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Beltrami M, Grande R, Giacomelli A, Sabaini F, Biondo L, Longo M, Grosso S, Oreni L, Fadelli S, Galimberti L, Ridolfo AL, Antinori S. Chagas disease prevalence among migrants from El Salvador in Milan: a cross- sectional study of an often-overlooked population. Infect Dis (Lond) 2023; 55:559-566. [PMID: 37317783 DOI: 10.1080/23744235.2023.2222817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Chagas disease (CD) is considered to be highly endemic in El Salvador, where its prevalence is estimated to be 1.3-3.7%. Although more than 40,000 migrants from El Salvador are currently living in Europe (particularly in Spain and Italy), there are few data regarding the prevalence of CD in this population. The aim of this study was to evaluate the prevalence of CD among Salvadorans living in Italy. METHODS A cross-sectional serological survey of CD among Salvadorans living in the metropolitan area of Milan was carried out between October 2017 and December 2019. The participants' blood samples were tested for Trypanosoma cruzi antibodies using two different serological assays. The collected demographic data included their biological sex, province of origin, the type of housing in their country of origin, and family history of CD. RESULTS Of the 384 subjects who voluntarily participated in the study, five (1.3%, most coming from La Paz) were positive to both serological assays and therefore conclusively diagnosed as having CD. Five other subjects had discrepant serological results but were not positive to a third assay. Three of the five subjects with a diagnosis of CD completed medical staging, one of whom had chronic disease (digestive and cardiac involvement). CONCLUSIONS The prevalence of CD among Salvadorans living in Milan is similar to that estimated by the WHO in 2010. Although they are often overlooked in CD surveys, Salvadoran migrants should be included in CD control programs in countries in which the disease is not endemic.
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Affiliation(s)
- Martina Beltrami
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | | | - Andrea Giacomelli
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Federico Sabaini
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Lidia Biondo
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Margherita Longo
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Silvia Grosso
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Letizia Oreni
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Italy
| | | | - Laura Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
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Ramponi F, Aerts C, Sartor P, Pinazo MJ, Freilij H, Guzmán CA, Malchiodi E, Sicuri E. Development of vaccines for Chagas disease (CRUZIVAX): stakeholders' preferences and potential impacts on healthcare. GACETA SANITARIA 2022; 37:102275. [PMID: 36563537 DOI: 10.1016/j.gaceta.2022.102275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 12/24/2022]
Abstract
A vaccine for Chagas disease does not currently exist. This study aims to inform the development of two vaccines for the prevention and treatment of Trypanosoma cruzi infection, and guide their pre-clinical phase up to clinical phase I. The three main objectives are: 1) to explore patients' and policy makers' preferences on the candidate vaccines in Argentina and Spain; 2) to investigate health-related quality of life of patients affected by Chagas disease; and 3) to assess the potential health provider savings associated with the vaccines, in terms of resource use and health care costs. Discrete choice experiments will be employed to estimate and characterize the theoretical demand for the vaccines and investigate patients' and policy makers' preferences. Health-related quality of life will be assessed using the EQ-5D-3L questionnaire. Resources use and costs associated with Chagas disease will be investigated using information from the databases of the Hospital Clínic of Barcelona.
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Affiliation(s)
- Francesco Ramponi
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Céline Aerts
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Paula Sartor
- Región Sanitaria 5, Ministerio de Salud del Chaco, Juan José Castelli, Chaco, Argentina; Universidad Nacional del Nordeste, Facultad de Ciencias Exactas Naturales y Agrimensura, Corrientes Capital, Argentina
| | | | - Héctor Freilij
- Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Carlos A Guzmán
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Emilio Malchiodi
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Inmunología, and Instituto de Estudios de la Inmunidad Humoral Ricardo A. Margni (IDEHU), UBA-CONICET, Buenos Aires, Argentina; Universidad de Buenos Aires, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, and Instituto de Microbiología y Parasitología Médica (IMPaM), UBA-CONICET, Buenos Aires, Argentina
| | - Elisa Sicuri
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; LSE Health, London School of Economics & Political Science, London, United Kingdom.
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Medina-Rincón GJ, Gallo-Bernal S, Jiménez PA, Cruz-Saavedra L, Ramírez JD, Rodríguez MJ, Medina-Mur R, Díaz-Nassif G, Valderrama-Achury MD, Medina HM. Molecular and Clinical Aspects of Chronic Manifestations in Chagas Disease: A State-of-the-Art Review. Pathogens 2021; 10:pathogens10111493. [PMID: 34832648 PMCID: PMC8619182 DOI: 10.3390/pathogens10111493] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022] Open
Abstract
Chronic manifestations of Chagas disease present as disabling and life-threatening conditions affecting mainly the cardiovascular and gastrointestinal systems. Although meaningful research has outlined the different molecular mechanisms underlying Trypanosoma cruzi’s infection and the host-parasite interactions that follow, prompt diagnosis and treatment remain a challenge, particularly in developing countries and also in those where the disease is considered non-endemic. This review intends to present an up-to-date review of the parasite’s life cycle, genetic diversity, virulence factors, and infective mechanisms, as well as the epidemiology, clinical presentation, diagnosis, and treatment options of the main chronic complications of Chagas disease.
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Affiliation(s)
- Germán J. Medina-Rincón
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Correspondence: ; Tel.: +57-310-817-2369
| | - Sebastián Gallo-Bernal
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Radiology, Harvard Medical School, Boston, MA 02114, USA
| | - Paula A. Jiménez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - Lissa Cruz-Saavedra
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 111221, Colombia; (P.A.J.); (L.C.-S.); (J.D.R.)
| | - María Juliana Rodríguez
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
| | - Ramón Medina-Mur
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
| | - Gustavo Díaz-Nassif
- Division of Gastroenterology and Liver Diseases, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 111221, Colombia;
| | | | - Héctor M. Medina
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (S.G.-B.); (M.D.V.-A.); (H.M.M.)
- Division of Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia; (M.J.R.); (R.M.-M.)
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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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5
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Guggenbühl Noller JM, Froeschl G, Eisermann P, Jochum J, Theuring S, Reiter-Owona I, Bissinger AL, Hoelscher M, Bakuli A, von Sonnenburg FJF, Rothe C, Bretzel G, Albajar-Viñas P, Grout L, Pritsch M. Describing nearly two decades of Chagas disease in Germany and the lessons learned: a retrospective study on screening, detection, diagnosis, and treatment of Trypanosoma cruzi infection from 2000 - 2018. BMC Infect Dis 2020; 20:919. [PMID: 33272201 PMCID: PMC7713040 DOI: 10.1186/s12879-020-05600-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022] Open
Abstract
Background The highly complex and largely neglected Chagas disease (CD) has become a global health problem due to population movements between Latin America and non-endemic countries, as well as non-vectorial transmission routes. Data on CD testing and treatment from routine patient care in Germany of almost two decades was collected and analysed. Methods German laboratories offering diagnostics for chronic Trypanosoma cruzi (T. cruzi) infection in routine patient care were identified. All retrievable data on tests performed during the years of 2000–2018 were analysed. Additional clinical information regarding patients diagnosed with CD was collected through questionnaires. Results Five German laboratories with diagnostics for T. cruzi infection in routine patient care were identified. Centres in Hamburg and Munich offered two independent serological tests to confirm the CD diagnosis, as recommended by WHO during the entire time period 2000–2018. Overall, a total of n = 10,728 independent tests involving n = 5991 individuals were identified with a progressive increase in testing rates over time, only n = 130 (16.0%) of the tested individuals with known nationality came from CD endemic countries. Of all test units conducted at the included institutes, a total of n = 347/10,728 (3.2%) tests on CD were positive, of which n = 200/347 (57.6%) were ELISA, n = 133/347 (38.3%) IFT, n = 10/347 (2.9%) PCR, and n = 4/347 (1.2%) RDT. Of the n = 5991 individuals only n = 81 (1.4%) with chronic infection were identified, n = 52 females and n = 28 males. Additional clinical information could only be collected from n = 47. Conclusion The results of this study give insight into the deployment of screening, detection, diagnosis, and treatment of T. cruzi over the last two decades in Germany and existing deficits therein; the creation of guidelines for Germany could be a step forward to improve the existing gaps. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05600-8.
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Affiliation(s)
- Jessica Michelle Guggenbühl Noller
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,Center for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany. .,Center for International Health, University Hospital, LMU Munich, Munich, Germany.
| | - Philip Eisermann
- National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Johannes Jochum
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Theuring
- Institute of Tropical Medicine and International Health, Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ingrid Reiter-Owona
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Alfred Lennart Bissinger
- Institute of Tropical Medicine, Medical Department, University Hospital Tübingen, Tübingen, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Abhishek Bakuli
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | | | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Gisela Bretzel
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Pedro Albajar-Viñas
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Lise Grout
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
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6
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Ikedionwu C, Dongarwar D, Kaur M, Nunez L, Awazi A, Mallet J, Kennedy K, Cano M, Dike C, Okwudi J, Stewart J, Igwegbe D, Estes FG, Spooner KK, Salemi JL, Salihu HM, Olaleye OA. Trends and associated characteristics for Chagas disease among women of reproductive age in the United States, 2002 to 2017. Parasite Epidemiol Control 2020; 11:e00167. [PMID: 32743081 PMCID: PMC7388767 DOI: 10.1016/j.parepi.2020.e00167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background American trypanosomiasis, commonly referred to as Chagas disease, is caused by a single cell protozoan known as Trypanosoma cruzi (T. cruzi). Although those affected are mainly in Latin America, Chagas has been detected in the United States (US), Canada and in many European countries due to migration. Few studies have explored the epidemiology of Chagas within the US or changes in disease burden over the past decade. The objective of this study was to explore the trends and associated characteristics for Chagas disease among hospitalized women of reproductive age in the US. Methods We analyzed admissions data including socio-demographic and hospital characteristics for inpatient hospitalization for women of reproductive age (15-49 years) in the US from 2002 through 2017. We employed Joinpoint regression analysis to determine trends in the prevalence of Chagas disease over this period. Results A total of 487 hospitalizations of Chagas disease were identified, corresponding to 3.7 per million hospitalizations over the study period. The rate statistically increased from 1.6 per million in 2002 to 7.6 per million hospitalizations in 2017. Chagas was most prevalent among older women, Hispanics and those in the highest zip income bracket. The in-hospital mortality rate was about 10 times greater among women with Chagas compared to those without the condition (3.1% versus 0.3%), and the condition tended to be clustered in women treated at large, urban teaching hospitals in the Northeastern region of the US. Conclusion Chagas disease diagnosis appears to be increasing among hospitalized women of reproductive age in the US with a 10-fold elevated risk of mortality.
