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Palacios Gil-Antuñano S, Gold S, Abril M, Segovia Hernández M, Cancelo-Hidalgo MJ, Flores-Chávez M, Pelayo-Delgado I. Mother-to-child Chagas disease transmission: The challenge of detection and prevention in areas without the risk of vectorial transmission. Int J Gynaecol Obstet 2024; 164:835-842. [PMID: 37493222 DOI: 10.1002/ijgo.14994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
Chagas disease (CD) is caused by the parasite Trypanosoma cruzi. Although it is endemic in many Latin American (LA) countries, mother-to-child transmission has caused it to expand to other countries and continents. In places where vector transmission is controlled or absent, the epidemiological importance of T. cruzi transmission of the infected mother to her child during pregnancy or childbirth (i.e., perinatal CD) increases. In countries where CD is not endemic, CD screening should be performed in pregnant or fertile women who are native to LA countries or whose mothers are native to LA countries. Diagnosis is established by detecting anti-T. cruzi IgG antibodies in a serum or plasma sample. Antiparasitic treatment cannot be offered during pregnancy, and since the majority of infected newborns are asymptomatic at birth, a diagnosis is made by direct observation or concentration (microhematocrit) or by using molecular testing techniques. Once the infected child receives a diagnosis, it is essential to offer treatment (benznidazole/nifurtimox) as soon as possible, with good tolerance and effectiveness in the first year of life. Even if the diagnosis is negative at birth, the newborn must be followed up for at least the first 9 months of life.
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Affiliation(s)
| | - Silvia Gold
- Mundo Sano Foundation, Buenos Aires, Argentina
| | | | - Manuel Segovia Hernández
- Microbiology and Parasitology Service, Universitary Hospital Virgen de la Arrixaca, Murcia University, Murcia, Spain
| | - Maria Jesus Cancelo-Hidalgo
- Obstetrics and Gynaecology Service, Universitary Hospital of Guadalajara, Gynaecology and Obstetrics Alcala de Henares Universitiy, Madrid, Spain
| | - Maria Flores-Chávez
- Mundo Sano Foundation - National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Irene Pelayo-Delgado
- Department of Obstetrics and Gynecology, Alcala de Henares University, Ramon y Cajal Hospital, Madrid, Spain
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de Sousa AS, Vermeij D, Ramos AN, Luquetti AO. Chagas disease. Lancet 2024; 403:203-218. [PMID: 38071985 DOI: 10.1016/s0140-6736(23)01787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 01/15/2024]
Abstract
Chagas disease persists as a global public health problem due to the high morbidity and mortality burden. Despite the possibility of a cure and advances in transmission control, epidemiological transformations, such as urbanisation and globalisation, and the emerging importance of oral and vertical transmission mean that Chagas disease should be considered an emerging disease, with new cases occurring worldwide. Important barriers to diagnosis, treatment, and care remain, resulting in repressed numbers of reported cases, which in turn leads to inadequate public policies. The validation of new diagnostic tools and treatment options is needed, as existing tools pose serious limitations to access to health care. Integrated models of surveillance, with community and intersectional participation, embedded in the concept of One Health, are essential for control. In addition, mitigation strategies for the main social determinants of health, including difficulties imposed by migration, are important to improve access to comprehensive health care in a globalised scenario.
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Affiliation(s)
- Andréa Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Debbie Vermeij
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alejandro O Luquetti
- Center of Studies for Chagas Disease, Hospital das Clínicas, Federal University of Goiás, Goiânia, Brazil
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3
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Herrero-Martínez JM, Trigo E, Navarro M, García-Alcázar D, Carrillo I, Fernández-López T, Calderón-Moreno M, Millán-Pérez R, Cuadros J, Velasco M, García-Bujalance S, Lizasoain M, Martín-Rabadán P, Pérez-Ayala A, Flores-Chávez M. Prevalence of Chagas disease in Latin American pregnant women in Madrid, Spain: A multicentre cross-sectional study from 2011 to 2016. Trop Med Int Health 2023; 28:912-922. [PMID: 37905331 DOI: 10.1111/tmi.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The aim of this study is to assess Trypanosoma cruzi infection prevalence among pregnant migrants living in Madrid according to the country of origin and to assess screening coverage in this at-risk population. METHODS Retrospective multicentre cross-sectional study conducted from January 2011 to December 2016 in eight Madrid hospitals. Each hospital reviewed their microbiology data records to assess the screening coverage and serological diagnosis in all pregnant women coming from endemic areas. RESULTS From 2011 to 2016, 149,470 deliveries were attended at the eight hospitals, and 11,048 pregnant women were screened for Chagas disease. Most cases (93.5%) were in women from Bolivia, who also showed the highest prevalence (12.4%, 95% confidence interval: 9.9-15.0). Pooled prevalence amongst the screened women was 2.9% (95% CI: 1.8-4.1). Chagas disease screening coverage varied greatly between centres, with a pooled mean coverage of 47% (95% CI: 37%-57%; 73% [95% CI: 63%-82%] for those centres with universal screening vs. 10% [95% CI: 6%-15%] for those with a selective screening approach; p < 0.001). CONCLUSION Our study provides useful data for policy makers and epidemiologists in a non-endemic area without congenital Chagas screening programmes.
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Affiliation(s)
| | - Elena Trigo
- Travel and Tropical Medicine Referral Unit. La Paz-Carlos III University Hospital, Madrid, Spain
| | - Miriam Navarro
- Epidemiology Unit, Public Health Centre of Elche-FISABIO, Alicante, Spain
- Department of Public Health, Science History and Gynaecology, University Miguel Hernández de Elche, Alicante, Spain
| | - Diana García-Alcázar
- Obstetrics and Gynaecology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - Irene Carrillo
- Infectious Diseases Division, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | - María Calderón-Moreno
- Internal Medicine Department, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Rosario Millán-Pérez
- Microbiology Department, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Juan Cuadros
- Microbiology Department, Hospital Príncipe de Asturias, Madrid, Spain
| | - María Velasco
- Internal Medicine Department, University Hospital Fundación de Alcorcón, Madrid, Spain
| | | | - Manuel Lizasoain
- Infectious Diseases Unit, Internal Medicine Department, University Hospital 12 de Octubre, Madrid, Spain
| | - Pablo Martín-Rabadán
- Microbiology Department, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Ana Pérez-Ayala
- Microbiology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - María Flores-Chávez
- Reference and Research Laboratory in Parasitology, National Centre of Microbiology, Madrid, Spain
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4
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Rapp E, Gold M. Knowledge Production on Congenital Chagas Disease across Time, Borders and Disciplines: A Comprehensive Scoping Review. Trop Med Infect Dis 2023; 8:422. [PMID: 37755884 PMCID: PMC10536740 DOI: 10.3390/tropicalmed8090422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/23/2023] [Accepted: 08/09/2023] [Indexed: 09/28/2023] Open
Abstract
Congenital transmission is a key route of Trypanosoma cruzi infection in Latin America and globally, contributing significantly to the burden of Chagas disease. The interruption of transmission from mother to child has recently become a focus issue. However, the research landscape on congenital Chagas disease remains largely unexplored. The purpose of this scoping review is to assess the production of knowledge on congenital Chagas disease (CCD), aiming to identify research trends and potential gaps. Our initial hypothesis was that the CCD literature overly represents the medical sciences and that there is a need for socio-cultural research on the subject. We conducted a systematic search of publications focusing on congenital Chagas disease in six languages (English, Spanish, Portuguese, French, German and Italian). This comprehensive literature search identified 876 studies that met the inclusion criteria, out of a total of 8893 sources. The relevant literature was analyzed by language, year of publication, discipline, source type and research location. The main outcome of this study has been to prove our hypothesis that there is a scarcity of knowledge produced within the non-biomedical sciences on CCD. This underscores the need for further exploration into the social and structural issues surrounding this disease. Visually clear data concerning congenital Chagas disease produced by this study can contribute to hone in future research efforts and support funding applications. Additionally, this article provides a reference list that other researchers can consult for their own studies.
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Affiliation(s)
- Elise Rapp
- HESAV School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, CH-2800 Delémont, Switzerland;
- Institute of Humanities in Medecine, Faculty of Biology and Medecine, University of Lausanne (UNIL), CH-1015 Lausanne, Switzerland
| | - Marina Gold
- Fundación Mundo Sano, Buenos Aires C1061ABC, Argentina
- Institut für Sozialanthropologie und Empirische Kulturwissenschaft (ISEK), University of Zürich, CH-8005 Zurich, Switzerland
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5
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Marin-Neto JA, Rassi A, Oliveira GMM, Correia LCL, Ramos Júnior AN, Luquetti AO, Hasslocher-Moreno AM, Sousa ASD, Paola AAVD, Sousa ACS, Ribeiro ALP, Correia Filho D, Souza DDSMD, Cunha-Neto E, Ramires FJA, Bacal F, Nunes MDCP, Martinelli Filho M, Scanavacca MI, Saraiva RM, Oliveira Júnior WAD, Lorga-Filho AM, Guimarães ADJBDA, Braga ALL, Oliveira ASD, Sarabanda AVL, Pinto AYDN, Carmo AALD, Schmidt A, Costa ARD, Ianni BM, Markman Filho B, Rochitte CE, Macêdo CT, Mady C, Chevillard C, Virgens CMBD, Castro CND, Britto CFDPDC, Pisani C, Rassi DDC, Sobral Filho DC, Almeida DRD, Bocchi EA, Mesquita ET, Mendes FDSNS, Gondim FTP, Silva GMSD, Peixoto GDL, Lima GGD, Veloso HH, Moreira HT, Lopes HB, Pinto IMF, Ferreira JMBB, Nunes JPS, Barreto-Filho JAS, Saraiva JFK, Lannes-Vieira J, Oliveira JLM, Armaganijan LV, Martins LC, Sangenis LHC, Barbosa MPT, Almeida-Santos MA, Simões MV, Yasuda MAS, Moreira MDCV, Higuchi MDL, Monteiro MRDCC, Mediano MFF, Lima MM, Oliveira MTD, Romano MMD, Araujo NNSLD, Medeiros PDTJ, Alves RV, Teixeira RA, Pedrosa RC, Aras Junior R, Torres RM, Povoa RMDS, Rassi SG, Alves SMM, Tavares SBDN, Palmeira SL, Silva Júnior TLD, Rodrigues TDR, Madrini Junior V, Brant VMDC, Dutra WO, Dias JCP. SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023. Arq Bras Cardiol 2023; 120:e20230269. [PMID: 37377258 PMCID: PMC10344417 DOI: 10.36660/abc.20230269] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- José Antonio Marin-Neto
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi , Goiânia , GO - Brasil
| | | | | | | | - Alejandro Ostermayer Luquetti
- Centro de Estudos da Doença de Chagas , Hospital das Clínicas da Universidade Federal de Goiás , Goiânia , GO - Brasil
| | | | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Hospital São Lucas , Rede D`Or São Luiz , Aracaju , SE - Brasil
| | | | | | | | - Edecio Cunha-Neto
- Universidade de São Paulo , Faculdade de Medicina da Universidade, São Paulo , SP - Brasil
| | - Felix Jose Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Ibrahim Scanavacca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Adalberto Menezes Lorga-Filho
- Instituto de Moléstias Cardiovasculares , São José do Rio Preto , SP - Brasil
- Hospital de Base de Rio Preto , São José do Rio Preto , SP - Brasil
| | | | | | - Adriana Sarmento de Oliveira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Ana Yecê das Neves Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Andre Schmidt
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Andréa Rodrigues da Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Barbara Maria Ianni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hcor , Associação Beneficente Síria , São Paulo , SP - Brasil
| | | | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Marselha - França
| | | | | | | | - Cristiano Pisani
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Evandro Tinoco Mesquita
- Hospital Universitário Antônio Pedro da Faculdade Federal Fluminense , Niterói , RJ - Brasil
| | | | | | | | | | | | - Henrique Horta Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Henrique Turin Moreira
- Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - João Paulo Silva Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Fundação Zerbini, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | | | | | - Luiz Cláudio Martins
- Universidade Estadual de Campinas , Faculdade de Ciências Médicas , Campinas , SP - Brasil
| | | | | | | | - Marcos Vinicius Simões
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | | | | | - Maria de Lourdes Higuchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | | | | | - Renato Vieira Alves
- Instituto René Rachou , Fundação Oswaldo Cruz , Belo Horizonte , MG - Brasil
| | - Ricardo Alkmim Teixeira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho , Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro , RJ - Brasil
| | | | | | | | | | - Silvia Marinho Martins Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico Universitário da Universidade de Pernambuco (PROCAPE/UPE), Recife , PE - Brasil
| | | | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | - Vagner Madrini Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | - João Carlos Pinto Dias
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
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Schaumburg F, Pujato N, Peverengo LM, Marcipar IS, Berli CLA. Coupling ELISA to smartphones for POCT of chronic and congenital Chagas disease. Talanta 2023; 256:124246. [PMID: 36657239 DOI: 10.1016/j.talanta.2022.124246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
Chagas disease (CD) affects about 7 million people worldwide, presents a large prevalence in Latin America, and is growing in the rest of the world, where congenital CD is the main mode of transmission. Point-of-care testing (POCT) methods are increasingly required to ease early diagnostics and increase treatment success. This work presents the development and validation of a smartphone-integrated ELISA-based POCT system for the detection of both chronic and congenital CD. Expensive and bulky equipment used for ELISA in conventional laboratories was replaced as follows. A miniaturized device was fabricated for incubation of commercial ELISA plates, achieving ∼±1 °C uniformity and stability. The ELISA plate reader was replaced by smartphone camera and image processing, comprising algorithms to account for variability sources and spatial light non-uniformity; thus, additional hardware like a dark-box is not required. The agreement between samples classified with this novel reading method vs. ELISA plate reader was found to be 99.7% and 95.4% for chronic and congenital CD, respectively. Furthermore, a smartphone application was designed and implemented to guide the user during the assay, provide connectivity, and access databases, facilitating patient monitoring and health-policy making. The whole system is aimed to be used as a practical diagnostic tool in primary health care settings, as well as to facilitate patients' follow-up to provide better treatment. Concerning the technology itself, the proposed POCT platform is versatile enough to be readily adapted for the detection of other infectious diseases.
