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Dumonteil E, Tu W, Desale H, Goff K, Marx P, Ortega-Lopez J, Herrera C. Immunoglobulin and T cell receptor repertoire changes induced by a prototype vaccine against Chagas disease in naïve rhesus macaques. J Biomed Sci 2024; 31:58. [PMID: 38824576 PMCID: PMC11143712 DOI: 10.1186/s12929-024-01050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/27/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND A vaccine against Trypanosoma cruzi, the agent of Chagas disease, would be an excellent additional tool for disease control. A recombinant vaccine based on Tc24 and TSA1 parasite antigens was found to be safe and immunogenic in naïve macaques. METHODS We used RNA-sequencing and performed a transcriptomic analysis of PBMC responses to vaccination of naïve macaques after each vaccine dose, to shed light on the immunogenicity of this vaccine and guide the optimization of doses and formulation. We identified differentially expressed genes and pathways and characterized immunoglobulin and T cell receptor repertoires. RESULTS RNA-sequencing analysis indicated a clear transcriptomic response of PBMCs after three vaccine doses, with the up-regulation of several immune cell activation pathways and a broad non-polarized immune profile. Analysis of the IgG repertoire showed that it had a rapid turnover with novel IgGs produced following each vaccine dose, while the TCR repertoire presented several persisting clones that were expanded after each vaccine dose. CONCLUSIONS These data suggest that three vaccine doses may be needed for optimum immunogenicity and support the further evaluation of the protective efficacy of this vaccine.
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Affiliation(s)
- Eric Dumonteil
- Department of Tropical Medicine and Infectious Disease, School of Public Health and Tropical Medicine, and Vector-Borne and Infectious Disease Research Center, Tulane University, 1440 Canal St, New Orleans, Louisiana, 70112, USA.
| | - Weihong Tu
- Department of Tropical Medicine and Infectious Disease, School of Public Health and Tropical Medicine, and Vector-Borne and Infectious Disease Research Center, Tulane University, 1440 Canal St, New Orleans, Louisiana, 70112, USA
| | - Hans Desale
- Department of Tropical Medicine and Infectious Disease, School of Public Health and Tropical Medicine, and Vector-Borne and Infectious Disease Research Center, Tulane University, 1440 Canal St, New Orleans, Louisiana, 70112, USA
| | - Kelly Goff
- Division of Microbiology, Tulane National Primate Research Center, Tulane University, Covington, LA, USA
| | - Preston Marx
- Department of Tropical Medicine and Infectious Disease, School of Public Health and Tropical Medicine, and Vector-Borne and Infectious Disease Research Center, Tulane University, 1440 Canal St, New Orleans, Louisiana, 70112, USA
- Division of Microbiology, Tulane National Primate Research Center, Tulane University, Covington, LA, USA
| | - Jaime Ortega-Lopez
- Departamento de Biotecnología y Bioingeniería, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de Mexico, México
| | - Claudia Herrera
- Department of Tropical Medicine and Infectious Disease, School of Public Health and Tropical Medicine, and Vector-Borne and Infectious Disease Research Center, Tulane University, 1440 Canal St, New Orleans, Louisiana, 70112, USA
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Agudelo Higuita NI, Beatty NL, Forsyth C, Henao-Martínez AF, Manne-Goehler J. Chagas disease in the United States: a call for increased investment and collaborative research. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100768. [PMID: 38798947 PMCID: PMC11127192 DOI: 10.1016/j.lana.2024.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Chagas disease, caused by the protozoan Trypanosoma cruzi, is a highly overlooked parasitic infection within the United States. It affects an estimated 300,000 individuals, often remaining asymptomatic for years before triggering severe complications such as cardiomyopathy in 30-40% of cases. While many contract the disease in Latin America, its transmission by local vectors in the southern U.S. presents a significant challenge. Unfortunately, limited access to diagnosis and treatment persists, alongside unresolved gaps in healthcare systems and disease pathogenesis. In this viewpoint, we discuss the need for focused research and public health initiatives, with U.S. research institutions playing a crucial role in developing new treatments and identifying biomarkers. Furthermore, investigating the genetic variations of T. cruzi between North and South America is vital for improving diagnostic and treatment strategies. Urgent action is required to implement national and local programs, bolstering healthcare responses and advancing research efforts.Q4As per journal style section heading 'Introduction' is mandatory, hence we have introduced the heading. Please check, and correct if necessary.ResolvedQ5If there are any drug dosages in your article, please verify them and indicate that you have done so by initialing this query.ResolvedQ6Please supply the year of publication.ResolvedFootnoteView Edit Log9.