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Affiliation(s)
- Chioma Ikedionwu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Manvir Kaur
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Lisa Nunez
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Annabella Awazi
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Jere' Mallet
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - KaShena Kennedy
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Michelle Cano
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Chinwe Dike
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Jessica Okwudi
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Justice Stewart
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - David Igwegbe
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Flora G Estes
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Kiara K Spooner
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.,Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Omonike A Olaleye
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
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7
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Velasco M, Gimeno-Feliú LA, Molina I, Salas-Coronas J, Solà I, Monge-Maillo B, Torrús-Tendero D, Caylà J, de Guzmán EN, Arellano JLP, Pérez-Molina JA. Screening for Trypanosoma cruzi infection in immigrants and refugees: Systematic review and recommendations from the Spanish Society of Infectious Diseases and Clinical Microbiology. Euro Surveill 2020; 25:1900393. [PMID: 32127121 PMCID: PMC7055039 DOI: 10.2807/1560-7917.es.2020.25.8.1900393] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundChagas disease has spread beyond its original borders on the American continent with migration. It can be transmitted from mother to child, through organ transplantation and transfusion of blood and blood products. It is necessary to determine when to screen for this infection.AimOur objective was to evaluate the appropriateness of screening for Trypanosoma cruzi infection in Latin American migrants and their descendants.MethodsWe reviewed the literature using rigorous criteria. The quality of evidence was ranked according to the GRADE classification. An evidence to decision framework was adopted to provide information on the most relevant aspects necessary to formulate recommendations.ResultsThe 33 studies evaluated revealed a prevalence of T. cruzi infection among Latin American migrants in Europe of 6.08% (95% confidence interval (CI): 3.24-9.69; 28 studies). Vertical transmission occurred in three of 100 live births (95% CI: 1-6; 13 studies). The prevalence of cardiovascular disease was 19% (95% CI: 13-27; nine studies), including only 1% severe cardiac events (95% CI: 0-2; 11 studies). The overall quality of evidence was low because of risk of bias in the studies and considerable heterogeneity of the evaluated populations. The recommendations took into account economic studies on the value of screening strategies and studies on acceptability of screening and knowledge of the disease in the affected population.ConclusionsWe identified five situations in which screening for T. cruzi infection is indicated. We recommend screening persons from endemic areas and children of mothers from these areas.
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Affiliation(s)
- María Velasco
- Infectious and Tropical Medicine Section, Internal Medicine Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Luis Andrés Gimeno-Feliú
- San Pablo Health Centre, Zaragoza, Spain,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza. EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Israel Molina
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Begoña Monge-Maillo
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Diego Torrús-Tendero
- Referral Unit for Imported Infections and International Health. Infectious Diseases Unit, Hospital General Universitario de Alicante. Parasitology Area, Miguel Hernández University, Alicante, Spain
| | - Joan Caylà
- Fundació de la Unitat d'Investigació en Tuberculosis (FuiTB), TB Research Unit, Barcelona, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - JL Pérez Arellano
- Infectious Diseases and Tropical Medicine Unit, Hospital Insular de Las Palmas. Las Palmas de Gran Canaria, Spain,Medical and Surgical Sciences Department. Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jose A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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8
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Albaladejo Blanco C, Bellvert Ríos A, Mayorga Criado A, Martín García J. Aproximación a la enfermedad de Chagas desde un área de salud: descripción de una serie de veinticinco casos. Semergen 2020; 46:e13-e15. [DOI: 10.1016/j.semerg.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/09/2019] [Accepted: 04/27/2019] [Indexed: 10/25/2022]
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9
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Mandacaru SC, Queiroz RML, Alborghetti MR, de Oliveira LS, de Lima CMR, Bastos IMD, Santana JM, Roepstorff P, Ricart CAO, Charneau S. Exoproteome profiling of Trypanosoma cruzi during amastigogenesis early stages. PLoS One 2019; 14:e0225386. [PMID: 31756194 PMCID: PMC6874342 DOI: 10.1371/journal.pone.0225386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/04/2019] [Indexed: 11/20/2022] Open
Abstract
Chagas disease is caused by the protozoan Trypanosoma cruzi, affecting around 8 million people worldwide. After host cell invasion, the infective trypomastigote form remains 2–4 hours inside acidic phagolysosomes to differentiate into replicative amastigote form. In vitro acidic-pH-induced axenic amastigogenesis was used here to study this step of the parasite life cycle. After three hours of trypomastigote incubation in amastigogenesis promoting acidic medium (pH 5.0) or control physiological pH (7.4) medium samples were subjected to three rounds of centrifugation followed by ultrafiltration of the supernatants. The resulting exoproteome samples were trypsin digested and analysed by nano flow liquid chromatography coupled to tandem mass spectrometry. Computational protein identification searches yielded 271 and 483 protein groups in the exoproteome at pH 7.4 and pH 5.0, respectively, with 180 common proteins between both conditions. The total amount and diversity of proteins released by parasites almost doubled upon acidic incubation compared to control. Overall, 76.5% of proteins were predicted to be secreted by classical or non-classical pathways and 35.1% of these proteins have predicted transmembrane domains. Classical secretory pathway analysis showed an increased number of mucins and mucin-associated surface proteins after acidic incubation. However, the number of released trans-sialidases and surface GP63 peptidases was higher at pH 7.4. Trans-sialidases and mucins are anchored to the membrane and exhibit an enzyme-substrate relationship. In general, mucins are glycoproteins with immunomodulatory functions in Chagas disease, present mainly in the epimastigote and trypomastigote surfaces and could be enzymatically cleaved and released in the phagolysosome during amastigogenesis. Moreover, evidence for flagella discard during amastigogenesis are addressed. This study provides the first comparative analysis of the exoproteome during amastigogenesis, and the presented data evidence the dynamism of its profile in response to acidic pH-induced differentiation.
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Affiliation(s)
- Samuel C. Mandacaru
- Laboratory of Protein Chemistry and Biochemistry, Department of Cell Biology, Institute of Biology, University of Brasilia, Brasilia, Brazil
| | - Rayner M. L. Queiroz
- Laboratory of Protein Chemistry and Biochemistry, Department of Cell Biology, Institute of Biology, University of Brasilia, Brasilia, Brazil
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Marcos R. Alborghetti
- Laboratory of Protein Chemistry and Biochemistry, Department of Cell Biology, Institute of Biology, University of Brasilia, Brasilia, Brazil
| | - Lucas S. de Oliveira
- Laboratory of Protein Chemistry and Biochemistry, Department of Cell Biology, Institute of Biology, University of Brasilia, Brasilia, Brazil
| | - Consuelo M. R. de Lima
- Laboratory of Protein Chemistry and Biochemistry, Department of Cell Biology, Institute of Biology, University of Brasilia, Brasilia, Brazil
| | - Izabela M. D. Bastos
- Pathogen-Host Interface Laboratory, Department of Cell Biology, Institute of Biology, University of Brasilia, Brasilia, Brazil
| | - Jaime M. Santana
- Pathogen-Host Interface Laboratory, Department of Cell Biology, Institute of Biology, University of Brasilia, Brasilia, Brazil
| | - Peter Roepstorff
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Carlos André O. Ricart
- Laboratory of Protein Chemistry and Biochemistry, Department of Cell Biology, Institute of Biology, University of Brasilia, Brasilia, Brazil
| | - Sébastien Charneau
- Laboratory of Protein Chemistry and Biochemistry, Department of Cell Biology, Institute of Biology, University of Brasilia, Brasilia, Brazil
- * E-mail:
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10
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Vieira RP, Santos VC, Ferreira RS. Structure-based Approaches Targeting Parasite Cysteine Proteases. Curr Med Chem 2019; 26:4435-4453. [PMID: 28799498 DOI: 10.2174/0929867324666170810165302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 12/17/2022]
Abstract
Cysteine proteases are essential hydrolytic enzymes present in the majority of organisms, including viruses and unicellular parasites. Despite the high sequence identity displayed among these proteins, specific structural features across different species grant distinct functions to these biomolecules, frequently related to pathological conditions. Consequently, their relevance as promising targets for potential specific inhibitors has been highlighted and occasionally validated in recent decades. In this review, we discuss the recent outcomes of structure-based campaigns aiming the discovery of new inhibitor prototypes against cruzain and falcipain, as alternative therapeutic tools for Chagas disease and malaria treatments, respectively. Computational and synthetic approaches have been combined on hit optimization strategies and are also discussed herein. These rationales are extended to additional tropical infectious and neglected pathologies, such as schistosomiasis, leishmaniasis and babesiosis, and also to Alzheimer's Disease, a widespread neurodegenerative disease poorly managed by currently available drugs and recently linked to particular physiopathological roles of human cysteine proteases.
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Affiliation(s)
- Rafael Pinto Vieira
- Departamento de Bioquimica e Imunologia, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil.,CAPES Foundation, Ministry of Education of Brazil, 70040-020 Brasília, DF, Brazil
| | - Viviane Corrêa Santos
- Departamento de Bioquimica e Imunologia, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
| | - Rafaela Salgado Ferreira
- Departamento de Bioquimica e Imunologia, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
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11
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Angheben A, Buonfrate D, Cruciani M, Jackson Y, Alonso-Padilla J, Gascon J, Gobbi F, Giorli G, Anselmi M, Bisoffi Z. Rapid immunochromatographic tests for the diagnosis of chronic Chagas disease in at-risk populations: A systematic review and meta-analysis. PLoS Negl Trop Dis 2019; 13:e0007271. [PMID: 31150377 PMCID: PMC6561601 DOI: 10.1371/journal.pntd.0007271] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/12/2019] [Accepted: 02/28/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Despite of a high disease burden, mainly in Latin America, Chagas disease (CD) is underdiagnosed and undertreated. Rapid diagnostic tests (RDTs) might improve the access to diagnosis. The aim of this study is to review the accuracy of commercially available RDTs used in field conditions for the diagnosis of chronic CD in populations at risk, in endemic and non-endemic countries. METHODS/PRINCIPAL FINDINGS We undertook a comprehensive search of the following databases: PubMed, SCOPUS, LILACS (last up-date on the 01st July, 2017), without language or date limits. Non-electronic sources have been also searched. This review included clinical studies with cohort recruitment of individuals at risk of T. cruzi exposure, without age limits; adequate reference standards for the diagnosis of CD. We excluded case-control studies and those testing RDTs during acute CD. Data on test accuracies were pooled through a bivariate random-effects model. Only one index test was evaluated separately. Geographical area, commercial brand, disease prevalence, study size, and risk of bias were explored as possible source of heterogeneity. Values of sensitivity and specificity were computed to obtain summary positive/negative likelihood ratios, and summary diagnostic odds ratio. Ten studies were included on six different immunochromatographic RDTs. The pooled sensitivity and specificity of the RDTs resulted 96.6% (95% CI 91.3-98.7%) and 99.3% (95% CI 98.4-99.7%), respectively. Test accuracy was particularly good in endemic areas (98.07%/99.03% of sensitivity/specificity, respectively). One test (Stat-Pak) showed an overall sensitivity of 97% (95% CI 87.6-99.3) and specificity of 99.4% (95% CI 98.6-99.8). CONCLUSIONS/SIGNIFICANCE RDTs demonstrated to be sufficiently accurate to recommend their use for screening in endemic areas, even as stand-alone tests. This approach might increase the accessibility to the diagnosis. However, an additional confirmatory test in case of positive result remains a prudent approach.
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Affiliation(s)
- Andrea Angheben
- Department of Infectious – Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar, Verona, Italy
| | - Dora Buonfrate
- Department of Infectious – Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar, Verona, Italy
| | - Mario Cruciani
- Infectious Diseases Unit, Azienda ULSS 9 Scaligera, Verona, Italy
| | - Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Institute of Global Health, Geneva University, Geneva, Switzerland
| | | | - Joaquim Gascon
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Federico Gobbi
- Department of Infectious – Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar, Verona, Italy
| | - Giovanni Giorli
- Department of Infectious – Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar, Verona, Italy
| | - Mariella Anselmi
- Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Zeno Bisoffi
- Department of Infectious – Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar, Verona, Italy
- Diagnostic and Public Health Department, University of Verona, Verona, Italy
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12
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Abstract
Endothelins were discovered more than thirty years ago as potent vasoactive compounds. Beyond their well-documented cardiovascular properties, however, the contributions of the endothelin pathway have been demonstrated in several neuroinflammatory processes and the peptides have been reported as clinically relevant biomarkers in neurodegenerative diseases. Several studies report that endothelin-1 significantly contributes to the progression of neuroinflammatory processes, particularly during infections in the central nervous system (CNS), and is associated with a loss of endothelial integrity at the blood brain barrier level. Because of the paucity of clinical trials with endothelin-1 antagonists in several infectious and non-infectious neuroinflammatory diseases, it remains an open question whether the 21 amino acid peptide is a mediator/modulator rather than a biomarker of the progression of neurodegeneration. This review focuses on the potential roles of endothelins in the pathology of neuroinflammatory processes, including infectious diseases of viral, bacterial or parasitic origin in which the synthesis of endothelins or its pharmacology have been investigated from the cell to the bedside in several cases, as well as in non-infectious inflammatory processes such as neurodegenerative disorders like Alzheimers Disease or central nervous system vasculitis.