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Affiliation(s)
- Federico Schaumburg
- INTEC (Universidad Nacional del Litoral-CONICET), Predio CCT CONICET-Santa Fe, RN 168, Santa Fe, S3000GLN, Argentina.
| | - Nazarena Pujato
- Laboratorio de Tecnología Inmunológica (FBCB, Universidad Nacional del Litoral), Ciudad Universitaria, RN 168, Santa Fe, S3000GLN, Argentina.
| | - Luz María Peverengo
- Laboratorio de Tecnología Inmunológica (FBCB, Universidad Nacional del Litoral), Ciudad Universitaria, RN 168, Santa Fe, S3000GLN, Argentina.
| | - Iván Sergio Marcipar
- Laboratorio de Tecnología Inmunológica (FBCB, Universidad Nacional del Litoral), Ciudad Universitaria, RN 168, Santa Fe, S3000GLN, Argentina.
| | - Claudio Luis Alberto Berli
- INTEC (Universidad Nacional del Litoral-CONICET), Predio CCT CONICET-Santa Fe, RN 168, Santa Fe, S3000GLN, Argentina.
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7
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Chancey RJ, Edwards MS, Montgomery SP. Congenital Chagas Disease. Pediatr Rev 2023; 44:213-221. [PMID: 37002357 PMCID: PMC10313159 DOI: 10.1542/pir.2022-005857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Affiliation(s)
- Rebecca J Chancey
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA
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8
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Diagnostic pathways of Chagas disease in Spain: a qualitative study. BMC Public Health 2023; 23:332. [PMID: 36788512 PMCID: PMC9930317 DOI: 10.1186/s12889-022-14938-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/23/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Due to the mobility of the population in recent years and the spread of Chagas disease (CD) to non-endemic regions, early diagnosis and treatment of CD has become increasingly relevant in non-endemic countries. In order for screening to be effective, health system accessibility must be taken into consideration. This study uses Tanahashi's Health Service Coverage model to gain a deeper understanding of the main diagnostic pathways for Chagas disease in a non-endemic country and the barriers and bottlenecks present in each pathway. METHODS This study used a qualitative design with a phenomenological approach. Twenty-one interviews, two focus group sessions, and two triangular group sessions were conducted between 2015 and 2018 with 37 Bolivian men and women diagnosed with CD in Madrid, Spain. A topic guide was designed to ensure that the interviewers obtained the data concerning knowledge of CD (transmission, symptoms, and treatment), attitudes towards CD, and health behaviour (practices in relation to CD). All interviews, focus groups and triangular groups were recorded and transcribed. A thematic, inductive analysis based on Grounded Theory was performed by two researchers. RESULTS Three main pathways to CD diagnosis were identified: 1) pregnancy or blood/organ donation, with no bottlenecks in effective coverage; 2) an individual actively seeking CD testing, with bottlenecks relating to administrative, physical, and time-related accessibility, and effectiveness based on the healthcare professional's knowledge of CD; 3) an individual not actively seeking CD testing, who expresses psychological discomfort or embarrassment about visiting a physician, with a low perception of risk, afraid of stigma, and testing positive, and with little confidence in physicians' knowledge of CD. CONCLUSIONS Existing bottlenecks in the three main diagnostic pathways for CD are less prevalent during pregnancy and blood donation, but are more prevalent in individuals who do not voluntarily seek serological testing for CD. Future screening protocols will need to take these bottlenecks into consideration to achieve effective coverage.
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9
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Barbiero A, Mazzi M, Mantella A, Trotta M, Rossolini GM, Antonelli A, Bordonaro P, Colao MG, Speciale AR, Di Benedetto T, Di Tommaso M, Mantengoli E, Petraglia F, Galli L, Pezzati M, Dani C, Caldes Pinilla MJ, Berni C, Dannaoui B, Albajar Viñas P, Bartoloni A, Zammarchi L. A Questionnaire Integrated with the Digital Medical Record Improved the Coverage of a Control Program for Congenital Chagas Disease in Tuscany, Italy. Microorganisms 2023; 11:microorganisms11010154. [PMID: 36677446 PMCID: PMC9866674 DOI: 10.3390/microorganisms11010154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
The leading route of Chagas disease transmission in nonendemic countries is congenital. However, policies concerning screening, prevention, and management of congenital Chagas disease are rare in these settings. Since 2012, serological screening for Chagas disease should be provided for pregnant women at risk in Tuscany, Italy according to a Regional resolution. Due to difficulties in the implementation, in November 2019, a checklist aimed at identifying pregnant women at risk for Chagas disease was introduced in digital clinical records at Careggi University Hospital, Florence, Italy. In order to evaluate the effectiveness of the "Chagas checklist", data about the number of deliveries by women at risk and their screening coverage between 2012 and June 2022 were collected. Out of 1348 deliveries by women at risk, 626 (47%) Trypanosoma cruzi serology tests were performed during the study period. The annual screening coverage increased from an average of 40.3% between 2012 and 2019 to 75.7% between 2020 and June 2022, underlining the big impact of the checklist. Four Chagas disease serological tests out of 626 (0.6%) resulted positive, corresponding to 2 affected women. No cases of congenital transmission occurred. The study showed that a simple digital tool led to a tangible improvement in the coverage of the screening program; its application in a setting where digital charts are available will contribute to the control and elimination of congenital Chagas disease.
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Affiliation(s)
- Anna Barbiero
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Martina Mazzi
- School of Human Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Antonia Mantella
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
- Tuscany Regional Referral Center for Tropical Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Michele Trotta
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
- Tuscany Regional Referral Center for Infectious Diseases in Pregnancy, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
- Clinical Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Patrizia Bordonaro
- Hospital General Laboratory, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Maria Grazia Colao
- Clinical Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Anna Rosa Speciale
- Department of Health Sciences, Obstetrics and Gynecology Branch, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Tullio Di Benedetto
- Department of Health Sciences, Obstetrics and Gynecology Branch, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Mariarosaria Di Tommaso
- Department of Health Sciences, Obstetrics and Gynecology Branch, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Elisabetta Mantengoli
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Felice Petraglia
- Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Luisa Galli
- Department of Health Sciences University of Florence, Paediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Marco Pezzati
- Pediatric Unit, Santa Maria Annunziata Hospital, AUSL Toscana Centro, Via Antella, 58, Bagno a Ripoli, 50012 Florence, Italy
| | - Carlo Dani
- Department of Neuroscience, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Maria José Caldes Pinilla
- Tuscany Regional Center for Global Health, Anna Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Cecilia Berni
- Citizenship Rights and Social Cohesion Directorate, Tuscany Region, Via Camillo Cavour, 2, 50122 Florence, Italy
| | - Bassam Dannaoui
- Technological Innovation in Clinical-Assistance Activities Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Pedro Albajar Viñas
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, CH-1211 Geneva, Switzerland
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
- Tuscany Regional Referral Center for Tropical Diseases, Careggi University Hospital, 50134 Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
- Tuscany Regional Referral Center for Tropical Diseases, Careggi University Hospital, 50134 Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
- Tuscany Regional Referral Center for Infectious Diseases in Pregnancy, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
- Correspondence:
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Simón M, Ladrón de Guevara P, Polo SA, Sierra S, Segovia M. The community pharmacy as a strategic ally in the fight against Chagas disease. Travel Med Infect Dis 2022; 52:102527. [PMID: 36539020 DOI: 10.1016/j.tmaid.2022.102527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Marina Simón
- Regional Unit of Tropical Medicine, Microbiology Service, Virgen de La Arrixaca University Clinical Hospital, Murcia, Spain.
| | | | | | | | - Manuel Segovia
- Regional Unit of Tropical Medicine, Microbiology Service, Virgen de La Arrixaca University Clinical Hospital, Murcia, Spain; Department of Genetics and Microbiology, University of Murcia, Spain
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Estimation of the morbidity and mortality of congenital Chagas disease: A systematic review and meta-analysis. PLoS Negl Trop Dis 2022; 16:e0010376. [DOI: 10.1371/journal.pntd.0010376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/17/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Chagas disease is caused by the parasite Trypanosoma cruzi which can be transmitted from mother to baby during pregnancy. There is no consensus on the proportion of infected infants with clinical signs of congenital Chagas disease (cCD). The objective of this systematic review is to determine the burden of cCD. Articles from journal inception to 2020 reporting morbidity and mortality associated with cCD were retrieved from academic search databases. Observational studies, randomized-control trials, and studies of babies diagnosed with cCD were included. Studies were excluded if they were case reports or series, without original data, case-control without cCD incidence estimates, and/or did not report number of participants. Two reviewers screened articles for inclusion. To determine pooled proportion of infants with cCD with clinical signs, individual clinical signs, and case-fatality, random effects meta-analysis was performed. We identified 4,531 records and reviewed 4,301, including 47 articles in the narrative summary and analysis. Twenty-eight percent of cCD infants showed clinical signs (95% confidence interval (CI) = 19.0%, 38.5%) and 2.2% of infants died (95% CI = 1.3%, 3.5%). The proportion of infected infants with hepatosplenomegaly was 12.5%, preterm birth 6.0%, low birth weight 5.8%, anemia 4.9%, and jaundice 4.7%. Although most studies did not include a comparison group of non-infected infants, the proportion of infants with cCD with clinical signs at birth are comparable to those with congenital toxoplasmosis (10.0%-30.0%) and congenital cytomegalovirus (10.0%-15.0%). We conclude that cCD burden appears significant, but more studies comparing infected mother-infant dyads to non-infected ones are needed to determine an association of this burden to cCD.
