37.7 years, 67.5% were women and 97% came from Bolivia. Thirteen patients had immunosuppressive conditions. The prevalence of cardiac involvement was 16.9%, lower than in previous studies performed in endemic areas (20-60%). Cardiac alterations were found in 33.8% of symptomatic and 14.1% of asymptomatic patients. The prevalence of digestive involvement was 14.8%. The rate of digestive involvement is very different among previous studies because of different diagnostic tools and strategies used. Barium enema alterations were found in 21.4% of symptomatic and 10.3% of asymptomatic patients, and oesophageal alterations were found in 3.7% of symptomatic and in 2.3% of asymptomatic patients. As shown in previous studies, Chagas disease in non-endemic countries affects younger patients and has lower morbidity.

Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis

“…The model started with a target population of 100 000 Latin American individuals from Chagas diseaseendemic countries, and 4·2% (95% CI 2·2-6·8) were assumed to be infected with T cruzi. 14 The first year-cycle of the model (year 0) starts with parameter values taken from the study by Salvador and colleagues, 17 indicating that 85·8% of individuals infected with T cruzi were asymptomatic and that 14·1% of asymptomatic patients were in the cardiac form, whereas the remainder were in the indeterminate form. 17 The mean age of the population was set at 35 years.…”

“…14 The first year-cycle of the model (year 0) starts with parameter values taken from the study by Salvador and colleagues, 17 indicating that 85·8% of individuals infected with T cruzi were asymptomatic and that 14·1% of asymptomatic patients were in the cardiac form, whereas the remainder were in the indeterminate form. 17 The mean age of the population was set at 35 years. 18 In the base case analysis, 80% of the target population (patients at risk of Chagas disease) was screened and treated.…”

“…Assumption was made that nobody would refuse the treatment and all positive cases received treatment according to the current clinical practice in nonendemic areas. 17,18 This entails treatment with the antiparasitic drug benznidazole for 60 days, as per WHO recommendations, 21 with complete blood count and basic biochemistry monitoring at follow-up visits every 15 days. 17,18 In the no-test option, only symptomatic patients transitioning to the cardiac or gastrointestinal forms were diagnosed with Chagas disease and treated accordingly.…”

“…17,18 This entails treatment with the antiparasitic drug benznidazole for 60 days, as per WHO recommendations, 21 with complete blood count and basic biochemistry monitoring at follow-up visits every 15 days. 17,18 In the no-test option, only symptomatic patients transitioning to the cardiac or gastrointestinal forms were diagnosed with Chagas disease and treated accordingly. Based on the literature, the probability of moving from the indeterminate form to the cardiac form was set at 2% a year for the no-test option (progression to cardiomyopathy in untreated patients 22 ) and at 0·5% for the test option.…”

Assessment of Rectocolonic Morphology and Function in Patients with Chagas Disease in Barcelona (Spain)

“…1 Chagas disease affects mainly Latin America, where the infection is highly endemic; nevertheless, T. cruzi infection has been increasingly diagnosed in recent decades in nonendemic countries (Europe, North America, Australia, and Japan) as a result of migrant flows from countries in Latin American countries. 2,3 The chronic form of the infection is characterized by the positivity of serologic tests, and the presence of symptoms in about 30-40% of patients who develop cardiac and/or digestive involvement. Prevalence of gastrointestinal involvement in Chagas disease patients varies depending on the tests performed for the evaluation and the geographical area where the study is performed: gastrointestinal involvement prevalence in endemic countries ranges from 14% to 35%, although in non-endemic countries it is 5-14%.…”