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13
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Martín-Escolano R, Aguilera-Venegas B, Marín C, Martín-Montes Á, Martín-Escolano J, Medina-Carmona E, Arán VJ, Sánchez-Moreno M. Synthesis and Biological in vitro and in vivo Evaluation of 2-(5-Nitroindazol-1-yl)ethylamines and Related Compounds as Potential Therapeutic Alternatives for Chagas Disease. ChemMedChem 2018; 13:2104-2118. [PMID: 30098232 DOI: 10.1002/cmdc.201800512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 12/17/2022]
Abstract
Chagas disease, a neglected tropical disease caused by infection with the protozoan parasite Trypanosoma cruzi, is a potentially life-threatening illness that affects 5-8 million people in Latin America, and more than 10 million people worldwide. It is characterized by an acute phase, which is partly resolved by the immune system, but then develops as a chronic disease without an effective treatment. There is an urgent need for new antiprotozoal agents, as the current standard therapeutic options based on benznidazole and nifurtimox are characterized by limited efficacy, toxicity, and frequent failures in treatment. In vitro and in vivo assays were used to identify some new low-cost 5-nitroindazoles as a potential antichagasic therapeutic alternative. Compound 16 (3-benzyloxy-5-nitro-1-vinyl-1H-indazole) showed improved efficiency and lower toxicity than benznidazole in both in vitro and in vivo experiments, and its trypanocidal activity seems to be related to its effect at the mitochondrial level. Therefore, compound 16 is a promising candidate for the development of a new anti-Chagas agent, and further preclinical evaluation should be considered.
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Affiliation(s)
- Rubén Martín-Escolano
- Department of Parasitology, Instituto de Investigación Biosanitaria (ibs.Granada), Hospitales Universitarios de Granada, University of Granada, c/ Severo Ochoa s/n, 18071, Granada, Spain
| | - Benjamín Aguilera-Venegas
- Department of Inorganic and Analytical Chemistry, Faculty of Chemical and Pharmaceutical Sciences, University of Chile, Box 233, Santiago, 8380492, Chile
| | - Clotilde Marín
- Department of Parasitology, Instituto de Investigación Biosanitaria (ibs.Granada), Hospitales Universitarios de Granada, University of Granada, c/ Severo Ochoa s/n, 18071, Granada, Spain
| | - Álvaro Martín-Montes
- Department of Parasitology, Instituto de Investigación Biosanitaria (ibs.Granada), Hospitales Universitarios de Granada, University of Granada, c/ Severo Ochoa s/n, 18071, Granada, Spain
| | - Javier Martín-Escolano
- Department of Parasitology, Instituto de Investigación Biosanitaria (ibs.Granada), Hospitales Universitarios de Granada, University of Granada, c/ Severo Ochoa s/n, 18071, Granada, Spain
| | - Encarnación Medina-Carmona
- Department of Physical Chemistry, Faculty of Sciences, University of Granada, Av. Fuentenueva s/n, 18071, Granada, Spain
| | - Vicente J Arán
- Instituto de Química Médica (IQM), Consejo Superior de Investigaciones Científicas (CSIC), c/ Juan de la Cierva 3, 28006, Madrid, Spain
| | - Manuel Sánchez-Moreno
- Department of Parasitology, Instituto de Investigación Biosanitaria (ibs.Granada), Hospitales Universitarios de Granada, University of Granada, c/ Severo Ochoa s/n, 18071, Granada, Spain
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14
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Pane S, Giancola ML, Piselli P, Corpolongo A, Repetto E, Bellagamba R, Cimaglia C, Carrara S, Ghirga P, Oliva A, Bevilacqua N, Al Rousan A, Nisii C, Ippolito G, Nicastri E. Serological evaluation for Chagas disease in migrants from Latin American countries resident in Rome, Italy. BMC Infect Dis 2018; 18:212. [PMID: 29739357 PMCID: PMC5941372 DOI: 10.1186/s12879-018-3118-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/27/2018] [Indexed: 12/18/2022] Open
Abstract
Background Chagas disease (CD) is a systemic parasitic infection caused by the protozoan Trypanosoma cruzi, whose chronic phase may lead to cardiac and intestinal disorders. Endemic in Latin America where it is transmitted mainly by vectors, large-scale migrations to other countries have turned CD into a global health problem because of its alternative transmission routes through blood transfusion, tissue transplantation, or congenital. Aim of this study was to compare the performance of two commercially available tests for serological diagnosis of CD in a group of Latin American migrants living in a non-endemic setting (Rome, Italy). The study was based on a cross-sectional analysis of seroprevalence in this group. Epidemiological risk factors associated to CD were also evaluated in this study population. Methods The present study was conducted on 368 subjects from the Latin American community resident in Rome. Following WHO guidelines, we employed a diagnostic strategy based on two tests to detect IgG antibodies against T. cruzi in the blood (a lysate antigen-based ELISA and a chemiluminescent microparticle CMIA composed of multiple recombinant antigens), followed by a third test (an immunochromatographic assay) on discordant samples. Results Our diagnostic approach produced 319/368 (86.7%) concordant negative and 30/368 (8.1%) concordant positive results after the first screening. Discrepancies were obtained for 19/368 (5.2%) samples that were tested using the third assay, obtaining 2 more positive and 17 negative results. The final count of positive samples was 32/368 (8.7% of the tested population). Increasing age, birth in Bolivia, and previous residence in a mud house were independent factors associated with T. cruzi positive serology. Conclusions Serological diagnosis of CD is still challenging, because of the lack of a reference standard serological assay for diagnosis. Our results reaffirm the importance of performing CD screening in non-endemic countries; employing a fully automated and highly sensitive CMIA assay first could be a cost- and resource-effective strategy for mass screening of low-risk patients. However, our results also suggest that the WHO strategy of using two different serological assays, combined with epidemiological information, remains the best approach for patients coming from endemic countries.
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Affiliation(s)
- Stefania Pane
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Maria Letizia Giancola
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy.
| | - Pierluca Piselli
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Ernestina Repetto
- Operational Center Bruxelles, Mèdecins Sans Frontières, Bruxelles, Belgium
| | - Rita Bellagamba
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Claudia Cimaglia
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Stefania Carrara
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Piero Ghirga
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Alessandra Oliva
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Nazario Bevilacqua
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Ahmad Al Rousan
- Operational Center Bruxelles, Mèdecins Sans Frontières, Bruxelles, Belgium
| | - Carla Nisii
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Via Portuense, 292, 00149, Rome, Italy
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15
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Stillwaggon E, Perez-Zetune V, Bialek SR, Montgomery SP. Congenital Chagas Disease in the United States: Cost Savings through Maternal Screening. Am J Trop Med Hyg 2018; 98:1733-1742. [PMID: 29714163 PMCID: PMC6086189 DOI: 10.4269/ajtmh.17-0818] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors through transfusions, transplants, insect feces in food, and from mother to child during gestation. Congenital infection could perpetuate Chagas disease indefinitely, even in countries without vector transmission. An estimated 30% of infected persons will develop lifelong, potentially fatal, cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment of Chagas disease in the United States. We constructed a decision-analytic model to find the lower cost option, comparing costs of testing and treatment, as needed, for mothers and infants with the lifetime societal costs without testing and the consequent morbidity and mortality due to lack of treatment or late treatment. We found that maternal screening, infant testing, and treatment of Chagas disease in the United States are cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence above 0.06% compared with no screening program. Newly approved diagnostics make universal screening cost saving with maternal prevalence as low as 0.008%. The present value of lifetime societal savings due to screening and treatment is about $634 million saved for every birth year cohort. The benefits of universal screening for T. cruzi as part of routine prenatal testing far outweigh the program costs for all U.S. births.
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Affiliation(s)
| | - Victoria Perez-Zetune
- International Finance Division, Board of Governors of the Federal Reserve System, Washington, District of Columbia
| | - Stephanie R Bialek
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Antinori S, Galimberti L, Grande R, Bianco R, Oreni L, Traversi L, Ricaboni D, Bestetti G, Lai A, Mileto D, Gismondo MR, Petullà M, Garelli S, De Maio G, Cogliati C, Torzillo D, Villa AM, Egidi AM, Repetto EC, Ridolfo AL, Corbellino M, Galli M. Chagas disease knocks on our door: a cross-sectional study among Latin American immigrants in Milan, Italy. Clin Microbiol Infect 2018; 24:1340.e1-1340.e6. [PMID: 29555394 DOI: 10.1016/j.cmi.2018.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We aimed to assess the prevalence and risk factors for Chagas disease (CD) in Latin American immigrants and to evaluate the accuracy of diagnostic tests. Moreover, we offered to all positive subjects a complete free-of-charge clinical/instrumental evaluation as well as benznidazole treatment in order to stage the disease and verify drug tolerability. METHODS A cross-sectional survey of CD among Latin Americans living in Milan and its metropolitan area was conducted between July 2013 and July 2014. Blood samples were tested for serologic evidence of CD together with a questionnaire covering demographic and clinical-epidemiological information. RESULTS Forty-eight (9.6%) of the 501 tested subjects were conclusively diagnosed as having CD. The highest prevalence of CD was among those from Bolivia (43/169, 25.4%) and El Salvador (4/68, 5.9%). Older age (adjusted odds ratio (aOR)] 1.05, p =0.004), a Bolivian origin (aOR 8.80; p =0.003), being born in the department of Santa Cruz (aOR 3.72, p =0.047), having lived in mud houses (aOR 2.68; p =0.019), and having an affected relative (aOR 12.77, p =0.001) were independently associated with CD. The ARCHITECT Chagas test showed the highest sensitivity (100%) and specificity (99.8%). Twenty-nine of the subjects with CD (60.4%) underwent disease staging, 10 of whom (35.7%) showed cardiac and/or digestive involvement. Benznidazole treatment was associated with high frequency of adverse reactions (19/27, 70.4%) and permanent discontinuation (8/27, 29.6%). CONCLUSIONS CD is highly prevalent among Bolivians and Salvadorans living in Milan. Regions with a large Latin American immigrant population should implement programmes of active detection and treatment.