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de Arias AR, Monroy C, Guhl F, Sosa-Estani S, Santos WS, Abad-Franch F. Chagas disease control-surveillance in the Americas: the multinational initiatives and the practical impossibility of interrupting vector-borne Trypanosoma cruzi transmission. Mem Inst Oswaldo Cruz 2022; 117:e210130. [PMID: 35830010 PMCID: PMC9261920 DOI: 10.1590/0074-02760210130] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/21/2022] Open
Abstract
Chagas disease (CD) still imposes a heavy burden on most Latin American countries. Vector-borne and mother-to-child transmission cause several thousand new infections per year, and at least 5 million people carry Trypanosoma cruzi. Access to diagnosis and medical care, however, is far from universal. Starting in the 1990s, CD-endemic countries and the Pan American Health Organization-World Health Organization (PAHO-WHO) launched a series of multinational initiatives for CD control-surveillance. An overview of the initiatives’ aims, achievements, and challenges reveals some key common themes that we discuss here in the context of the WHO 2030 goals for CD. Transmission of T. cruzi via blood transfusion and organ transplantation is effectively under control. T. cruzi, however, is a zoonotic pathogen with 100+ vector species widely spread across the Americas; interrupting vector-borne transmission seems therefore unfeasible. Stronger surveillance systems are, and will continue to be, needed to monitor and control CD. Prevention of vertical transmission demands boosting current efforts to screen pregnant and childbearing-aged women. Finally, integral patient care is a critical unmet need in most countries. The decades-long experience of the initiatives, in sum, hints at the practical impossibility of interrupting vector-borne T. cruzi transmission in the Americas. The concept of disease control seems to provide a more realistic description of what can in effect be achieved by 2030.
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Affiliation(s)
| | - Carlota Monroy
- Universidad de San Carlos, Laboratorio de Entomología y Parasitología Aplicadas, Ciudad de Guatemala, Guatemala
| | - Felipe Guhl
- Universidad de los Andes, Facultad de Ciencias, Centro de Investigaciones en Microbiología y Parasitología Tropical, Bogotá, Colombia
| | - Sergio Sosa-Estani
- Drugs for Neglected Diseases initiative Latin America, Rio de Janeiro, RJ, Brasil.,Centro de Investigaciones en Epidemiología y Salud Pública, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Walter Souza Santos
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Instituto Evandro Chagas, Laboratório de Epidemiologia das Leishmanioses, Ananindeua, PA, Brasil
| | - Fernando Abad-Franch
- Universidade de Brasília, Faculdade de Medicina, Núcleo de Medicina Tropical, Brasília, DF, Brasil
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Family cluster of Chagas disease among Bolivian immigrants in Italy: High rate of materno-fetal transmission. Travel Med Infect Dis 2022; 49:102370. [DOI: 10.1016/j.tmaid.2022.102370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/20/2022]
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Shikanai Yasuda MA. Emerging and reemerging forms of Trypanosoma cruzi transmission. Mem Inst Oswaldo Cruz 2022; 117:e210033. [PMID: 35584508 PMCID: PMC9113729 DOI: 10.1590/0074-02760210033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/13/2023] Open
Abstract
This review aims to update and discuss the main challenges in controlling emergent and reemergent forms of Trypanosoma cruzi transmission through organ transplantation, blood products and vertical transmission in endemic and non-endemic areas as well as emergent forms of transmission in endemic countries through contaminated food, currently representing the major cause of acute illness in several countries. As a neglected tropical disease potentially controllable with a major impact on morbimortality and socioeconomic aspects, Chagas disease (CD) was approved at the WHO global plan to interrupt four transmission routes by 2030 (vector/blood transfusion/organ transplant/congenital). Implementation of universal or target screening for CD are highly recommended in blood banks of non-endemic regions; in organ transplants donors in endemic/non-endemic areas as well as in women at risk from endemic areas (reproductive age women/pregnant women-respective babies). Moreover, main challenges for surveillance are the application of molecular methods for identification of infected babies, donor transmitted infection and of live parasites in the food. In addition, the systematic recording of acute/non-acute cases and transmission sources is crucial to establish databases for control and surveillance purposes. Remarkably, antiparasitic treatment of infected reproductive age women and infected babies is essential for the elimination of congenital CD by 2030.
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Affiliation(s)
- Maria Aparecida Shikanai Yasuda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Ptarasitárias, São Paulo, SP, Brasil,Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina, Laboratório de Imunologia, São Paulo, SP, Brasil,WHO Technical Group IVb on Prevention and Control of Transmission and Case Management of Trypanosoma cruzi Infections, WHO, Geneva, Switzerland,+ Corresponding author:
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15
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Colussi C, Stafuza M, Nepote M, Mendicino D. Seroprevalence of Chagas disease in urban and rural indigenous populations of the south of Gran Chaco. Rev Soc Bras Med Trop 2022; 55:e04792021. [PMID: 35522808 PMCID: PMC9070071 DOI: 10.1590/0037-8682-0479-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Latin America, Chagas disease is endemic, with a high prevalence in rural indigenous communities and an increasing prevalence in urban areas owing to migration from rural areas with active vector transmission. This study aimed to assess differences in the prevalence of Chagas disease in urban and rural moqoit communities, one of the main ethnic indigenous groups in the south of Gran Chaco. METHODS A seroprevalence study was conducted in six moqoit populations in the Santa Fe province, Argentina. The variables studied were serology results for Chagas disease, residents of urban or rural areas, age, and sex. RESULTS The results showed that 9.26% of the 702 volunteers evaluated and 18.32% of the 131women of childbearing potential were seropositive. According to the calculated prevalence ratio, the prevalence of Chagas disease in urban communities was6.41 (95% confidence inverval: 3.73-11.02) times higher than that in rural communities: 21.59% in urban communities vs. 3.37%in rural communities. CONCLUSIONS The seroprevalence found in the moqoit community was higher than the estimated level for the general population of the same region, with a greater impact in urban areas than in rural areas. The urbanization of groups of people with poor socio-sanitary conditions in the second half of the 20th century could have caused this higher seroprevalence of Chagas disease.
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Affiliation(s)
- Carlina Colussi
- Universidad Nacional del Litoral, Facultad de Bioquímica y Ciencias Biológicas, Centro de Investigaciones sobre Endemias Nacionales. Santa Fe, Argentina
| | - Mariana Stafuza
- Ministerio de Salud de la Provincia de Santa Fe, Hospital Central de Reconquista. Reconquista, Argentina
| | - Marcelo Nepote
- Ministerio de Salud de la Provincia de Santa Fe, Programa Provincial de Control de la Enfermedad de Chagas. Santa Fe, Argentina
| | - Diego Mendicino
- Universidad Nacional del Litoral, Facultad de Bioquímica y Ciencias Biológicas, Centro de Investigaciones sobre Endemias Nacionales. Santa Fe, Argentina
- Consejo de Investigaciones Científicas y Técnicas. Buenos Aires, Argentina
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Worldwide Control and Management of Chagas Disease in a New Era of Globalization: a Close Look at Congenital Trypanosoma cruzi Infection. Clin Microbiol Rev 2022; 35:e0015221. [PMID: 35239422 PMCID: PMC9020358 DOI: 10.1128/cmr.00152-21] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Population movements have turned Chagas disease (CD) into a global public health problem. Despite the successful implementation of subregional initiatives to control vectorial and transfusional Trypanosoma cruzi transmission in Latin American settings where the disease is endemic, congenital CD (cCD) remains a significant challenge. In countries where the disease is not endemic, vertical transmission plays a key role in CD expansion and is the main focus of its control. Although several health organizations provide general protocols for cCD control, its management in each geopolitical region depends on local authorities, which has resulted in a multitude of approaches. The aims of this review are to (i) describe the current global situation in CD management, with emphasis on congenital infection, and (ii) summarize the spectrum of available strategies, both official and unofficial, for cCD prevention and control in countries of endemicity and nonendemicity. From an economic point of view, the early detection and treatment of cCD are cost-effective. However, in countries where the disease is not endemic, national health policies for cCD control are nonexistent, and official regional protocols are scarce and restricted to Europe. Countries of endemicity have more protocols in place, but the implementation of diagnostic methods is hampered by economic constraints. Moreover, most protocols in both countries where the disease is endemic and those where it is not endemic have yet to incorporate recently developed technologies. The wide methodological diversity in cCD diagnostic algorithms reflects the lack of a consensus. This review may represent a first step toward the development of a common strategy, which will require the collaboration of health organizations, governments, and experts in the field.
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Gómez I Prat J, Essadek HO, Esperalba J, Serrat FZ, Guiu IC, Goterris L, Zules-Oña R, Choque E, Pastoret C, Ponces NC, de Los Santos JJ, Pons JS, Dehousse A, Albajar-Viñas P, Pumarola T, Campins M, Sulleiro E. COVID-19: an opportunity of systematic integration for Chagas disease. Example of a community-based approach within the Bolivian population in Barcelona. BMC Infect Dis 2022; 22:298. [PMID: 35346096 PMCID: PMC8960226 DOI: 10.1186/s12879-022-07305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a Neglected Tropical Disease associated with Latin America, Chagas Disease (CD) is little known in non-endemic territories of the Americas, Europe and Western Pacific, making its control challenging, with limited detection rates, healthcare access and consequent epidemiological silence. This is reinforced by its biomedical characteristics-it is usually asymptomatic-and the fact that it mostly affects people with low social and financial resources. Because CD is mainly a chronic infection, which principally causes a cardiomyopathy and can also cause a prothrombotic status, it increases the risk of contracting severe COVID-19. METHODS In order to get an accurate picture of CD and COVID-19 overlapping and co-infection, this operational research draws on community-based experience and participative-action-research components. It was conducted during the Bolivian elections in Barcelona on a representative sample of that community. RESULTS The results show that 55% of the people interviewed had already undergone a previous T. cruzi infection screening-among which 81% were diagnosed in Catalonia and 19% in Bolivia. The prevalence of T. cruzi infection was 18.3% (with 3.3% of discordant results), the SARS-CoV-2 22.3% and the coinfection rate, 6%. The benefits of an integrated approach for COVID-19 and CD were shown, since it only took an average of 25% of additional time per patient and undoubtedly empowered the patients about the co-infection, its detection and care. Finally, the rapid diagnostic test used for COVID-19 showed a sensitivity of 89.5%. CONCLUSIONS This research addresses CD and its co-infection, through an innovative way, an opportunity of systematic integration, during the COVID-19 pandemic.
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Affiliation(s)
- Jordi Gómez I Prat
- Public Health and Community Team (eSPiC), Unit of Tropical Medicine and International Health Drassanes-Vall d'Hebron (UTMIHD-VH), PROSICS, Servei de Medicina Preventiva, Carrer de Sant Oleguer, 17, 08001, Barcelona, Spain.
- Asociación de Amigos de las Personas con la Enfermedad de Chagas (ASAPECHA), Barcelona, Spain.
| | - Hakima Ouaarab Essadek
- Public Health and Community Team (eSPiC), Unit of Tropical Medicine and International Health Drassanes-Vall d'Hebron (UTMIHD-VH), PROSICS, Servei de Medicina Preventiva, Carrer de Sant Oleguer, 17, 08001, Barcelona, Spain
- Asociación de Amigos de las Personas con la Enfermedad de Chagas (ASAPECHA), Barcelona, Spain
| | - Juliana Esperalba
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Isabel Claveria Guiu
- Public Health and Community Team (eSPiC), Unit of Tropical Medicine and International Health Drassanes-Vall d'Hebron (UTMIHD-VH), PROSICS, Servei de Medicina Preventiva, Carrer de Sant Oleguer, 17, 08001, Barcelona, Spain
- Asociación de Amigos de las Personas con la Enfermedad de Chagas (ASAPECHA), Barcelona, Spain
| | - Lidia Goterris
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ricardo Zules-Oña
- Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Estefa Choque
- Public Health and Community Team (eSPiC), Unit of Tropical Medicine and International Health Drassanes-Vall d'Hebron (UTMIHD-VH), PROSICS, Servei de Medicina Preventiva, Carrer de Sant Oleguer, 17, 08001, Barcelona, Spain
- Asociación de Amigos de las Personas con la Enfermedad de Chagas (ASAPECHA), Barcelona, Spain
| | - Conxita Pastoret
- Departament de Salut, Generalitat de Catalunya, Banc de Sang i Teixits de Catalunya, Barcelona, Spain
| | | | | | | | - Aurore Dehousse
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneve, Switzerland
| | - Pedro Albajar-Viñas
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneve, Switzerland
| | - Tomàs Pumarola
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Elena Sulleiro
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Pediatric Chagas disease in the non-endemic area of Madrid: A fifteen-year review (2004–2018). PLoS Negl Trop Dis 2022; 16:e0010232. [PMID: 35202395 PMCID: PMC8903257 DOI: 10.1371/journal.pntd.0010232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 03/08/2022] [Accepted: 02/03/2022] [Indexed: 01/18/2023] Open
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, caused by the protozoan Trypanosoma cruzi, has traditionally been confined to endemic locations in South America (with vectorial transmission), but is nowadays emerging in Europe, mainly in Spain, due to immigration. A series of characteristics of this disease condition its management. It is usually asymptomatic (especially in early stages), it can be transmitted from mothers to child (vertical transmission) and treatment is more effective at a younger age or during the early stages of infection. For these reasons early diagnosis and treatment of infected children is a priority. To date, there are few publications on pediatric CD series in non-endemic regions. In this paper we describe the epidemiological and clinical characteristics of 51 children diagnosed with pediatric CD in a non-endemic area, as well as the the safety and efficacy of treatment in this patient population. We found that most patients were asymptomatic at diagnosis. The cure percentage was clearly higher when they were treated before one year-old (80% vs 4.3% in children older than one).Adverse events to treatment have occurred especially in older children, being frequent in this age group (median age 11 years). The high proportion of patients lost to follow-up that occurs in this vulnerable population is also noteworthy (35.3% in our case). We highlight, as a conclusion of our study, the need of carrying out systematic screening for this disease (women of childbearing age, children of mothers with positive serology) to reduce the rate of vertical transmission and to achieve higher cure rates and better tolerance to treatment.
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Iglesias-Rus L, Romay-Barja M, Boquete T, Benito A, Jordan B, Blasco-Hernández T. Mapping health behaviour related to Chagas diagnosis in a non-endemic country: Application of Andersen’s Behavioural Model. PLoS One 2022; 17:e0262772. [PMID: 35051245 PMCID: PMC8775331 DOI: 10.1371/journal.pone.0262772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background Chagas disease has become a challenge for non-endemic countries since population mobility has increased in recent years and it has spread to these regions. In order to prevent vertical transmission and improve the prognosis of the disease, it is important to make an early diagnosis. And to develop strategies that improve access to diagnosis, it is important to know the factors that most influence the decision of the population to know their serological status. For this reason, this study uses Andersen’s Behavioural Model and its proposed strategies to explore the health behaviours of Bolivian population. Methods Twenty-three interviews, two focus groups, and two triangular groups were performed with Bolivian men and women, involving a total of 39 participants. In addition, four interviews were conducted with key informants in contact with Bolivian population to delve into possible strategies to improve the Chagas diagnosis. Results The most relevant facts for the decision to being diagnosed pointed out by participants were having relatives who were sick or deceased from Chagas disease or, for men, having their pregnant wife with a positive result. After living in Spain more than ten years, population at risk no longer feels identified with their former rural origin and the vector. Moreover, their knowledge and awareness about diagnosis and treatment still remains low, especially in younger people. Limitations on access to healthcare professionals and services were also mentioned, and proposed strategies focused on eliminating these barriers and educating the population in preventive behaviours. Conclusions Based on Andersen’s Behavioural Model, the results obtained regarding the factors that most influence the decision to carry out Chagas diagnosis provide information that could help to develop strategies to improve access to health services and modify health behaviours related to Chagas screening.
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Affiliation(s)
- Laura Iglesias-Rus
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
| | - María Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Teresa Boquete
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Agustín Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | | | - Teresa Blasco-Hernández
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
- * E-mail:
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Pérez-Molina JA, Crespillo-Andújar C, Bosch-Nicolau P, Molina I. Trypanocidal treatment of Chagas disease. ACTA ACUST UNITED AC 2021; 39:458-470. [PMID: 34736749 DOI: 10.1016/j.eimce.2020.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/18/2020] [Indexed: 11/24/2022]
Abstract
Chagas disease is a neglected parasitosis caused by the protozoan parasite Trypanosoma cruzi. This infection is present in most Latin American countries, although, due to migratory movements, it is a growing cause for concern in non-endemic countries. The only two drugs currently available for its treatment-benznidazole and nifurtimox-were marketed 50 years ago. While they are very effective for acute and recent infection, and for the prevention of maternofoetal transmission, their efficacy declines in people who have chronic infection, especially those older than 18 years of age. In the presence of visceral involvement, parasiticidal treatment is of little or no value. The safety profile of both drugs is far from ideal, with frequent adverse events and high rates of drug discontinuation, mainly in adults. So far, new drugs and new strategies have not been shown to improve the results of the current nitroimidazoles, although the results are promising. In this review, we focus on the aspects that allow clinicians to make the best use of currently available drugs. In addition, we discuss new therapeutic options and ongoing research in the field.
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Affiliation(s)
- Jose A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
| | - Clara Crespillo-Andújar
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Pau Bosch-Nicolau
- Tropical Medicine Unit, Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Israel Molina
- Tropical Medicine Unit, Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Instituto René Rachou-FIOCRUZ Minas, Chagas Disease Research Group, Belo Horizonte, MG, Brazil
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21
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Berto CG, Coyle CM, Friedman L, Walker PF. Where was my patient born? The Intersection of tropical medicine and migrant health. Curr Opin Infect Dis 2021; 34:447-454. [PMID: 34267044 DOI: 10.1097/qco.0000000000000773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is unprecedented movement of people across international borders and parasitic infections, previously restricted to endemic regions, are now encountered in nonendemic areas of the world. RECENT FINDINGS Migrants may import parasitic infections acquired in their countries of origin. Increasingly, clinicians in nonendemic regions are faced with patients with neglected diseases such as Chagas disease, malaria and strongyloidiasis. There are gaps in knowledge among physicians in nonendemic regions, which lead to missed opportunities for preventive strategies and early treatment. Both primary care and infectious disease physicians should have a broad knowledge of common parasitic infections to improve health outcomes and decrease healthcare disparities through early identification and treatment of disease encountered in migrants. SUMMARY Migrant health is still a young field in medicine; clinicians should be aware of diseases seen in migrants, and access both educational and clinical resources, including experts in tropical medicine, in order to reduce health disparities among migrants. Collaboration between primary care and infectious disease/tropical medicine experts should be strengthened.
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Affiliation(s)
- Cesar G Berto
- Department of Medicine, NYC Health and Hospitals/Jacobi, Albert Einstein College of Medicine
| | - Christina M Coyle
- Department of Medicine, NYC Health and Hospitals/Jacobi, Albert Einstein College of Medicine
- Division of Infectious Disease, Albert Einstein College of Medicine, Bronx, New York
| | | | - Patricia F Walker
- Department of Medicine, Global Medicine, University of Minnesota, Minneapolis
- Health Partners Institute, Bloomington
- HealthPartners Travel and Tropical Medicine Center, St Paul, Minnesota, USA
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22
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Edwards MS, Montgomery SP. Chagas Disease: Implementation of Screening to Benefit Mother and Infant. Clin Perinatol 2021; 48:331-342. [PMID: 34030817 PMCID: PMC10186386 DOI: 10.1016/j.clp.2021.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pregnancy-based screening would identify women with Chagas disease, allowing for treatment of Trypanosoma cruzi-infected women and infants to prevent potentially fatal Chagas cardiomyopathy.
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Affiliation(s)
- Morven S Edwards
- Texas Children's Hospital, Feigin Center, 1102 Bates Avenue, Suite 1120, Houston, TX 77030, USA.