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Affiliation(s)
- S Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy.
| | - L Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - R Grande
- Laboratory of Clinical Microbiology, Virology and Bioemergency, ASST Fatebenefratelli Sacco, Milan, Luigi Sacco Hospital, Italy
| | - R Bianco
- Radiology Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - L Oreni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - L Traversi
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - D Ricaboni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - G Bestetti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - A Lai
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - D Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergency, ASST Fatebenefratelli Sacco, Milan, Luigi Sacco Hospital, Italy
| | - M R Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergency, ASST Fatebenefratelli Sacco, Milan, Luigi Sacco Hospital, Italy
| | - M Petullà
- Radiology Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - S Garelli
- II Division of Internal Medicine, ASST Fatebenefratelli Sacco, Milan, Italy
| | - G De Maio
- II Division of Internal Medicine, ASST Fatebenefratelli Sacco, Milan, Italy
| | - C Cogliati
- Médecins San Frontières, Medical Department, Operational Centre Rome, MSF, Italy
| | - D Torzillo
- Médecins San Frontières, Medical Department, Operational Centre Rome, MSF, Italy
| | - A M Villa
- Opera San Francesco per i Poveri, Milan, Italy
| | - A M Egidi
- II Division of Internal Medicine, ASST Fatebenefratelli Sacco, Milan, Italy
| | - E C Repetto
- II Division of Internal Medicine, ASST Fatebenefratelli Sacco, Milan, Italy
| | - A L Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - M Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - M Galli
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
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17
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Chagas Disease in a Non-endemic Country: A Multidisciplinary Research, Bologna, Italy. J Immigr Minor Health 2017; 18:616-623. [PMID: 25935443 DOI: 10.1007/s10903-015-0214-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Global processes have brought about a substantial change in the epidemiological landscape of Chagas disease, spreading it to non-endemic areas. Italy is the second country in Europe in terms of Latin American migrants and expected infection rate. Given that scenario, the Bologna University Teaching Hospital undertaken a study aimed at providing preliminary data on the prevalence and investigating the knowledge and the subjective perceptions of Chagas disease, migration pathways and other relevant ill-health experiences. A cross-sectional study was undertaken in association with an ethnographic research. Between November 2010 and May 2013 Chagas disease testing was offered to people who attended the hospital and data were collected to investigate the broader socio-demographic and cultural factors. 151 individuals were screened for anti T. cruzi antibodies; 12 of them, 10 Bolivians and 2 Argentinians, were seroreactive, resulting in an overall prevalence of 7.94 %. Both the quantitative and the qualitative analysis revealed a degree of heterogeneity in terms of knowledge and perceptions of the disease as well as of migration pathways. The results are comparable with those reported by previous studies with similar characteristics and highlight the relevance of such public health issue in a non-endemic context. Moreover, the interdisciplinary approach has greatly helped to unveil the complex social and cultural implications of Chagas disease, to explain the subjective ill-health experiences, and to understand the ways in which the broader socio-economic and cultural context affects an intervention and its potential for success or failure.
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18
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Conners EE, Ordoñez TL, Cordon-Rosales C, Casanueva CF, Miranda SM, Brouwer KC. Chagas Disease Infection among Migrants at the Mexico/Guatemala Border. Am J Trop Med Hyg 2017; 97:1134-1140. [PMID: 29016286 PMCID: PMC5637586 DOI: 10.4269/ajtmh.16-0777] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 06/30/2017] [Indexed: 12/31/2022] Open
Abstract
Chagas disease results in the largest burden, in terms of disability-adjusted-life-years, of any parasitic disease in the Americas. Monitoring Chagas disease among migrants is critical to controlling its spread and to serving the needs of the migrant community. Therefore, we determined the prevalence and correlates of Chagas disease in regional and international migrant populations at the Mexico/Guatemala border. Data were collected as part of a larger study of human immunodeficiency virus (HIV) and migration. Participants were a sample of recent regional and international migrants who used an illicit substance or had recent problem drinking. Trypanosoma cruzi infection was classified as testing positive on two different enzyme-linked immunosorbent assays (ELISAs). Interviewer-administered surveys captured sociodemographics, migration history, Chagas disease knowledge, and access to care. We enrolled 389 recent migrants, and the prevalence of Chagas disease was 3.1%. Only 19% of the participants reported having ever heard of the disease and less than 1% had been previously tested. Trypanosoma cruzi-positive participants were more likely to have been born in a rural area or town than a city (92% yes versus 59% no, P = 0.02) and have recently lived in a house with a makeshift roof (33% yes versus 8% no, P < 0.01), walls (42% yes versus 13% no, P < 0.01), or floor (50% yes versus 21% no, P < 0.02), or cinderblock walls (92% yes versus 63% no, P = 0.04). With migration rapidly changing the distribution of Chagas disease, more work needs to be done to create targeted surveillance programs and provide access to affordable treatment among Latin American migrants.
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Affiliation(s)
- Erin E. Conners
- Department of Medicine, University of California, San Diego, La Jolla, California
- Graduate School of Public Health, San Diego State University, San Diego, California
| | | | | | | | | | - Kimberly C. Brouwer
- Department of Medicine, University of California, San Diego, La Jolla, California
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19
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Antinori S, Galimberti L, Bianco R, Grande R, Galli M, Corbellino M. Chagas disease in Europe: A review for the internist in the globalized world. Eur J Intern Med 2017; 43:6-15. [PMID: 28502864 DOI: 10.1016/j.ejim.2017.05.001] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 02/08/2023]
Abstract
Chagas disease (CD) or American trypanosomiasis identified in 1909 by Carlos Chagas, has become over the last 40years a global health concern due to the huge migration flows from Latin America to Europe, United States, Canada and Japan. In Europe, most migrants from CD-endemic areas are concentrated in Spain, Italy, France, United Kingdom and Switzerland. Pooled seroprevalence studies conducted in Europe show an overall 4.2% prevalence, with the highest infection rates observed among individuals from Bolivia (18.1%). However, in most European countries the disease is neglected with absence of screening programmes and low access to diagnosis and treatment. Physicians working in Europe should also be aware of the risk of autochthonous transmission of Trypanosoma cruzi to newborns by their infected mothers and to recipients of blood or transplanted organs from infected donors. Finally, physicians should be able to recognize and treat the most frequent and serious complications of chronic Chagas disease, namely cardiomyopathy, megacolon and megaesophagus. This review aims to highlights the problem of CD in Europe by reviewing papers published by European researchers on this argument, in order to raise the awareness of internists who are bound to increasingly encounter patients with the disease in their routine daily activities.
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Affiliation(s)
- Spinello Antinori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy.
| | - Laura Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Roberto Bianco
- Department of Radiology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Romualdo Grande
- Clinical Microbiology, Virology and Bioemergence Diagnostics, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
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Seiringer P, Pritsch M, Flores-Chavez M, Marchisio E, Helfrich K, Mengele C, Hohnerlein S, Bretzel G, Löscher T, Hoelscher M, Berens-Riha N. Comparison of four PCR methods for efficient detection of Trypanosoma cruzi in routine diagnostics. Diagn Microbiol Infect Dis 2017; 88:225-232. [PMID: 28456430 DOI: 10.1016/j.diagmicrobio.2017.04.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/06/2017] [Accepted: 04/04/2017] [Indexed: 01/08/2023]
Abstract
Due to increased migration, Chagas disease has become an international health problem. Reliable diagnosis of chronically infected people is crucial for prevention of non-vectorial transmission as well as treatment. This study compared four distinct PCR methods for detection of Trypanosoma cruzi DNA for the use in well-equipped routine diagnostic laboratories. DNA was extracted of T. cruzi-positive and negative patients' blood samples and cultured T. cruzi, T. rangeli as well as Leishmania spp. One conventional and two real-time PCR methods targeting a repetitive Sat-DNA sequence as well as one conventional PCR method targeting the variable region of the kDNA minicircle were compared for sensitivity, intra- and interassay precision, limit of detection, specificity and cross-reactivity. Considering the performance, costs and ease of use, an algorithm for PCR-diagnosis of patients with a positive serology for T. cruzi antibodies was developed.
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Affiliation(s)
- Peter Seiringer
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802 Munich, Germany; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802 Munich, Germany; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.
| | - María Flores-Chavez
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo km 2, Madrid, Spain.
| | - Edoardo Marchisio
- Dia.Pro Diagnostic BioProbes srl, Via Giosuè n°27, 20099 Sesto San Giovanni, Milan, Italy.
| | - Kerstin Helfrich
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802 Munich, Germany.
| | - Carolin Mengele
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802 Munich, Germany.
| | - Stefan Hohnerlein
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802 Munich, Germany.
| | - Gisela Bretzel
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802 Munich, Germany.
| | - Thomas Löscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802 Munich, Germany.
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802 Munich, Germany; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.
| | - Nicole Berens-Riha
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802 Munich, Germany.
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21
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Shikanai Yasuda MA, Sátolo CG, Carvalho NB, Atala MM, Ferrufino RQ, Leite RM, Furucho CR, Luna E, Silva RA, Hage M, de Oliveira CMR, Busser FD, de Freitas VLT, Wanderley DMV, Martinelli L, Almeida SR, Viñas PA, Carneiro N. Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo. PLoS Negl Trop Dis 2017; 11:e0005466. [PMID: 28333923 PMCID: PMC5380346 DOI: 10.1371/journal.pntd.0005466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 04/04/2017] [Accepted: 03/07/2017] [Indexed: 12/13/2022] Open
Abstract
Background/Methods In a pioneering cross-sectional study among Bolivian immigrants in the city of São Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients. Results The majority of the 28 seropositive patients were women, of whom 88.89% were of child-bearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed. Conclusion An interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system. Chagas disease affects approximately 6 million Latin American people. It is considered a neglected tropical disease since it mainly affects vulnerable, poverty-stricken people. Public health policies and investments in research on new treatment and control instruments have not been prioritized. In fact, disease urbanization occurred in Latin America in the 80s, and an estimated 15 million people moved from disease-endemic areas to nonendemic areas. Estimations have indicated that 2.9% of immigrants were infected by T. cruzi in 15 European countries, and more than 300,000 infected immigrants resided in the USA. In São Paulo, the estimated number of Bolivian immigrants exceeds 300,000. This study revealed the presence of mild clinical manifestations in predominantly young infected individuals, including reproductive-age women. For the first time, the feasibility of managing chronic Chagas disease at primary healthcare level centers with a biomedical and psychosocial interdisciplinary approach has been reported in the National Public Health System of Brazil. Additionally, the utilized commercial tests did not confirm the previously expected performance for diagnosis of infection. Finally, the itinerant characteristics of the Bolivian immigrant population was reported as a main factor underlying the lack of adherence to antiparasitic treatment and a main challenge for complete clinical management.