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Northeast, Atlanta, GA 30333, USA
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23
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Romay-Barja M, Iglesias-Rus L, Boquete T, Benito A, Blasco-Hernández T. Key Chagas disease missing knowledge among at-risk population in Spain affecting diagnosis and treatment. Infect Dis Poverty 2021; 10:55. [PMID: 33892808 PMCID: PMC8067288 DOI: 10.1186/s40249-021-00841-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background Chagas disease is endemic in Latin America and, over the last few decades, due to population movements, the disease has spread to other continents. Early diagnosis and treatment are critical in terms of improving outcomes for those living with Chagas disease. However, poor knowledge and awareness is one of barriers that affects access to Chagas disease diagnosis and treatment for the population at risk. Information regarding immigrants’ knowledge concerning Chagas disease control and prevention is insufficient in non-endemic countries and, therefore, this study sought to assess Chagas disease knowledge and awareness within the Bolivian community residing in Madrid. Methods This cross-sectional study was carried out in March–August 2017. A total of 376 Bolivians answered a structured questionnaire. A knowledge index was created based on respondents’ knowledge about transmission, symptoms, diagnosis, and place to seek treatment. Multivariate logistic regressions analyses were performed to assess the factors associated with respondents’ knowledge of Chagas disease. Results A total 159 (42.4%) of Bolivians interviewed about their knowledge of Chagas disease were men and 217 (57.6%) were women. Vinchuca was mentioned as mode of transmission by 71% of the Bolivians surveyed, while only 9% mentioned vertical transmission. Almost half of the Bolivians did not know any symptom of Chagas disease and only 47% knew that a specific blood test is necessary for diagnosis. Most of Bolivians were aware of the severity of Chagas disease, but 45% of Bolivians said that there is no cure for Chagas and 96% did not know any treatment. Based on the index of knowledge generated, only 34% of Bolivians had a good knowledge about Chagas disease transmission, symptoms, diagnosis and treatment. According to the multiple logistic regression analysis, knowledge regarding Chagas disease, diagnosis and treatment was significantly higher amongst older Bolivians who had secondary education at least, as well as amongst those who had already been tested for Chagas disease. Conclusions This study found that most of the Bolivian population living in Spain had poor knowledge about Chagas disease transmission, symptoms, diagnostic methods and treatment. A poor understanding of the disease transmission and management is one of the most important barriers when it comes to searching for early diagnosis and appropriate care. ![]()
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Affiliation(s)
- María Romay-Barja
- National Centre of Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain. .,Collaborative Research Network on Tropical Diseases, RICET, Madrid, Spain.
| | - Laura Iglesias-Rus
- National Centre of Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa Boquete
- National Centre of Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain.,Collaborative Research Network on Tropical Diseases, RICET, Madrid, Spain
| | - Agustín Benito
- National Centre of Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain.,Collaborative Research Network on Tropical Diseases, RICET, Madrid, Spain
| | - Teresa Blasco-Hernández
- National Centre of Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain.,Collaborative Research Network on Tropical Diseases, RICET, Madrid, Spain
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24
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Klein MD, Proaño A, Noazin S, Sciaudone M, Gilman RH, Bowman NM. Risk factors for vertical transmission of Chagas disease: A systematic review and meta-analysis. Int J Infect Dis 2021; 105:357-373. [PMID: 33618005 PMCID: PMC8370023 DOI: 10.1016/j.ijid.2021.02.074] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Vertical transmission of Trypanosoma cruzi infection from mother to infant accounts for a growing proportion of new Chagas disease cases. However, no systematic reviews of risk factors for T. cruzi vertical transmission have been performed. METHODS We performed a systematic review of the literature in PubMed, LILACS, and Embase databases, following PRISMA guidelines. Studies were not excluded based on language, country of origin, or publication date. RESULTS Our literature review yielded 27 relevant studies examining a wide variety of risk factors, including maternal age, parasitic load, immunologic factors and vector exposure. Several studies suggested that mothers with higher parasitic loads may have a greater risk of vertical transmission. A meta-analysis of 2 studies found a significantly higher parasitic load among transmitting than non-transmitting mothers with T. cruzi infection. A second meta-analysis of 10 studies demonstrated that maternal age was not significantly associated with vertical transmission risk. CONCLUSIONS The literature suggests that high maternal parasitic load may be a risk factor for congenital Chagas disease among infants of T. cruzi seropositive mothers. Given the considerable heterogeneity and risk of bias among current literature, additional studies are warranted to assess potential risk factors for vertical transmission of T. cruzi infection.
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Affiliation(s)
- Melissa D Klein
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Alvaro Proaño
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sassan Noazin
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Sciaudone
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Robert H Gilman
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Natalie M Bowman
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
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25
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Ramos-Rincón JM. Chagas disease in Spain. Med Clin (Barc) 2021; 156:390-392. [PMID: 33653575 DOI: 10.1016/j.medcli.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Affiliation(s)
- José-Manuel Ramos-Rincón
- Servicio de Medicina Interna. Hospital General Universitario de Alicante e Instituto de Investigación Sanitaria y Biomédica de Alicante. Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Sant Joan d'Alacant, Alicante, España.
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26
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Dumonteil E, Herrera C. The Case for the Development of a Chagas Disease Vaccine: Why? How? When? Trop Med Infect Dis 2021; 6:tropicalmed6010016. [PMID: 33530605 PMCID: PMC7851737 DOI: 10.3390/tropicalmed6010016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/06/2021] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
Chagas disease is a major neglected tropical disease, transmitted predominantly by triatomine insect vectors, but also through congenital and oral routes. While endemic in the Americas, it has turned into a global disease. Because of the current drug treatment limitations, a vaccine would represent a major advancement for better control of the disease. Here, we review some of the rationale, advances, and challenges for the ongoing development of a vaccine against Chagas disease. Recent pre-clinical studies in murine models have further expanded (i) the range of vaccine platforms and formulations tested; (ii) our understanding of the immune correlates for protection; and (iii) the extent of vaccine effects on cardiac function, beyond survival and parasite burden. We further discuss outstanding issues and opportunities to move Chagas disease development forward in the near future.
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27
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Colombo V, Giacomelli A, Casazza G, Galimberti L, Bonazzetti C, Sabaini F, Ridolfo AL, Antinori S. Trypanosoma cruzi infection in Latin American pregnant women living outside endemic countries and frequency of congenital transmission: a systematic review and meta-analysis. J Travel Med 2021; 28:5908540. [PMID: 32946555 DOI: 10.1093/jtm/taaa170] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chagas disease, as a consequence of globalization and immigration, is no more restricted to Central and Latin America. Therefore, congenital transmission represents a growing public health concern in non-endemic countries. METHODS The aim of this study was to assess the prevalence of Trypanosoma cruzi infection in pregnant Latin American (LA) women living outside endemic countries and the rate of congenital transmission. Data were extracted from studies indexed in PubMed, Scopus, Embase, Lilacs and SciELO databases without language restriction. Two investigators independently collected data on study characteristics, diagnosis, prevalence of infection in pregnant women and congenital infection rate. The data were pooled using a random effects model. RESULTS The search identified 1078 articles of which 29 were eligible regarding prevalence of T. cruzi infection among pregnant women and 1795 articles of which 32 were eligible regarding the congenital transmission rate. The estimated pooled prevalence of T. cruzi infection in LA pregnant women was 4.2% [95% confidence interval (CI): 3.0-5.5]. The prevalence of T. cruzi infection in pregnant women from Bolivia was 15.5% (95% CI: 11.7-19.7) and 0.5% (95% CI: 0.2-0.89) for those coming from all other LA countries. The estimated global rate of congenital transmission was 3.5% (95% CI: 2.5-4.5); excluding poor-quality studies, the rate of congenital transmission was 3.8% (95% CI: 2.4-5.1). CONCLUSIONS Prevalence of Chagas disease among LA pregnant women living outside endemic countries is high, particularly in Bolivian women. The rate of vertical transmission of T. cruzi infection is similar to the rate reported in South and Central American countries.
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Affiliation(s)
- Valeria Colombo
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Andrea Giacomelli
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giovanni Casazza
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Laura Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Cecilia Bonazzetti
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Federico Sabaini
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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28
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Losada Galván I, Alonso-Padilla J, Cortés-Serra N, Alonso-Vega C, Gascón J, Pinazo MJ. Benznidazole for the treatment of Chagas disease. Expert Rev Anti Infect Ther 2020; 19:547-556. [PMID: 33043726 DOI: 10.1080/14787210.2021.1834849] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Chagas disease affects 6-7 million people, mainly in the Americas, and benznidazole is one of the two therapeutic options available. Trypanocide treatment aims to eliminate the parasite from the body to prevent the establishment or progression of visceral damage, mainly cardiac and/or digestive. Remarkably, it helps interrupt vertical transmission when administered to women of childbearing age. AREAS COVERED We discuss the basic and scarce data regarding chemical, pharmacokinetic, and pharmacodynamic structure. We also collect the most important data from previous phase II and III studies, as well as studies currently underway and upcoming. We reflect on the main indications for treatment and its challenges, such as the profile of adverse effects in adults, the pharmaceutical formulations, the search for reliable biomarkers, as well as regulatory aspects and access barriers. Alternative strategies such as shorter regimens, lower doses, and fixed doses are currently being evaluated to improve access and the safety profile of this treatment. EXPERT OPINION Benznidazole is likely to continue to be the drug of choice for Chagas disease in the coming years. However, it would probably be with a different treatment scheme.
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Affiliation(s)
| | | | | | | | - Joaquim Gascón
- ISGlobal, Hospital Clínic - Universitat De Barcelona, Barcelona, Spain
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29
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Cerny N, Bivona AE, Sanchez Alberti A, Trinitario SN, Morales C, Cardoso Landaburu A, Cazorla SI, Malchiodi EL. Cruzipain and Its Physiological Inhibitor, Chagasin, as a DNA-Based Therapeutic Vaccine Against Trypanosoma cruzi. Front Immunol 2020; 11:565142. [PMID: 33162979 PMCID: PMC7583359 DOI: 10.3389/fimmu.2020.565142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022] Open
Abstract
Chagas disease caused by the protozoan parasite Trypanosoma cruzi is endemic in 21 Latin American countries and the southern United States and now is spreading into several other countries due to migration. Despite the efforts to control the vector throughout the Americas, currently, there are almost seven million infected people worldwide, causing ~10,000 deaths per year, and 70 million people at risk to acquire the infection. Chagas disease treatment is restricted only to two parasiticidal drugs, benznidazole and nifurtimox, which are effective during the acute and early infections but have not been found to be as effective in chronic infection. No prophylactic or therapeutic vaccine for human use has been communicated at this moment. Here, we evaluate in a mouse model a therapeutic DNA vaccine combining Cruzipain (Cz), a T. cruzi cysteine protease that proved to be protective in several settings, and Chagasin (Chg), which is the natural Cz inhibitor. The DNAs of both antigens, as well as a plasmid encoding GM-CSF as adjuvant, were orally administrated and delivered by an attenuated Salmonella strain to treat mice during the acute phase of T. cruzi infection. The bicomponent vaccine based on Salmonella carrying Cz and Chg (SChg+SCz) was able to improve the protection obtained by each antigen as monocomponent therapeutic vaccine and significantly increased the titers of antigen- and parasite-specific antibodies. More importantly, the bicomponent vaccine triggered a robust cellular response with interferon gamma (IFN-γ) secretion that rapidly reduced the parasitemia during the acute phase and decreased the tissue damage in the chronic stage of the infection, suggesting it could be an effective tool to ameliorate the pathology associated to Chagas disease.
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Affiliation(s)
- Natacha Cerny
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Augusto Ernesto Bivona
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Andrés Sanchez Alberti
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Sebastián Nicolás Trinitario
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Celina Morales
- Instituto de Fisiopatología Cardiovascular, Departamento de Patología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Cardoso Landaburu
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Silvia Inés Cazorla
- Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.,Laboratorio de Inmunología, Centro de Referencia Para Lactobacilos (CERELA-CONICET), Tucumán, Argentina
| | - Emilio Luis Malchiodi
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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What is the role of real time PCR in the follow up of patients with chronic Chagas’ disease? Enferm Infecc Microbiol Clin 2020; 38:353-355. [DOI: 10.1016/j.eimc.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/18/2022]
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31
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Testing for Chagas disease in an at-risk population. J Card Fail 2020; 27:109-111. [PMID: 32905847 DOI: 10.1016/j.cardfail.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022]
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32
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Basile L, Ciruela P, Requena-Méndez A, Vidal MJ, Dopico E, Martín-Nalda A, Sulleiro E, Gascon J, Jané M. Epidemiology of congenital Chagas disease 6 years after implementation of a public health surveillance system, Catalonia, 2010 to 2015. ACTA ACUST UNITED AC 2020; 24. [PMID: 31266591 PMCID: PMC6607740 DOI: 10.2807/1560-7917.es.2019.24.26.19-00011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Chagas disease is endemic in Latin America and affects 8 million people worldwide. In 2010, Catalonia introduced systematic public health surveillance to detect and treat congenital Chagas disease. Aim The objective was to evaluate the health outcomes of the congenital Chagas disease screening programme during the first 6 years (2010–2015) after its introduction in Catalonia. Methods In a surveillance system, we screened pregnant women and newborns and other children of positive mothers, and treated Chagas-positive newborns and children. Diagnosis was confirmed for pregnant women and children with two positive serological tests and for newborns with microhaematocrit and/or PCR at birth or serology at age 9 months. Results From 2010 to 2015, the estimated screening coverage rate increased from 68.4% to 88.6%. In this period, 33,469 pregnant women were tested for Trypanosoma cruzi and 937 positive cases were diagnosed. The overall prevalence was 2.8 cases per 100 pregnancies per year (15.8 in Bolivian women). We followed 82.8% of newborns until serological testing at age 9–12 months and 28 were diagnosed with Chagas disease (congenital transmission rate: 4.17%). Of 518 siblings, 178 (34.3%) were tested and 14 (7.8%) were positive for T. cruzi. Having other children with Chagas disease and the heart clinical form of Chagas disease were maternal risk factors associated with congenital T. cruzi infection (p < 0.05). Conclusion The increased screening coverage rate indicates consolidation of the programme in Catalonia. The rate of Chagas disease congenital transmission in Catalonia is in accordance with the range in non-endemic countries.
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Affiliation(s)
- Luca Basile
- Public Health Agency of Catalonia, Barcelona, Spain
| | - Pilar Ciruela
- CIBER Epidemiology and Public Health CIBERESP, Carlos III Health Institute, Madrid, Spain.,Public Health Agency of Catalonia, Barcelona, Spain
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | | | - Eva Dopico
- Laboratori Clínic de l'Hospitalet, Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Martín-Nalda
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elena Sulleiro
- Microbiology Department, Hospital Universitari Vall d'Hebron (HUVH), PROSICS Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Joaquim Gascon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Mireia Jané
- CIBER Epidemiology and Public Health CIBERESP, Carlos III Health Institute, Madrid, Spain.,Public Health Agency of Catalonia, Barcelona, Spain
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Vázquez C, García-Vázquez E, Carrilero B, Simón M, Franco F, Iborra MA, Gil-Gallardo LJ, Segovia M. Pregnancy and Chagas Disease: Benznidazole's Impact on Pregnancy and Newborns: A Report of Four Cases. Am J Trop Med Hyg 2020; 102:1075-1077. [PMID: 32207404 DOI: 10.4269/ajtmh.19-0348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In recent decades and because of migration, Chagas disease has become a global public health problem. A significant focus has been placed on pregnant women who can transmit the disease to their offspring. Here, we report four cases of women who did not know that they were pregnant while they were being treated with benznidazole. A diagnosis was established according to serology and Trypanosoma cruzi polymerase chain reaction (PCR)-standardized tests. Treatment was discontinued when pregnancy was confirmed, and a thorough follow-up was carried out. Although each case was different, none of the mothers developed health problems during pregnancy, and their newborns were delivered without any teratogenic effects.
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Affiliation(s)
- Cristina Vázquez
- Unidad de Medicina Tropical, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Elisa García-Vázquez
- Universidad de Murcia, Murcia, Spain.,Unidad de Medicina Tropical, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Bartolomé Carrilero
- Unidad de Medicina Tropical, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Marina Simón
- Unidad de Medicina Tropical, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Fuensanta Franco
- Unidad de Medicina Tropical, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Maria A Iborra
- Universidad de Murcia, Murcia, Spain.,Unidad de Medicina Tropical, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Luis J Gil-Gallardo
- Unidad de Medicina Tropical, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Manuel Segovia
- Universidad de Murcia, Murcia, Spain.,Unidad de Medicina Tropical, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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Pérez-Molina JA, Crespillo-Andújar C, Bosch-Nicolau P, Molina I. Trypanocidal treatment of Chagas disease. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30193-2. [PMID: 32527494 DOI: 10.1016/j.eimc.2020.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/02/2020] [Accepted: 04/18/2020] [Indexed: 01/16/2023]
Abstract
Chagas disease is a neglected parasitosis caused by the protozoan parasite Trypanosoma cruzi. This infection is present in most Latin American countries, although, due to migratory movements, it is a growing cause for concern in non-endemic countries. The only two drugs currently available for its treatment-benznidazole and nifurtimox-were marketed 50 years ago. While they are very effective for acute and recent infection, and for the prevention of maternofoetal transmission, their efficacy declines in people who have chronic infection, especially those older than 18 years of age. In the presence of visceral involvement, parasiticidal treatment is of little or no value. The safety profile of both drugs is far from ideal, with frequent adverse events and high rates of drug discontinuation, mainly in adults. So far, new drugs and new strategies have not been shown to improve the results of the current nitroimidazoles, although the results are promising. In this review, we focus on the aspects that allow clinicians to make the best use of currently available drugs. In addition, we discuss new therapeutic options and ongoing research in the field.
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Affiliation(s)
- Jose A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
| | - Clara Crespillo-Andújar
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Pau Bosch-Nicolau
- Tropical Medicine Unit, Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Israel Molina
- Tropical Medicine Unit, Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Instituto René Rachou-FIOCRUZ Minas, Chagas Disease Research Group, Belo Horizonte, MG, Brazil
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The Clinical and Parasitologic Follow-up of Trypanosoma cruzi-infected Children in a Nonendemic Country. Pediatr Infect Dis J 2020; 39:494-499. [PMID: 32091491 DOI: 10.1097/inf.0000000000002603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chagas disease has become a global health problem, with the pediatric population being especially vulnerable. Our aim was to describe the clinical-epidemiologic aspects of disease in this population, as well as tolerance and adherence to treatment and the subsequent evolution of the disease. METHODS A prospective study involving 949 children 0-14 years of age screened from 2007 to 2018. Diagnosis was performed by polymerase chain reaction and/or microhematocrit in <1-year-old children or serology in those ≥1 year of age. After diagnosis, children were examined for the clinical manifestation of Chagas disease and were treated with benznidazole. Treatment response was monitored by polymerase chain reaction and serology. RESULTS Forty children were infected (4.2% of the population screened). Twelve children were diagnosed during the acute phase (≤1-year-old), 3 of whom were symptomatic, and 28 (4- to 14-year-olds) were in the chronic phase: 18 in the indeterminate phase and 10 presented cardiac and/or digestive involvement. Regarding treatment, 10 (25.6%) children had side effects (6 mild, 2 moderate and 2 severe reactions), leading to treatment interruption in 3 of them. No side effects were detected in ≤1-year-old children (P < 0.05). Cure was confirmed in 29.4% of the children during follow-up, and the age of the children at treatment (≤1 year) was clearly associated with the effectiveness of treatment (P < 0.05). CONCLUSIONS Effectiveness and safety of treatment were optimum in ≤1-year-old children. Increased side effects, cardiac and/or digestive disorder incidence and lower treatment effectiveness were detected in older children, highlighting the need for early screening.
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Yoshioka K, Manne-Goehler J, Maguire JH, Reich MR. Access to Chagas disease treatment in the United States after the regulatory approval of benznidazole. PLoS Negl Trop Dis 2020; 14:e0008398. [PMID: 32569280 PMCID: PMC7347212 DOI: 10.1371/journal.pntd.0008398] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 07/09/2020] [Accepted: 05/18/2020] [Indexed: 01/06/2023] Open
Abstract
Approximately 300,000 persons in the United States (US) are infected with Trypanosoma cruzi, the protozoan that causes Chagas disease, but less than 1% are estimated to have received antiparasitic treatment. Benznidazole was approved by the US Food and Drug Administration (FDA) for treatment of T. cruzi infection in 2017 and commercialized in May 2018. This paper analyzes factors that affect access to benznidazole following commercialization and suggests directions for future actions to expand access. We applied an access framework to identify barriers, facilitators, and key actors that influence the ability of people with Chagas disease to receive appropriate treatment with benznidazole. Data were collected from the published literature, key informants, and commercial databases. We found that the mean number of persons who obtained benznidazole increased from just under 5 when distributed by the CDC to 13 per month after the commercial launch (from May 2018 to February 2019). Nine key barriers to access were identified: lack of multi-sector coordination, failure of health care providers to use a specific order form, lack of an emergency delivery system, high medical costs for uninsured patients, narrow indications for use of benznidazole, lack of treatment guidelines, limited number of qualified treaters, difficulties for patients to make medical appointments, and inadequate evaluation by providers to determine eligibility for treatment. Our analysis shows that access to benznidazole is still limited after FDA approval. We suggest six areas for strategic action for the pharmaceutical company that markets benznidazole and its allied private foundation to expand access to benznidazole in the US. In addition, we recommend expanding the existing researcher-clinician network by including government agencies, companies and others. This paper's approach could be applied to access programs for benznidazole in other countries or for other health products that target neglected populations throughout the world.
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Affiliation(s)
- Kota Yoshioka
- Doctor of Public Health Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - James H. Maguire
- Division of Infectious Disease, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael R. Reich
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Santana KH, Oliveira LGR, Barros de Castro D, Pereira M. Epidemiology of Chagas disease in pregnant women and congenital transmission of
Trypanosoma cruzi
in the Americas: systematic review and meta‐analysis. Trop Med Int Health 2020; 25:752-763. [DOI: 10.1111/tmi.13398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Kaio Henrique Santana
- Center of Biological and Health Sciences Universidade Federal do Oeste da Bahia Barreiras Brazil
| | | | | | - Marcos Pereira
- Collective Health Institute Universidade Federal da Bahia Salvador Brazil
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Danesi E, Fabbro DL, Segura EL, Sosa-Estani S. Higher congenital transmission rate of Trypanosoma cruzi associated with family history of congenital transmission. Rev Soc Bras Med Trop 2020; 53:e20190560. [PMID: 32348431 PMCID: PMC7198065 DOI: 10.1590/0037-8682-0560-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/19/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION: Congenital transmission (CT) of Trypanosoma cruzi has led to globalization of Chagas disease and its growing relevance as a public health problem. Although the occurrence of CT has been associated with several factors, its mechanisms are still unknown. This study aimed to analyze the geographical and familiar variables of mothers and their association with CT of Chagas disease in a population living in non-endemic areas of Argentina for the last decades. METHODS: We developed a retrospective cohort study in a sample of 2120 mother-child pairs who attended three reference centers in the cities of Buenos Aires, Santa Fe, and Salta between 2002 and 2015. RESULTS: The highest CT rates were observed in children born to Argentinean mothers (10.7%) and in children born to mothers from Buenos Aires (11.7%). Considering the areas of origin of the mothers, those from areas of null-low risk for vector-borne infection had higher CT rates than those from areas of medium-high risk (11.1% vs 8.2%). We also observed a significant intra-familiar “cluster effect,” with CT rates of 35.9% in children with an infected sibling, compared to 8.2% in children without infected siblings (RR=4.4 95% CI 2.3-8.4). CONCLUSIONS: The associations observed suggest a higher CT rate in children born to mothers who acquired the infection congenitally, with familiar antecedents, and from areas without the presence of vectors. These observations are considered new epidemiological evidence about Chagas disease in a contemporary urban population, which may contribute to the study of CT and may also be an interesting finding for healthcare professionals.