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Affiliation(s)
- Maria Aparecida Shikanai Yasuda
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Camila Gonçalves Sátolo
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Noemia Barbosa Carvalho
- Division of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Magda Maya Atala
- Hospital das Clínicas, Faculdade de Medicina Ribeirão Preto of the University of São Paulo, São Paulo, Brazil
| | - Rosario Quiroga Ferrufino
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Ruth Moreira Leite
- Centro de Vigilância Epidemiológica, Coordenadoria de Controle de Doenças da Secretaria da Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Célia Regina Furucho
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Expedito Luna
- Tropical Medicine Institute of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Rubens Antonio Silva
- Superintendência de Controle de Endemias, Secretaria da Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Marcia Hage
- Laboratory of Parasitology (LIM 46), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | | | - Felipe Delatorre Busser
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | - Vera Lucia Teixeira de Freitas
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
- Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil
| | | | - Luzia Martinelli
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Sonia Regina Almeida
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Pedro Albajar Viñas
- Control of Neglected Tropical Diseases, World Health Organization, Geneve, Switzerland
| | - Nivaldo Carneiro
- Centro de Saúde Escola Barra Funda “Alexandre Vranjac”, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Department of Social Medicine, School of Medical Sciences of Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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Requena-Méndez A, Bussion S, Aldasoro E, Jackson Y, Angheben A, Moore D, Pinazo MJ, Gascón J, Muñoz J, Sicuri E. Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis. LANCET GLOBAL HEALTH 2017; 5:e439-e447. [PMID: 28256340 DOI: 10.1016/s2214-109x(17)30073-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/17/2017] [Accepted: 01/25/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Chagas disease is currently prevalent in European countries hosting large communities from Latin America. Whether asymptomatic individuals at risk of Chagas disease living in Europe should be screened and treated accordingly is unclear. We performed an economic evaluation of systematic Chagas disease screening of the Latin American population attending primary care centres in Europe. METHODS We constructed a decision tree model that compared the test option (screening of asymptomatic individuals, treatment, and follow-up of positive cases) with the no-test option (screening, treating, and follow-up of symptomatic individuals). The decision tree included a Markov model with five states, related to the chronic stage of the disease: indeterminate, cardiomyopathy, gastrointestinal, response to treatment, and death. The model started with a target population of 100 000 individuals, of which 4·2% (95% CI 2·2-6·8) were estimated to be infected by Trypanosoma cruzi. The primary outcome was the incremental cost-effectiveness ratio (ICER) between test and no-test options. Deterministic and probabilistic analyses (Monte Carlo simulations) were performed. FINDINGS In the deterministic analysis, total costs referred to 100 000 individuals in the test and no-test option were €30 903 406 and €6 597 403 respectively, with a difference of €24 306 003. The respective number of quality-adjusted life-years (QALYs) gained in the test and no-test option were 61 820·82 and 57 354·42. The ICER was €5442. In the probabilistic analysis, total costs for the test and no-test option were €32 163 649 (95% CI 31 263 705-33 063 593) and €6 904 764 (6 703 258-7 106 270), respectively. The respective number of QALYs gained was 64 634·35 (95% CI 62 809·6-66 459·1) and 59 875·73 (58 191·18-61 560·28). The difference in QALYs gained between the test and no test options was 4758·62 (95% CI 4618·42-4898·82). The incremental cost-effectiveness ratio (ICER) was €6840·75 (95% CI 2545-2759) per QALY gained for a treatment efficacy of 20% and €4243 per QALY gained for treatment efficacy of 50%. Even with a reduction in Chagas disease prevalence to 0·05% and with large variations in all the parameters, the test option would still be more cost-effective than the no-test option (less than €30000 per QALY). INTERPRETATION Screening for Chagas disease in asymptomatic Latin American adults living in Europe is a cost-effective strategy. Findings of our model provide an important element to support the implementation of T cruzi screening programmes at primary health centres in European countries hosting Latin American migrants. FUNDING European Commission 7th Framework Program.
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Affiliation(s)
- Ana Requena-Méndez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Spain.
| | - Sheila Bussion
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Spain
| | - Edelweiss Aldasoro
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Spain
| | - Yves Jackson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Angheben
- Centre for Tropical Diseases, Sacro-Cuore Don Calabria Hospital, Negrar, Italy
| | - David Moore
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria-Jesús Pinazo
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Spain
| | - Joaquim Gascón
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Spain
| | - Jose Muñoz
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Spain
| | - Elisa Sicuri
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Spain; Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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23
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Abras A, Gállego M, Muñoz C, Juiz NA, Ramírez JC, Cura CI, Tebar S, Fernández-Arévalo A, Pinazo MJ, de la Torre L, Posada E, Navarro F, Espinal P, Ballart C, Portús M, Gascón J, Schijman AG. Identification of Trypanosoma cruzi Discrete Typing Units (DTUs) in Latin-American migrants in Barcelona (Spain). Parasitol Int 2016; 66:83-88. [PMID: 27940065 DOI: 10.1016/j.parint.2016.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/24/2016] [Accepted: 12/05/2016] [Indexed: 12/20/2022]
Abstract
Trypanosoma cruzi, the causative agent of Chagas disease, is divided into six Discrete Typing Units (DTUs): TcI-TcVI. We aimed to identify T. cruzi DTUs in Latin-American migrants in the Barcelona area (Spain) and to assess different molecular typing approaches for the characterization of T. cruzi genotypes. Seventy-five peripheral blood samples were analyzed by two real-time PCR methods (qPCR) based on satellite DNA (SatDNA) and kinetoplastid DNA (kDNA). The 20 samples testing positive in both methods, all belonging to Bolivian individuals, were submitted to DTU characterization using two PCR-based flowcharts: multiplex qPCR using TaqMan probes (MTq-PCR), and conventional PCR. These samples were also studied by sequencing the SatDNA and classified as type I (TcI/III), type II (TcII/IV) and type I/II hybrid (TcV/VI). Ten out of the 20 samples gave positive results in the flowcharts: TcV (5 samples), TcII/V/VI (3) and mixed infections by TcV plus TcII (1) and TcV plus TcII/VI (1). By SatDNA sequencing, we classified the 20 samples, 19 as type I/II and one as type I. The most frequent DTU identified by both flowcharts, and suggested by SatDNA sequencing in the remaining samples with low parasitic loads, TcV, is common in Bolivia and predominant in peripheral blood. The mixed infection by TcV-TcII was detected for the first time simultaneously in Bolivian migrants. PCR-based flowcharts are very useful to characterize DTUs during acute infection. SatDNA sequence analysis cannot discriminate T. cruzi populations at the level of a single DTU but it enabled us to increase the number of characterized cases in chronically infected patients.
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Affiliation(s)
- Alba Abras
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia, Universitat de Barcelona, Av. Joan XXIII 27-31, 08028 Barcelona, Spain; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Roselló 134-4°, 08036 Barcelona, Spain; Laboratori d'Ictiologia Genètica, Departament de Biologia, Universitat de Girona, Campus de Montilivi, 17071 Girona, Spain
| | - Montserrat Gállego
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia, Universitat de Barcelona, Av. Joan XXIII 27-31, 08028 Barcelona, Spain; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Roselló 134-4°, 08036 Barcelona, Spain.
| | - Carmen Muñoz
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Campus de Bellaterra, 08193 Cerdanyola del Vallès, Spain
| | - Natalia A Juiz
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres" (INGEBI-CONICET), Vuelta de Obligado 2490-2°, C1428ADN Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan Carlos Ramírez
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres" (INGEBI-CONICET), Vuelta de Obligado 2490-2°, C1428ADN Ciudad Autónoma de Buenos Aires, Argentina
| | - Carolina I Cura
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres" (INGEBI-CONICET), Vuelta de Obligado 2490-2°, C1428ADN Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvia Tebar
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia, Universitat de Barcelona, Av. Joan XXIII 27-31, 08028 Barcelona, Spain; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Roselló 134-4°, 08036 Barcelona, Spain
| | - Anna Fernández-Arévalo
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia, Universitat de Barcelona, Av. Joan XXIII 27-31, 08028 Barcelona, Spain; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Roselló 134-4°, 08036 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - María-Jesús Pinazo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Roselló 134-4°, 08036 Barcelona, Spain
| | - Leonardo de la Torre
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Roselló 134-4°, 08036 Barcelona, Spain
| | - Elizabeth Posada
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Roselló 134-4°, 08036 Barcelona, Spain
| | - Ferran Navarro
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Campus de Bellaterra, 08193 Cerdanyola del Vallès, Spain
| | - Paula Espinal
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Cristina Ballart
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia, Universitat de Barcelona, Av. Joan XXIII 27-31, 08028 Barcelona, Spain; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Roselló 134-4°, 08036 Barcelona, Spain
| | - Montserrat Portús
- Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia, Universitat de Barcelona, Av. Joan XXIII 27-31, 08028 Barcelona, Spain
| | - Joaquim Gascón
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Roselló 134-4°, 08036 Barcelona, Spain
| | - Alejandro G Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas (LaBMECh), Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres" (INGEBI-CONICET), Vuelta de Obligado 2490-2°, C1428ADN Ciudad Autónoma de Buenos Aires, Argentina
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Abras A, Gállego M, Llovet T, Tebar S, Herrero M, Berenguer P, Ballart C, Martí C, Muñoz C. Serological Diagnosis of Chronic Chagas Disease: Is It Time for a Change? J Clin Microbiol 2016; 54:1566-1572. [PMID: 27053668 PMCID: PMC4879299 DOI: 10.1128/jcm.00142-16] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/18/2016] [Indexed: 01/18/2023] Open
Abstract
Chagas disease has spread to areas that are nonendemic for the disease with human migration. Since no single reference standard test is available, serological diagnosis of chronic Chagas disease requires at least two tests. New-generation techniques have significantly improved the accuracy of Chagas disease diagnosis by the use of a large mixture of recombinant antigens with different detection systems, such as chemiluminescence. The aim of the present study was to assess the overall accuracy of a new-generation kit, the Architect Chagas (cutoff, ≥1 sample relative light units/cutoff value [S/CO]), as a single technique for the diagnosis of chronic Chagas disease. The Architect Chagas showed a sensitivity of 100% (95% confidence interval [CI], 99.5 to 100%) and a specificity of 97.6% (95% CI, 95.2 to 99.9%). Five out of six false-positive serum samples were a consequence of cross-reactivity with Leishmania spp., and all of them achieved results of <5 S/CO. We propose the Architect Chagas as a single technique for screening in blood banks and for routine diagnosis in clinical laboratories. Only gray-zone and positive sera with a result of ≤6 S/CO would need to be confirmed by a second serological assay, thus avoiding false-positive sera and the problem of cross-reactivity with Leishmania species. The application of this proposal would result in important savings in the cost of Chagas disease diagnosis and therefore in the management and control of the disease.
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Affiliation(s)
- Alba Abras
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Montserrat Gállego
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Teresa Llovet
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Silvia Tebar
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Mercedes Herrero
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pere Berenguer
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Ballart
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Carmen Martí
- Unitat de Microbiologia, Hospital General de Granollers, Granollers, Spain
| | - Carmen Muñoz
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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Conners EE, Vinetz JM, Weeks JR, Brouwer KC. A global systematic review of Chagas disease prevalence among migrants. Acta Trop 2016; 156:68-78. [PMID: 26777312 DOI: 10.1016/j.actatropica.2016.01.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/31/2015] [Accepted: 01/02/2016] [Indexed: 12/31/2022]
Abstract
Human migration has been identified as a potential factor for increased Chagas disease risk and has transformed the disease from a Latin American problem to a global one. We conducted a systematic review of the scientific literature between 2004-2014 in order to: summarize recent seroprevalence estimates of Chagas disease among Latin American migrants, in both endemic and non-endemic settings; compare seroprevalence estimates in migrants to countrywide prevalence estimates; and identify risk factors for Chagas disease among migrants. A total of 320 studies were screened and 23 studies were included. We found evidence that the prevalence of Chagas disease is higher than expected in some migrant groups and that reliance on blood donor screening prevalence estimates underestimates the burden of disease. Overall there is a dearth of high quality epidemiologic studies on the prevalence of Chagas disease in migrants, especially among intra-regional migrants within Latin America. Given that this zoonotic disease cannot likely be eradicated, improved surveillance and reporting is vital to continuing control efforts. More accurate health surveillance of both Latin American migrants and the Chagas disease burden will help countries appropriately scale up their response to this chronic disease. Overall, improved estimates of Chagas disease among migrants would likely serve to highlight the real need for better screening, diagnostics, and treatment of individuals living with the disease.
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Ramos JM, León R, Andreu M, de las Parras ER, Rodríguez-Díaz JC, Esteban Á, Saugar JM, Torrús D. Serological study of Trypanosoma cruzi, Strongyloides stercoralis, HIV, human T cell lymphotropic virus (HTLV) and syphilis infections in asymptomatic Latin-American immigrants in Spain. Trans R Soc Trop Med Hyg 2016; 109:447-53. [PMID: 26065661 DOI: 10.1093/trstmh/trv043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE We aimed to perform a serological screening for T. cruzi, Strongyloides stercoralis, HIV, human T cell lymphotropic virus (HTLV) and syphilis in Latin American immigrants admitted to hospital in Spain. METHODS We have carried out a cross-sectional study of Latin American immigrants admitted to the Hospital General Universitario Alicante (Spain) from June 2012 to May 2014, where screening of Chagas disease, strongyloidiasis, HTLV, HIV and syphilis was performed by serology. RESULTS A total 180 patients were included in the study. Patients' median age was 38 years old, 123 (68.3%; 123/180) were female and 57 (31.7%; 57/180) male. Five of the 180 (2.5%) patients were positive for Chagas disease; associated with knowledge about Chagas disease (p=0.005), previous contact with patients with Chagas disease (p=0.04) and being Bolivian (p<0.001). Forty-two of the 157 (26.8%) patients were positive for Strongyloides serology; associated positively with being male (p<0.001), eosinophilia (p=0.001), hyper-IgE (p<0.001) and being Ecuadorian (p=0.001), and negatively associated with being Colombian (p=0.03). Positive serology of latent syphilis was found in 1.8% (3/171) of patients. Serology of HTLV was negative in all cases. No new cases of HIV infection were diagnosed. CONCLUSIONS We propose that Latin American immigrant patients admitted to hospital in Spain be screened for strongyloidiasis, Chagas disease and syphilis by serology.
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Affiliation(s)
- José M Ramos
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante Spain Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Spain
| | - Rafael León
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante Spain
| | - Mariano Andreu
- Division of Microbiology, Hospital General Universitario de Alicante, Alicante, Spain Department of Microbiology, Universidad de Alicante, Alicante, Spain
| | | | - Juan C Rodríguez-Díaz
- Division of Microbiology, Hospital General Universitario de Alicante, Alicante, Spain Department of Microbiology, Universidad Miguel Hernandez de Elche, Spain
| | - Ángel Esteban
- Department of Clinical Laboratory, Hospital General Universitario de Alicante, Alicante, Spain
| | - José M Saugar
- Service of Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Diego Torrús
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante Spain
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Imaz-Iglesia I, Miguel LGS, Ayala-Morillas LE, García-Pérez L, González-Enríquez J, Blasco-Hernández T, Martín-Águeda MB, Sarría-Santamera A. Economic evaluation of Chagas disease screening in Spain. Acta Trop 2015; 148:77-88. [PMID: 25917718 DOI: 10.1016/j.actatropica.2015.04.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
Abstract
Although Spain is the European country with the highest Chagas disease burden, the country does not have a national control program of the disease. The purpose of this study is to evaluate the efficiency of several strategies for Chagas disease screening among Latin American residents living in Spain. The following screening strategies were evaluated: (1) non-screening; (2) screening of the Latin American pregnant women and their newborns; (3) screening also the relatives of the positive pregnant women; (4) screening also the relatives of the negative pregnant women. A cost-utility analysis was carried out to compare the four strategies from two perspectives, the societal and the Spanish National Health System (SNHS). A decision tree representing the clinical evolution of Chagas disease throughout patient's life was built. The strategies were compared through the incremental cost-utility ratio, using euros as cost measurement and quality-adjusted life years as utility measurement. A sensitivity analysis was performed to test the model parameters and their influence on the results. We found the "Non-screening" as the most expensive and less effective of the evaluated strategies, from both the societal and the SNHS perspectives. Among the screening evaluated strategies the most efficient was, from both perspectives, to extent the antenatal screening of the Latin American pregnant women and their newborns up to the relatives of the positive women. Several parameters influenced significantly on the sensitivity analyses, particularly the chronic treatment efficacy or the prevalence of Chagas disease. In conclusion, for the general Latin American immigrants living in Spain the most efficient would be to screen the Latin American mothers, their newborns and the close relatives of the mothers with a positive serology. However for higher prevalence immigrant population the most efficient intervention would be to extend the program to the close relatives of the negative mothers.
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Favila Escobio P, Ribas J, G Morillo M, Rodríguez-Ramírez G, Vicens-Ferrer J, Esteva M. Prevalence of Chagas disease in the Bolivian population of Majorca (Spain). GACETA SANITARIA 2015; 29:288-91. [PMID: 26026727 DOI: 10.1016/j.gaceta.2015.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 03/11/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To establish the prevalence of Trypanosoma cruzi infection in Bolivian (Spain) participants. METHODS A cross sectional study was carried out in Majorca. Bolivian residents older than 18 years assigned to the family physicians of two primary care centers were randomly selected from the health card population database. Participants were invited to attend a serology test and an interview. T. cruzi infection was confirmed after two positive ELISA tests. If the result was positive or dubious, the serological test was sent to the National Microbiology Center for confirmation. RESULTS A total of 251 participants were included (response rate 36.3%). The overall seroprevalence of Chagas infection was 19.1% (95% CI: 14.06-24.19). Seroprevalence was higher in participants from highly endemic provinces, those from rural areas, those who had lived in mud houses, and in those whose mother or a family member had contracted this infection. CONCLUSION This study demonstrates a high prevalence of T. cruzi in Bolivian residents, which was strongly associated with established risk factors.
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Affiliation(s)
- Pedro Favila Escobio
- Escola Graduada Health Center, Family Medicine Majorca Teaching Unit, Majorca Primary Health Care Department, Balearic Institute of Health, Palma Majorca, Baleares, Spain
| | - Joana Ribas
- Emergencies Department, Hospital Son Llàtzer, Balearic Institute of Health, Levante, Palma Majorca, Baleares, Spain.
| | - Marta G Morillo
- Son Pisá Health Center, Family Medicine Majorca Teaching Unit, Majorca Primary Health Care Department, Balearic Institute of Health, Palma Majorca, Baleares, Spain
| | - Ginna Rodríguez-Ramírez
- Son Pisá Health Center, Family Medicine Majorca Teaching Unit, Majorca Primary Health Care Department, Balearic Institute of Health, Palma Majorca, Baleares, Spain
| | - Jeronima Vicens-Ferrer
- Camp Redó Health Center, Family Medicine Majorca Teaching Unit, Majorca Primary Health Care Department, Balearic Institute of Health, Palma Majorca, Baleares, Spain
| | - Magdalena Esteva
- Family Medicine Majorca Teaching Unit, Research Unit, Majorca Primary Health Care Department, Balearic Institute of Health, Instituto de Investigación Sanitaria de Palma (idiSPA), Palma Majorca, Baleares, Spain
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Roura M, Domingo A, Leyva-Moral JM, Pool R. Hispano-Americans in Europe: what do we know about their health status and determinants? A scoping review. BMC Public Health 2015; 15:472. [PMID: 25948239 PMCID: PMC4430018 DOI: 10.1186/s12889-015-1799-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/24/2015] [Indexed: 12/19/2022] Open
Abstract
Background Policy makers and health practitioners are in need of guidance to respond to the growing geographic mobility of Hispano-American migrants in Europe. Drawing from contributions from epidemiology, social sciences, demography, psychology, psychiatry and economy, this scoping review provides an up-to-date and comprehensive synthesis of studies addressing the health status and determinants of this population. We describe major research gaps and suggest specific avenues of further inquiry. Methods We identified systematically papers that addressed the concepts “health” and “Hispano Americans” indexed in five data bases from Jan 1990 to May 2014 with no language restrictions. We screened the 4,464 citations retrieved against exclusion criteria and classified 193 selected references in 12 thematic folders with the aid of the reference management software ENDNOTE X6. After reviewing the full text of all papers we extracted relevant data systematically into a table template to facilitate the synthesising process. Results Most studies focused on a particular disease, leaving unexplored the interlinkages between different health conditions and how these relate to legislative, health services, environmental, occupational, and other health determinants. We elucidated some consistent results but there were many heterogeneous findings and several popular beliefs were not fully supported by empirical evidence. Few studies adopted a trans-national perspective and many consisted of cross-sectional descriptions that considered “Hispano-Americans” as a homogeneous category, limiting our analysis. Our results are also constrained by the availability and varying quality of studies reviewed. Conclusions Burgeoning research has produced some consistent findings but there are huge gaps in knowledge. To prevent unhelpful generalisations we need a more holistic and nuanced understanding of how mobility, ethnicity, income, gender, legislative status, employment status, working conditions, neighbourhood characteristics and social status intersect with demographic variables and policy contexts to influence the health of the diverse Hispano-American populations present in Europe. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1799-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Roura
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB) Hospital Clínic, Universitat de Barcelona, Rosselló 132, 4th floor, 08036, Barcelona, Spain.
| | - Andreu Domingo
- Centre for Demographic Studies, Autonomous University of Barcelona, Carrer de Ca n'Altayó. Edifici E2, Bellaterra, Barcelona, 08193, Spain.
| | - Juan M Leyva-Moral
- Escola Superior d'Infemeria del Mar, University Pompeu Fabra, Doctor Aiguader, 80, Barcelona, Spain.
| | - Robert Pool
- Social Science and Global Health, Centre for Social Science and Global Health, University of Amsterdam, Postbus 15718, 1001, NE, Amsterdam, The Netherlands.
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[Consensus document for the detection and management of Chagas disease in primary health care in a non-endemic areas]. Aten Primaria 2015; 47:308-17. [PMID: 25704793 PMCID: PMC6985595 DOI: 10.1016/j.aprim.2015.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 10/19/2014] [Accepted: 01/14/2015] [Indexed: 01/04/2023] Open
Abstract
Chagas disease is caused by the protozoan Trypanosoma cruzi. Although it is commonly transmitted by an insect vector in continental Latin-America, in recent decades, due migration, has been diagnosed in other countries such Spain, the European country with a largest immigrant population of Latin American. For a long time, the patient remains asymptomatic, but some years after this stage, the symptoms can be serious (dilated cardiomyopathy, megacolon, megaesophagus). In addition, detection in pregnant women has a high priority because of the route of vertical transmission. Several specific guidelines about Chagas disease has been developed on the Banks of blood, maternal hospitals, HIV co-infection, organ transplant. But due to the detection of lack of information to primary care professionals, we consider to will be useful this document written and agreed to by family phisicians, pediatricians and specialists in International Health.
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Prevalence of Chagas disease in Latin-American migrants living in Europe: a systematic review and meta-analysis. PLoS Negl Trop Dis 2015; 9:e0003540. [PMID: 25680190 PMCID: PMC4332678 DOI: 10.1371/journal.pntd.0003540] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few studies have assessed the burden of Chagas disease in non-endemic countries and most of them are based on prevalence estimates from Latin American (LA) countries that likely differ from the prevalence in migrants living in Europe. The aim of this study was to systematically review the existing data informing current understanding of the prevalence of Chagas disease in LA migrants living in European countries. METHODS We conducted a systematic review and meta-analysis of studies reporting prevalence of Chagas disease in European countries belonging to the European Union (EU) before 2004 in accordance with the MOOSE guidelines and based on the database sources MEDLINE and Global Health. No restrictions were placed on study date, study design or language of publication. The pooled prevalence was estimated using random effect models based on DerSimonian & Laird method. RESULTS We identified 18 studies conducted in five European countries. The random effect pooled prevalence was 4.2% (95%CI:2.2-6.7%); and the heterogeneity of Chagas disease prevalence among studies was high (I2 = 97%,p<0.001). Migrants from Bolivia had the highest prevalence of Chagas disease (18.1%, 95%CI:13.9-22.7%). CONCLUSIONS Prevalence of Chagas in LA migrants living in Europe is high, particularly in migrants from Bolivia and Paraguay. Data are highly heterogeneous dependent upon country of origin and within studies of migrants from the same country of origin. Country-specific prevalence differs from the estimates available from LA countries. Our meta-analysis provides prevalence estimates of Chagas disease that should be used to estimate the burden of disease in European countries.