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Affiliation(s)
- Emmaría Danesi
- Administración Nacional de Laboratorio e Institutos de Salud, Centro Nacional de Diagnóstico e Investigación en Endemo-epidemias, Buenos Aires, Argentina
| | - Diana Lucrecia Fabbro
- Centro de Investigaciones sobre Endemias Nacionales, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Elsa Leonor Segura
- Administración Nacional de Laboratorio e Institutos de Salud, Centro Nacional de Diagnóstico e Investigación en Endemo-epidemias, Buenos Aires, Argentina
| | - Sergio Sosa-Estani
- Administración Nacional de Laboratorio e Institutos de Salud, Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben", Buenos Aires, Argentina
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Romay-Barja M, Boquete T, Martinez O, Benito A, Blasco-Hernández T. Factors associated with Chagas screening among immigrants from an endemic country in Madrid, Spain. PLoS One 2020; 15:e0230120. [PMID: 32168359 PMCID: PMC7069611 DOI: 10.1371/journal.pone.0230120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/21/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Approximately 120,000 people live with Chagas disease in Europe, 43% of whom are living in Spain. Early diagnosis and treatment are critical to improve outcomes for those living with Chagas, and also for the prevention of ongoing transmission. The decision to be tested for Chagas is affected by a range of factors. Studies have highlighted the need to consider the wider social determinants of healthcare seeking behaviour related to Chagas. In Madrid, 44% of Bolivians undergo Chagas screening, which is a higher rate than other European regions, but studies concerning the factors which determine testing have not been performed. This study aimed to assess, for a first time, the factors associated with screening for Chagas among Bolivians living in Madrid trying to help in developing strategies and health recommendations. METHODS This was a cross-sectional survey about knowledge of Chagas and practices of Bolivians living in Madrid, Spain. A structured questionnaire was administered to 376 participants regarding Chagas health-seeking behaviour. Determinants were assessed by multiple logistic regressions adjusted by sex. RESULTS After adjusting for others variables and sex, the factors shown to be associated with Chagas screening were to have between 35 and 54 years of age; coming from a department with high prevalence of Chagas (OR 2.17 95% CI 0.99-4.76); received information about Chagas in Spain (OR 2.44 95% CI 1.32-4.51); and received any advice to do the test, especially if the advice came from a professional. CONCLUSIONS Health authorities should coordinate and promote strategies addressed to diagnose and treat Chagas taking into account all factors associated with screening. Our study suggests that professional advice appears to be the cornerstone to encourage Bolivians to undergo Chagas screening in Madrid. It is time to change the burden of the decision of being screened from the patient to the doctor. Being diagnosed for Chagas needs to become an institutional strategy.
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Affiliation(s)
- María Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Teresa Boquete
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Obdulia Martinez
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
| | - Agustin Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Teresa Blasco-Hernández
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
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Bartsch SM, Stokes-Cawley OJ, Buekens P, Asti L, Bottazzi ME, Strych U, Wedlock PT, Mitgang EA, Meymandi S, Falcon-Lezama JA, Hotez PJ, Lee BY. The potential economic value of a therapeutic Chagas disease vaccine for pregnant women to prevent congenital transmission. Vaccine 2020; 38:3261-3270. [PMID: 32171575 DOI: 10.1016/j.vaccine.2020.02.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Currently, there are no solutions to prevent congenital transmission of Chagas disease during pregnancy, which affects 1-40% of pregnant women in Latin America and is associated with a 5% transmission risk. With therapeutic vaccines under development, now is the right time to determine the economic value of such a vaccine to prevent congenital transmission. METHODS We developed a computational decision model that represented the clinical outcomes and diagnostic testing strategies for an infant born to a Chagas-positive woman in Mexico and evaluated the impact of vaccination. RESULTS Compared to no vaccination, a 25% efficacious vaccine averted 125 [95% uncertainty interval (UI): 122-128] congenital cases, 1.9 (95% UI: 1.6-2.2) infant deaths, and 78 (95% UI: 66-91) DALYs per 10,000 infected pregnant women; a 50% efficacious vaccine averted 251 (95% UI: 248-254) cases, 3.8 (95% UI: 3.6-4.2) deaths, and 160 (95% UI: 148-171) DALYs; and a 75% efficacious vaccine averted 376 (95% UI: 374-378) cases, 5.8 (95% UI: 5.5-6.1) deaths, and 238 (95% UI: 227-249) DALYs. A 25% efficacious vaccine was cost-effective (incremental cost-effectiveness ratio <3× Mexico's gross domestic product per capita, <$29,698/DALY averted) when the vaccine cost ≤$240 and ≤$310 and cost-saving when ≤$10 and ≤$80 from the third-party payer and societal perspectives, respectively. A 50% efficacious vaccine was cost-effective when costing ≤$490 and ≤$615 and cost-saving when ≤$25 and ≤$160, from the third-party payer and societal perspectives, respectively. A 75% efficacious vaccine was cost-effective when ≤$720 and ≤$930 and cost-saving when ≤$40 and ≤$250 from the third-party payer and societal perspectives, respectively. Additionally, 13-42 fewer infants progressed to chronic disease, saving $0.41-$1.21 million to society. CONCLUSION We delineated the thresholds at which therapeutic vaccination of Chagas-positive pregnant women would be cost-effective and cost-saving, providing economic guidance for decision-makers to consider when developing and bringing such a vaccine to market.
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Affiliation(s)
- Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA
| | - Owen J Stokes-Cawley
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA
| | - Pierre Buekens
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Lindsey Asti
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA
| | - Maria Elena Bottazzi
- National School of Tropical Medicine and Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, BCM113 Houston, TX 77030, USA
| | - Ulrich Strych
- National School of Tropical Medicine and Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, BCM113 Houston, TX 77030, USA
| | - Patrick T Wedlock
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA
| | - Elizabeth A Mitgang
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA
| | - Sheba Meymandi
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, 14445 Olive View Drive, Sylmar, CA 91342, USA
| | - Jorge Abelardo Falcon-Lezama
- Carlos Slim Foundation, Lago Zurich 245, Piso 20. Ampliación Granada, Del. Miguel Hidalgo, C.P. 11529 Ciudad de México, Mexico
| | - Peter J Hotez
- National School of Tropical Medicine and Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, BCM113 Houston, TX 77030, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, 55 W 125th Street, New York City, NY 10027, USA.
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Rios L, Campos EE, Menon R, Zago MP, Garg NJ. Epidemiology and pathogenesis of maternal-fetal transmission of Trypanosoma cruzi and a case for vaccine development against congenital Chagas disease. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165591. [PMID: 31678160 PMCID: PMC6954953 DOI: 10.1016/j.bbadis.2019.165591] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/12/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Abstract
Trypanos o ma cruzi (T. cruzi or Tc) is the causative agent of Chagas disease (CD). It is common for patients to suffer from non-specific symptoms or be clinically asymptomatic with acute and chronic conditions acquired through various routes of transmission. The expecting women and their fetuses are vulnerable to congenital transmission of Tc. Pregnant women face formidable health challenges because the frontline antiparasitic drugs, benznidazole and nifurtimox, are contraindicated during pregnancy. However, it is worthwhile to highlight that newborns can be cured if they are diagnosed and given treatment in a timely manner. In this review, we discuss the pathogenesis of maternal-fetal transmission of Tc and provide a justification for the investment in the development of vaccines against congenital CD.
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Affiliation(s)
- Lizette Rios
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - E Emanuel Campos
- Instituto de Patología Experimental, Universidad Nacional de Salta - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - M Paola Zago
- Instituto de Patología Experimental, Universidad Nacional de Salta - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Salta, Argentina.
| | - Nisha J Garg
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX, USA; Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA.
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Contributions of molecular techniques in the chronic phase of Chagas disease in the absence of treatment. Enferm Infecc Microbiol Clin 2020; 38:356-360. [PMID: 32087978 DOI: 10.1016/j.eimc.2020.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The chronic phase of Chagas disease (CD) is characterised by a low and intermittent parasitaemia. The Polymerase Chain Reaction (PCR) presents a variable sensitivity in this stage limiting its use as a diagnostic tool. Despite this, the use of PCR in untreated patients can provide information on the parasite behaviour and its presence in peripheral blood. METHODS A timely real-time PCR determination was performed on a cohort of 495 untreated chronic CD patients. Also, a subcohort of 29 patients was followed-up by serial real-time PCR during a period from 8 to 12 months in which they could not have access to the treatment due to lack of supply. RESULTS The positive percentage of real-time PCR in our series was 42%. Nevertheless, real-time PCR positive results were significantly higher in patients with five years or less of residence in Spain (P=.041). The detection of DNA was not related to the existence of cardiac and/or gastrointestinal abnormalities. In the follow-up subgroup, real-time PCR was consistently positive in 13.8% of patients, consistently negative in 31%, and intermittent in 55.2%. CONCLUSIONS The different real-time PCR results regarding the time of residence suggests the possible relationship of external factors in the parasite presence in peripheral blood. On the other hand, specific host factors may be involved in the behaviour of parasitaemia over time.
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Iglesias-Rus L, Romay-Barja M, Boquete T, Benito A, Blasco-Hernández T. The role of the first level of health care in the approach to Chagas disease in a non-endemic country. PLoS Negl Trop Dis 2019; 13:e0007937. [PMID: 31841503 PMCID: PMC6913928 DOI: 10.1371/journal.pntd.0007937] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/19/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chagas disease has crossed South America's borders and in recent years has spread to regions that were not previously affected. Early diagnosis and treatment of Chagas disease improves the clinical prognosis and prevents vertical transmission. Taking into account the lack of evidence of how primary care services manage Chagas disease in a non-endemic country, this study assessed Chagas disease knowledge, attitudes and practices among primary health care professionals. METHODS AND PRINCIPAL FINDINGS Between 2017 and 2019, eight focus groups were formed with 41 family physicians and 40 nurses from healthcare centers in Madrid, Spain, and 70 field notes were collected during non-participant observation. The family physicians and nurses showed a lack of general knowledge about Chagas disease, and they did not identify the country of origin to request the blood test. The family physicians and nurses thought that the population did not talk broadly about Chagas disease because of the stigma or shame. The role of nurses was more focused on vaccination status and chronic disease follow-up, and family physicians assumed a facilitating role to send patients to different hospital facilities. Communication between primary care professionals and the hospital is a barrier frequently experienced by family physicians. CONCLUSIONS The diagnosis of CD in non-endemic countries continues being an important challenge for health systems. The results obtained with the study of the knowledge, attitudes and practices at primary care through a qualitative approach allows to obtain evidence that could help to develop strategies for the screening of CD in a protocolized way in order to avoid that the diagnosis depends exclusively on the request of the patient.