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Lepletier A, de Almeida L, Santos L, da Silva Sampaio L, Paredes B, González FB, Freire-de-Lima CG, Beloscar J, Bottasso O, Einicker-Lamas M, Pérez AR, Savino W, Morrot A. Early double-negative thymocyte export in Trypanosoma cruzi infection is restricted by sphingosine receptors and associated with human chagas disease. PLoS Negl Trop Dis 2014; 8:e3203. [PMID: 25330249 PMCID: PMC4199546 DOI: 10.1371/journal.pntd.0003203] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/20/2014] [Indexed: 12/20/2022] Open
Abstract
The protozoan parasite Trypanosoma cruzi is able to target the thymus and induce alterations of the thymic microenvironmental and lymphoid compartments. Acute infection results in severe atrophy of the organ and early release of immature thymocytes into the periphery. To date, the pathophysiological effects of thymic changes promoted by parasite-inducing premature release of thymocytes to the periphery has remained elusive. Herein, we show that sphingosine-1-phosphate (S1P), a potent mediator of T cell chemotaxis, plays a role in the exit of immature double-negative thymocytes in experimental Chagas disease. In thymuses from T. cruzi-infected mice we detected reduced transcription of the S1P kinase 1 and 2 genes related to S1P biosynthesis, together with increased transcription of the SGPL1 sphingosine-1-lyase gene, whose product inactivates S1P. These changes were associated with reduced intrathymic levels of S1P kinase activity. Interestingly, double-negative thymocytes from infected animals expressed high levels of the S1P receptor during infection, and migrated to lower levels of S1P. Moreover, during T. cruzi infection, this thymocyte subset expresses high levels of IL-17 and TNF-α cytokines upon polyclonal stimulation. In vivo treatment with the S1P receptor antagonist FTY720 resulted in recovery the numbers of double-negative thymocytes in infected thymuses to physiological levels. Finally, we showed increased numbers of double-negative T cells in the peripheral blood in severe cardiac forms of human Chagas disease. The formation of mature lineage-committed T cells requires the specialized environment of the thymus, a central organ of the immune system supporting the development of self-tolerant T cells. Key events of intrathymic T-cell development include lineage commitment, selection events and thymic emigration. This organ undergoes physiological involution during aging. However, acute thymic atrophy can occur in the presence autoimmune diseases, malignant tumors and infections caused by intracellular pathogens. The present study shows that the protozoan parasite Trypanosoma cruzi changes the thymic microenvironmental and lymphoid compartments, resulting in premature release of very immature CD4−CD8− double-negative thymocytes, TCRneg/low, which bear a pro-inflammatory activation profile. Strikingly, we also found elevated levels of these undifferentiated T lymphocytes in the peripheral blood of patients in severe cardiac forms of chronic Chagas disease. Importantly, we provided evidence that migration of CD4−CD8− T cells from infected mouse thymus is due to sphingosine-1-phosphate receptor-1-dependent chemotaxis. These findings point to an important role for bioactive signaling sphingolipids in the thymic escape of immature thymocytes to the periphery in Chagas disease.
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Affiliation(s)
- Ailin Lepletier
- Laboratory on Thymus Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Liliane de Almeida
- Institute of Microbiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Santos
- Institute of Microbiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luzia da Silva Sampaio
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Paredes
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Juan Beloscar
- Servicio de Clínica Médica, Hospital J.B. Iturraspe, Santa Fe, Argentina
| | - Oscar Bottasso
- Servicio de Clínica Médica, Hospital J.B. Iturraspe, Santa Fe, Argentina
| | - Marcelo Einicker-Lamas
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Rosa Pérez
- Institute of Immunology, National University of Rosario, Rosario, Argentina
| | - Wilson Savino
- Laboratory on Thymus Research, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Alexandre Morrot
- Institute of Microbiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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Queiroz RML, Charneau S, Mandacaru SC, Schwämmle V, Lima BD, Roepstorff P, Ricart CAO. Quantitative proteomic and phosphoproteomic analysis of Trypanosoma cruzi amastigogenesis. Mol Cell Proteomics 2014; 13:3457-72. [PMID: 25225356 DOI: 10.1074/mcp.m114.040329] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Chagas disease is a tropical neglected disease endemic in Latin America caused by the protozoan Trypanosoma cruzi. The parasite has four major life stages: epimastigote, metacyclic trypomastigote, bloodstream trypomastigote, and amastigote. The differentiation from infective trypomastigotes into replicative amastigotes, called amastigogenesis, takes place in vivo inside mammalian host cells after a period of incubation in an acidic phagolysosome. This differentiation process can be mimicked in vitro by incubating tissue-culture-derived trypomastigotes in acidic DMEM. Here we used this well-established differentiation protocol to perform a comprehensive quantitative proteomic and phosphoproteomic analysis of T. cruzi amastigogenesis. Samples from fully differentiated forms and two biologically relevant intermediate time points were Lys-C/trypsin digested, iTRAQ-labeled, and multiplexed. Subsequently, phosphopeptides were enriched using a TiO2 matrix. Non-phosphorylated peptides were fractionated via hydrophilic interaction liquid chromatography prior to LC-MS/MS analysis. LC-MS/MS and bioinformatics procedures were used for protein and phosphopeptide quantitation, identification, and phosphorylation site assignment. We were able to identify regulated proteins and pathways involved in coordinating amastigogenesis. We also observed that a significant proportion of the regulated proteins were membrane proteins. Modulated phosphorylation events coordinated by protein kinases and phosphatases that are part of the signaling cascade induced by incubation in acidic medium were also evinced. To our knowledge, this work is the most comprehensive quantitative proteomics study of T. cruzi amastigogenesis, and these data will serve as a trustworthy basis for future studies, and possibly for new potential drug targets.
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Affiliation(s)
- Rayner M L Queiroz
- From the ‡Department of Cell Biology, Institute of Biology, University of Brasilia, Brasília, 70910-900 Brazil; §Department of Biochemistry and Molecular Biology, University of Southern Denmark, 5230 Odense M, Denmark
| | - Sébastien Charneau
- From the ‡Department of Cell Biology, Institute of Biology, University of Brasilia, Brasília, 70910-900 Brazil
| | - Samuel C Mandacaru
- From the ‡Department of Cell Biology, Institute of Biology, University of Brasilia, Brasília, 70910-900 Brazil
| | - Veit Schwämmle
- §Department of Biochemistry and Molecular Biology, University of Southern Denmark, 5230 Odense M, Denmark
| | - Beatriz D Lima
- From the ‡Department of Cell Biology, Institute of Biology, University of Brasilia, Brasília, 70910-900 Brazil
| | - Peter Roepstorff
- §Department of Biochemistry and Molecular Biology, University of Southern Denmark, 5230 Odense M, Denmark
| | - Carlos A O Ricart
- From the ‡Department of Cell Biology, Institute of Biology, University of Brasilia, Brasília, 70910-900 Brazil;
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Endothelin-1 and its role in the pathogenesis of infectious diseases. Life Sci 2014; 118:110-9. [PMID: 24780317 DOI: 10.1016/j.lfs.2014.04.021] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/08/2014] [Accepted: 04/15/2014] [Indexed: 12/12/2022]
Abstract
Endothelins are potent regulators of vascular tone, which also have mitogenic, apoptotic, and immunomodulatory properties (Rubanyi and Polokoff, 1994; Kedzierski and Yanagisawa, 2001; Bagnato et al., 2011). Three isoforms of endothelin have been identified to date, with endothelin-1 (ET-1) being the best studied. ET-1 is classically considered a potent vasoconstrictor. However, in addition to the effects of ET-1 on vascular smooth muscle cells, the peptide is increasingly recognized as a pro-inflammatory cytokine (Teder and Noble, 2000; Sessa et al., 1991). ET-1 causes platelet aggregation and plays a role in the increased expression of leukocyte adhesion molecules, the synthesis of inflammatory mediators contributing to vascular dysfunction. High levels of ET-1 are found in alveolar macrophages, leukocytes (Sessa et al., 1991) and fibroblasts (Gu et al., 1991). Clinical and experimental data indicate that ET-1 is involved in the pathogenesis of sepsis (Tschaikowsky et al., 2000; Goto et al., 2012), viral and bacterial pneumonia (Schuetz et al., 2008; Samransamruajkit et al., 2002), Rickettsia conorii infections (Davi et al., 1995), Chagas disease (Petkova et al., 2000, 2001), and severe malaria (Dai et al., 2012; Machado et al., 2006; Wenisch et al., 1996a; Dietmann et al., 2008). In this minireview, we will discuss the role of endothelin in the pathogenesis of infectious processes.
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Fumadó V, Juncosa T, Posada E, Fisa R, Gállego M, Gascón J. [Paediatric Chagas in a non-endemic area]. Enferm Infecc Microbiol Clin 2014; 32:293-6. [PMID: 24491481 DOI: 10.1016/j.eimc.2013.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/18/2013] [Accepted: 04/24/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Immigration has introduced new diseases into Spanish society, one of which is Chagas disease. Young women of childbearing age and children infected with Trypanosoma cruzi from endemic areas are at risk of developing the disease years later, and pregnant women can transmit the infection through the placenta. METHODS Serological screening for anti-T.cruzi antibodies was performed on all immigrant children coming from a Chagas endemic area and seen in our Pathology Unit between 2003 and 2008, as well as on newborns of T.cruzi positive infected pregnant women coming from Latin America. Two ELISA tests were used (bioelisa Chagas Biokit® with recombinant antigens, and an 'in house' ELISA with crude antigen). Patients with sufficient sample were also screened by nested PCR (TCZ3/Z4). RESULTS A total of 202 children, aged 1 day to 14 years old were included in the study, of whom 22 (10.8%) were diagnosed with asymptomatic infection, 5 of which were congenital as they were born in this country. All infected patients received treatment with benznidazole, with three of them currently with a serologically negative result after treatment. CONCLUSION Chagas disease is a new imported paediatric disease that can affect children from endemic countries, but can also be acquired in our country by vertical transmission. Therefore, we believe that it is essential to perform serological screening on all children and pregnant women in the prenatal care from endemic areas, and provide specific treatment for those infected patients, given the good results observed in the paediatric population.
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Affiliation(s)
- Victoria Fumadó
- Servicio de Pediatría, Unidad de Medicina Importada, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Teresa Juncosa
- Servicio de Microbiología, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
| | - Elizabet Posada
- Diago Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Barcelona, España
| | - Roser Fisa
- Laboratorio de Parasitología, Facultad de Farmacia, Universidad de Barcelona, Barcelona, España
| | - Montserrat Gállego
- Laboratorio de Parasitología, Facultad de Farmacia, Universidad de Barcelona, Barcelona, España
| | - Joaquim Gascón
- Diago Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Barcelona, España
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De Maio FG, Llovet I, Dinardi G. Chagas disease in non-endemic countries: ‘sick immigrant’ phobia or a public health concern? CRITICAL PUBLIC HEALTH 2013. [DOI: 10.1080/09581596.2013.836589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Indazoles: a new top seed structure in the search of efficient drugs against Trypanosoma cruzi. Future Med Chem 2013; 5:1843-59. [DOI: 10.4155/fmc.13.144] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
For years, Chagas disease treatment has been limited to only two drugs of highly questionable and controversial use (Nifurtimox® and Benznidazole®). In the search of effective drugs, many efforts have been made, but only a few structures have emerged as actual candidates. Heading into this, the multitarget-directed approach appears as the best choice. In this framework, indazoles were shown to be potent Trypanosoma cruzi growth inhibitors, being able to lead both the formation of reactive oxygen species and the inhibition of trypanothione reductase. Herein, we discuss the main structural factors that rule the anti-T. cruzi properties of indazoles, and how they would be involved in the biological properties as well as in the action mechanisms, attempting to make parallels between the old paradigms and current evidences in order to outline what could be the next steps to follow in regard to the future drug design for Chagas disease treatment.