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Affiliation(s)
- Laura Iglesias-Rus
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
| | - María Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Teresa Boquete
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Agustín Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Teresa Blasco-Hernández
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
- * E-mail:
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Edwards MS, Stimpert KK, Bialek SR, Montgomery SP. Evaluation and Management of Congenital Chagas Disease in the United States. J Pediatric Infect Dis Soc 2019; 8:461-469. [PMID: 31016324 PMCID: PMC10186111 DOI: 10.1093/jpids/piz018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/26/2019] [Indexed: 01/18/2023]
Abstract
Chagas disease is underappreciated as a health concern in the United States. Approximately 40 000 women of childbearing age living in the United States have chronic Chagas disease. Most of them are unaware that they have an infection that is transmissible to their offspring. The estimated US maternal-to-infant transmission rate of Trypanosoma cruzi is 1% to 5%. Ten percent to 40% of neonates with congenital T cruzi infection have clinical signs consistent with a congenital infection but no findings are unique to Chagas disease. If left untreated, 20% to 40% of infants with Chagas disease will later develop potentially fatal cardiac manifestations. Molecular testing can confirm the diagnosis in neonates. Treatment is well tolerated in infancy and usually results in cure. Screening of at-risk women during pregnancy can identify maternal infection and allow early assessment and treatment for congenital T cruzi infection.
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Affiliation(s)
- Morven S Edwards
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Kelly K Stimpert
- IHRC, Inc, Atlanta, Georgia.,Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie R Bialek
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Simón M, Gil-Gallardo LJ, Asunción Iborra M, Carrilero B, López MC, Romay-Barja M, Murcia L, Carmen Thomas M, Benito A, Segovia M. An observational longitudinal study to evaluate tools and strategies available for the diagnosis of Congenital Chagas Disease in a non-endemic country. Acta Trop 2019; 199:105127. [PMID: 31394076 DOI: 10.1016/j.actatropica.2019.105127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/19/2019] [Accepted: 08/04/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Congenital Chagas Disease (CCD) has become a global health problem. Early diagnosis and treatment is essential for the cure of the disease. Our aim was to evaluate techniques and samples used for the diagnosis of CCD in order to improve diagnostic strategies. METHODS A total of 181 children born in Spain from Latin American Chagas-infected mothers were consecutively enrolled and studied by microhematocrit, PCR and serology tests at 0-2, 6 and 9-12 months of age and followed up when it was required. Samples of cord blood and peripheral blood were collected for T. cruzi detection by PCR. Parasite culture was performed in patients with a positive PCR. RESULTS Of 181 children, 7 children (3.9%) were lost to follow-up. A total of 174 children completed follow-up, 12 were diagnosed with CCD (6.9%) and 162 (93.1%) as uninfected children (negative serology tests at the end of the follow-up). Traditional parasitological diagnosis by microhematocrit had a poor performance (sensitivity was 10%), while PCR in peripheral blood showed high sensitivity (90.9%) and specificity (100%), allowing the early diagnosis of 9 infected children during the first 6-months-old. In the other 3 congenital cases, diagnosis was only possible at 12 months by serological and molecular techniques. However, PCR in cord blood showed low sensitivity (33.3%) and less specificity (96.4%) for the diagnosis. CONCLUSION PCR in peripheral blood has proven to be the most adequate strategy for the diagnosis of CCD, allowing an early and reliable diagnosis.
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Carlier Y, Altcheh J, Angheben A, Freilij H, Luquetti AO, Schijman AG, Segovia M, Wagner N, Albajar Vinas P. Congenital Chagas disease: Updated recommendations for prevention, diagnosis, treatment, and follow-up of newborns and siblings, girls, women of childbearing age, and pregnant women. PLoS Negl Trop Dis 2019; 13:e0007694. [PMID: 31647811 PMCID: PMC6812740 DOI: 10.1371/journal.pntd.0007694] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yves Carlier
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Jaime Altcheh
- Servicio de Parasitología, Hospital de Niños Ricardo Gutiérrez (Centro colaborador en Chagas pediátrico OPS/OMS), Instituto Multidisciplinario de Investigación en Patologías Pediátricas (IMIPP), CONICET-GCBA, Buenos Aires, Argentina
| | - Andrea Angheben
- Centro per le Malattie Tropicali, IRCCS Ospedale “Sacro Cuore—Don Calabria,” Negrar (Verona), Italy
| | - Hector Freilij
- Servicio de Parasitología, Hospital de Niños Ricardo Gutiérrez (Centro colaborador en Chagas pediátrico OPS/OMS), Instituto Multidisciplinario de Investigación en Patologías Pediátricas (IMIPP), CONICET-GCBA, Buenos Aires, Argentina
| | - Alejandro O. Luquetti
- Laboratório de Chagas, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Alejandro G. Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, INGEBI-CONICET, Buenos Aires, Argentina
| | - Manuel Segovia
- Unidad Regional de Medicina Tropical, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar (Murcia), Spain
| | - Noemie Wagner
- Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pedro Albajar Vinas
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Caicedo Díaz RA, Forsyth C, Bernal OA, Marchiol A, Beltrán Duran M, Batista C, Herazo R, Vera MJ, Pachón Abril E, Valencia-Hernández CA, Flórez Sánchez AC. Comparative evaluation of immunoassays to improve access to diagnosis for Chagas disease in Colombia. Int J Infect Dis 2019; 87:100-108. [DOI: 10.1016/j.ijid.2019.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 12/28/2022] Open
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Congenital Chagas disease: current diagnostics, limitations and future perspectives. Curr Opin Infect Dis 2019; 31:415-421. [PMID: 30095485 DOI: 10.1097/qco.0000000000000478] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Congenital transmission is an important route of Trypanosoma cruzi infection, both in Latin America and internationally, with considerable populations of infected women of child-bearing age residing in the United States and Europe. This review examines recent literature on congenital Chagas disease, with a focus on the changing clinical spectrum and potential new diagnostic tools. RECENT FINDINGS Vertical transmission occurs in approximately 5-10% of births from T. cruzi-infected mothers. Historically, congenital Chagas disease was associated with high levels of neonatal morbidity and mortality. Bolivian birth cohort data from the early 1990s to the present indicate that the incidence of symptomatic neonatal disease has declined. Treatment with trypanocides is greater than 90% effective and well tolerated in infants. Current programs face challenges from the multistep screening algorithm, low sensitivity of microscopy and high loss to follow-up. SUMMARY Congenital Chagas disease remains an important contributor to the global disease burden because of T. cruzi. PCR and related molecular techniques represent the most sensitive diagnostic modalities for early detection but require further optimization for resource-limited settings. Several novel diagnostic tests show promise for the future but further validation and adaptation to field settings are needed.
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Francisco-González L, Rubio-San-Simón A, González-Tomé MI, Manzanares Á, Epalza C, Santos MDM, Gastañaga T, Merino P, Ramos-Amador JT. Congenital transmission of Chagas disease in a non-endemic area, is an early diagnosis possible? PLoS One 2019; 14:e0218491. [PMID: 31291269 PMCID: PMC6619651 DOI: 10.1371/journal.pone.0218491] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/02/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chagas disease (CD) is an emergent disease in Europe, due to immigration. The aims of this study are to describe the epidemiological characteristics of a cohort of Chagas infected pregnant women in Spain, to assess the vertical transmission (VT) rate and evaluate the usefulness of the PCR in the diagnosis of congenital infection in the first months of life. METHODS A descriptive, retrospective study including Chagas seropositive pregnant women who were attended at three tertiary hospitals in Madrid, from January 2012 to September 2016. Infants were examined by PCR at birth and 1 month later and serologically studied at 9 months or later. Children were considered infected when the parasite was detected by PCR at any age or when serology remained positive without decline over the age of 9 months. RESULTS We included 122 seropositive-infected pregnant women, 81% were from Bolivia and only 8.2% had been treated before. 125 newborns were studied and finally 109 were included (12.8% lost the follow-up before performing the last serology). The VT rate was 2.75% (95% CI: 0,57-8,8%). Infected infants had positive PCR at birth and 1 month later. All of them were treated successfully with benznidazole (PCR and serology became negative later on). All non-infected children presented negative PCR. The mean age at which uninfected patients had negative serology was 10.5 months. CONCLUSIONS The VT rate is in keeping with literature and confirms the need to carry out a screening in pregnant women coming from endemic areas. PCR seems to be a useful tool to provide early diagnosis of congenital CD.
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Affiliation(s)
- Laura Francisco-González
- Department of Pediatrics, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | | | | | | | - Cristina Epalza
- Department of Pediatrics, Hospital Doce de Octubre, Madrid, Spain
| | | | - Teresa Gastañaga
- Department of Obstetrics and Gynaecology, Hospital Clínico San Carlos, Madrid, Spain
| | - Paloma Merino
- Department of Microbiology, Hospital Clínico San Carlos, Madrid, Spain
| | - José Tomás Ramos-Amador
- Department of Pediatrics, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, Madrid, Spain
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Bustos PL, Milduberger N, Volta BJ, Perrone AE, Laucella SA, Bua J. Trypanosoma cruzi Infection at the Maternal-Fetal Interface: Implications of Parasite Load in the Congenital Transmission and Challenges in the Diagnosis of Infected Newborns. Front Microbiol 2019; 10:1250. [PMID: 31231337 PMCID: PMC6568191 DOI: 10.3389/fmicb.2019.01250] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022] Open
Abstract
Trypanosoma cruzi is the protozoan unicellular parasite that causes Chagas disease. It can be transmitted from infected mothers to their babies via the connatal route, thus being able to perpetuate even in the absence of Triatomine insect vectors. Chagas disease was originally endemic in Central and South America, but migration of infected women of childbearing age has spread the T. cruzi congenital infection to non-endemic areas like North America, Europe, Japan, and Australia. Currently, 7 million people are affected by this infection worldwide. This review focuses on the relevance of the T. cruzi parasite levels in different aspects of the congenital T. cruzi infection such as the mother-to-child transmission rate, the maternal and fetal immune response, and its impact on the diagnosis of infected newborns. Improvements in detection of this parasite, with tools that can be easily adapted to be used in remote rural areas, will make the early diagnosis of infected children possible, allowing a prompt trypanocidal treatment and avoiding the current loss of opportunities for the diagnosis of 100% of T. cruzi congenitally infected infants.
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Affiliation(s)
- Patricia L Bustos
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina
| | - Natalia Milduberger
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina.,Centro de Altos Estudios en Ciencias Humanas y de la Salud (CAECIHS), Universidad Abierta Interamericana, Buenos Aires, Argentina
| | - Bibiana J Volta
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina
| | - Alina E Perrone
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina
| | - Susana A Laucella
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina
| | - Jacqueline Bua
- Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben" - ANLIS C. G. Malbrán, Buenos Aires, Argentina.,Centro de Altos Estudios en Ciencias Humanas y de la Salud (CAECIHS), Universidad Abierta Interamericana, Buenos Aires, Argentina
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