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Strasen J, Williams T, Ertl G, Zoller T, Stich A, Ritter O. Epidemiology of Chagas disease in Europe: many calculations, little knowledge. Clin Res Cardiol 2013; 103:1-10. [DOI: 10.1007/s00392-013-0613-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 08/14/2013] [Indexed: 12/16/2022]
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Díaz-Menéndez M, Pérez-Molina JA, Serre N, Treviño B, Torrús D, Matarranz M, Martín E, Rojo-Marcos G, Aguilera P, Rico A, Suárez-García I, López-Vélez R. Infecciones importadas por inmigrantes y viajeros: resultados de la Red Cooperativa para el estudio de las Enfermedades Importadas por Inmigrantes y Viajeros +Redivi. Enferm Infecc Microbiol Clin 2012; 30:528-34. [DOI: 10.1016/j.eimc.2012.01.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 11/25/2022]
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Dumonteil E, Bottazzi ME, Zhan B, Heffernan MJ, Jones K, Valenzuela JG, Kamhawi S, Ortega J, de Leon Rosales SP, Lee BY, Bacon KM, Fleischer B, Slingsby BT, Cravioto MB, Tapia-Conyer R, Hotez PJ. Accelerating the development of a therapeutic vaccine for human Chagas disease: rationale and prospects. Expert Rev Vaccines 2012; 11:1043-55. [PMID: 23151163 PMCID: PMC3819810 DOI: 10.1586/erv.12.85] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chagas disease is a leading cause of heart disease affecting approximately 10 million people in Latin America and elsewhere worldwide. The two major drugs available for the treatment of Chagas disease have limited efficacy in Trypanosoma cruzi-infected adults with indeterminate (patients who have seroconverted but do not yet show signs or symptoms) and determinate (patients who have both seroconverted and have clinical disease) status; they require prolonged treatment courses and are poorly tolerated and expensive. As an alternative to chemotherapy, an injectable therapeutic Chagas disease vaccine is under development to prevent or delay Chagasic cardiomyopathy in patients with indeterminate or determinate status. The bivalent vaccine will be comprised of two recombinant T. cruzi antigens, Tc24 and TSA-1, formulated on alum together with the Toll-like receptor 4 agonist, E6020. Proof-of-concept for the efficacy of these antigens was obtained in preclinical testing at the Autonomous University of Yucatan. Here the authors discuss the potential for a therapeutic Chagas vaccine as well as the progress made towards such a vaccine, and the authors articulate a roadmap for the development of the vaccine as planned by the nonprofit Sabin Vaccine Institute Product Development Partnership and Texas Children's Hospital Center for Vaccine Development in collaboration with an international consortium of academic and industrial partners in Mexico, Germany, Japan, and the USA.
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Affiliation(s)
- Eric Dumonteil
- Laboratorio de Parasitología Centro De Investigaciones Regional, “Dr. Hideo Noguchi” Autonomous University of Yucatan (UADY), Merida, Mexico
| | - Maria Elena Bottazzi
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics (Section of Pediatric Tropical Medicine) and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Bin Zhan
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Department of Pediatrics (Section of Pediatric Tropical Medicine), National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Michael J Heffernan
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Department of Pediatrics (Section of Pediatric Tropical Medicine), National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kathryn Jones
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics (Section of Pediatric Tropical Medicine) and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jesus G Valenzuela
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Shaden Kamhawi
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Jaime Ortega
- Departamento de Biotecnología y Bioingeniería, Centro de Investigacion y de Estudios Avanzados - Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City, Mexico
| | | | - Bruce Y Lee
- Public Health Computational and Operations Research (PHICOR), University of Pittsburgh, Pittsburgh PA, USA
| | - Kristina M Bacon
- Public Health Computational and Operations Research (PHICOR), University of Pittsburgh, Pittsburgh PA, USA
| | | | | | | | | | - Peter J Hotez
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics (Section of Pediatric Tropical Medicine) and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
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Seroprevalence of Chagas infection in the donor population. PLoS Negl Trop Dis 2012; 6:e1771. [PMID: 22860152 PMCID: PMC3409134 DOI: 10.1371/journal.pntd.0001771] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 06/23/2012] [Indexed: 11/19/2022] Open
Abstract
We retrospectively calculated the prevalence and epidemiologic characteristics of Chagas infection in the New York blood donor population over three years utilizing the New York Blood Center's database of the New York metropolitan area donor population. Seventy Trypanosoma cruzi positive donors were identified from among 876,614 donors over a 3-year period, giving an adjusted prevalence of 0.0083%, with 0.0080% in 2007, 0.0073% in 2008, and 0.0097% in 2009. When filtered only for self-described “Hispanic/Latino” donors, there were 52 Chagas positive donors in that 3-year period (among 105,122 self-described Hispanic donors) with an adjusted prevalence of 0.052%, with 0.055% in 2007, 0.047% in 2008, and 0.053% in 2009. In conclusion, we found a persistent population of patients with Chagas infection in the New York metropolitan area donor population. There was geographic localization of cases which aligned with Latin American immigration clusters. Chagas Disease is a common and economically devastating disease of Latin America, with millions infected and many more at risk of infection. The hallmark of Chagas Disease is a long asymptomatic latent period (after an often tiny bug bite) followed by potentially fatal cardiac or gastrointestinal sequelae. Despite the significant number of immigrants from Chagas-endemic regions, prevalence data outside of its countries of origin remains limited. Our study looks at Trypanosoma cruzi infection in one group, blood donors in the New York metropolitan area, as this was a non invasive way to sample a sometimes difficult-to-reach population. We found that Chagas infection is in fact present, particularly in the Hispanic donors, at a consistent level over the three years we studied. We then compared the blood donor locations to a map of foreign born Hispanics in eastern Long Island in New York and found overlapping concentrations. This may mean that there is an opportunity for large scale community-focused screenings of foreign-born populations that could be both lifesaving and cost effective.
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Pérez-Arellano JL. [Chagas disease in Spain, 2012]. Rev Clin Esp 2012; 212:344-6. [PMID: 22664216 DOI: 10.1016/j.rce.2012.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 04/10/2012] [Indexed: 11/28/2022]
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Valerio-Sallent L, Roure S, Basile L, Ballesteros LA, Sabrià M, Rodrigo C. [A clinical and epidemiological study of the Trypanosoma cruzi infected population in the north metropolitan area of Barcelona]. Rev Clin Esp 2012; 212:329-36. [PMID: 22608192 DOI: 10.1016/j.rce.2012.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/21/2012] [Accepted: 03/24/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND As an inevitable consequence of Latin American immigration to Europe, Spain and other European countries, it is necessary to confront the approach to cases of Chagas infection/disease for which, epidemiologically, there are more questions than answers. This study has aimed to describe all the Chagas-infected population in the north metropolitan area of Barcelona (406,000 inhabitants). PATIENTS AND METHODS A prospective and multicentric study was performed in 3 hospitals and 1 International Health Unit. It included all patients with Trypanosoma cruzi positive serology, regardless of the requesting reason.Results The 139 diagnosed cases represent an annual incidence of: a) 0.68/10,000 inhabitants and, b) 73.2/10,000 immigrants coming from endemic zones. Of the patients, 80 (57.6%) had alterations in some complementary tests: cardiologic 62 (44.6%), digestive 38 (27.3%) and 20 (14.4%) both. According to the Brazilian Consensus of Chagas cardiomyopathy, they were classified as: 0=84 (60.4%); a=40 (28.7%); b1=4 (2.9%), b2=10 (7.2%) and c/d=1 (0.7%). Treatment with benznidazole (5mg/kg/24h for 60 days) was prescribed in 116 (83.4%) patients, 89 (76.7%) of whom completed it. Secondary effects were recorded in 56 (50.9%), which made it necessary to withdraw it in 21 (19.1%). CONCLUSIONS Fewer cases of Chagas infection/disease than expected have been diagnosed in the North Metropolitan area of Barcelona. The series contains a high number of patients and there may be an elevated number of immigrants from endemic zones who have the asymptomatic chronic stages of the infection and who were unaware of their condition.
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Affiliation(s)
- L Valerio-Sallent
- Unitat de Salut Internacional Metropolitana Nord, Universitat Autònoma de Barcelona, Barcelona, España.
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Machado FS, Jelicks LA, Kirchhoff LV, Shirani J, Nagajyothi F, Mukherjee S, Nelson R, Coyle CM, Spray DC, Campos de Carvalho AC, Guan F, Prado CM, Lisanti MP, Weiss LM, Montgomery SP, Tanowitz HB. Chagas heart disease: report on recent developments. Cardiol Rev 2012; 20:53-65. [PMID: 22293860 PMCID: PMC3275684 DOI: 10.1097/crd.0b013e31823efde2] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chagas disease, caused by the parasite Trypanosoma cruzi, is an important cause of cardiac disease in endemic areas of Latin America. It is now being diagnosed in nonendemic areas because of immigration. Typical cardiac manifestations of Chagas disease include dilated cardiomyopathy, congestive heart failure, arrhythmias, cardioembolism, and stroke. Clinical and laboratory-based research to define the pathology resulting from T. cruzi infection has shed light on many of the cellular and molecular mechanisms leading to these manifestations. Antiparasitic treatment may not be appropriate for patients with advanced cardiac disease. Clinical management of Chagas heart disease is similar to that used for cardiomyopathies caused by other processes. Cardiac transplantation has been successfully performed in a small number of patients with Chagas heart disease.
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Affiliation(s)
- Fabiana S. Machado
- Departments of Biochemistry and Immunology, Institute of Biological Sciences, and Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Linda A. Jelicks
- Gruss Magnetic Resonance Research Center and Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY
| | - Louis V. Kirchhoff
- Departments of Internal Medicine and Epidemiology, University of Iowa, Iowa City, IA
- Department of Veterans Affairs Medical Center, Iowa City, IA
| | - Jamshid Shirani
- Department of Cardiology St Luke’s Hospital and Health Network, Bethlehem, PA
| | - Fnu Nagajyothi
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY
| | - Shankar Mukherjee
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY
| | - Randin Nelson
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY
| | - Christina M. Coyle
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Parasitology, Jacobi Medical Center, Bronx, NY
| | - David C. Spray
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY
| | - Antonio C. Campos de Carvalho
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY
- National Cardiology Institute, Rio de Janeiro, Brazil
- Institute of Biophysics, Federal University of Rio de Janeiro, Brazil
| | - Fangxia Guan
- Bioengineering Department of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Cibele M. Prado
- Department of Pathology, University of São Paulo, Ribeirão Preto, Brazil
| | - Michael P. Lisanti
- Kimmel Cancer Center, Departments of Cancer Biology and Stem Cell Biology and Regenerative Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Louis M. Weiss
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Parasitology, Jacobi Medical Center, Bronx, NY
- Global Health Center, Albert Einstein College of Medicine, Bronx, NY
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA
| | - Herbert B. Tanowitz
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Parasitology, Jacobi Medical Center, Bronx, NY
- Global Health Center, Albert Einstein College of Medicine, Bronx, NY
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Affiliation(s)
- Herbert B Tanowitz
- Department of Pathology, Division of Parasitology, Albert Einstein College of Medicine, Bronx, New York, USA.
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