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Affiliation(s)
- Nelson Iván Agudelo Higuita
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Norman L. Beatty
- Department of Medicine, Division of Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Colin Forsyth
- Drugs for Neglected Diseases Initiative–North America, New York, NY, USA
| | - Andrés F. Henao-Martínez
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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3
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Antequera A, Molin-Veglia AD, López-Alcalde J, Álvarez-Díaz N, Muriel A, Muñoz J. Reactivation of Trypanosoma cruzi infection in immunosuppressed patients: a systematic review and meta-analysis. Clin Microbiol Infect 2024:S1198-743X(24)00210-6. [PMID: 38697392 DOI: 10.1016/j.cmi.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND The risk of Trypanosoma cruzi reactivation is poorly understood. Previous studies evaluating the risk of reactivation report imprecise findings, and recommendations for monitoring and management from clinical guidelines rely on consensus opinion. OBJECTIVES We conducted a systematic review and meta-analysis to estimate the cumulative T. cruzi reactivation incidence in immunosuppressed adults, summarize the available evidence on prognostic factors for reactivation, and examine its prognostic effect on mortality. DATA SOURCES MEDLINE, Embase, LILACS, Clinical Trials, and CENTRAL from inception to 4 July 2022. STUDY ELIGIBILITY CRITERIA Studies reporting the incidence of T. cruzi reactivation. PARTICIPANTS Immunosuppressed adults chronically infected by T. cruzi. METHODS Two authors independently extracted data (including, but not limited to, incidence data, reactivation definition, follow-up, treatment, monitoring schedule, examined prognostic factors) and evaluated the risk of bias. We pooled cumulative incidence using a random-effects model. RESULTS Twenty-two studies (806 participants) were included. The overall pooled incidence of T. cruzi reactivation was 27% (95% CI, 19-36), with the highest pooled proportion in the sub-group of transplant recipients (36%; 95% CI, 25-48). The highest risk period was in the first 6 months after transplant (32%; 95% CI, 17-58), decreasing drastically the number of new cases later. People living with HIV and patients with autoimmune diseases experienced significantly lower cumulative reactivation incidences (17%; 95% CI, 8-29 and 18%; 95% CI, 9-29, respectively). A single study explored the independent effect of benznidazole and found benefits for preventing reactivations. No studies evaluated the independent association between reactivation and mortality, while sensitivity analysis results using unadjusted estimates were inconclusive. The heterogeneity of diagnostic algorithms was substantial. CONCLUSIONS Reactivation occurs in three out of ten T. cruzi-seropositive immunosuppressed adults. These findings can assist clinicians and panel guidelines in tailoring monitoring schedules. There is a great need for an accurate definition of reactivation and targeted monitoring.
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Affiliation(s)
- Alba Antequera
- Barcelona Institute for Global Health, Hospital Clínic Universitat de Barcelona (UB), Barcelona, Spain.
| | - Agustina Dal Molin-Veglia
- Barcelona Institute for Global Health, Hospital Clínic Universitat de Barcelona (UB), Barcelona, Spain
| | - Jesús López-Alcalde
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain; Clinical Biostatistics Unit, Instituto Ramon y Cajal de Investigación Sanitaria, Madrid, Spain; CIBERESP, Madrid, Spain; Institute for Complementary and Integrative Medicine, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Noelia Álvarez-Díaz
- Medical Library, Hospital Universitario Ramon y Cajal, Irycis, Madrid, Spain
| | - Alfonso Muriel
- Clinical Biostatistics Unit, Instituto Ramon y Cajal de Investigación Sanitaria, Madrid, Spain; CIBERESP, Madrid, Spain; Department of Nursing and Physiotherapy, Universidad Alcalá de Henares, Alcalá de Henares, Spain
| | - José Muñoz
- Barcelona Institute for Global Health, Hospital Clínic Universitat de Barcelona (UB), Barcelona, Spain
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Herrera C, Bernabé KJ, Dumonteil E, DeCuir J, Thompson JM, Avendano M, Tu W, Leonhardt MM, Northland BA, Frederick J, Prieto B, Paternina-Caicedo A, Ortega E, Fonseca M, Hincapie M, Echeverri M. Assessment of Community Awareness and Screening of Chagas Disease in the Latin American Community of Greater New Orleans. Trop Med Infect Dis 2023; 8:515. [PMID: 38133447 PMCID: PMC10747578 DOI: 10.3390/tropicalmed8120515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Chagas disease is a public health problem in the Americas, from the southern United States (USA) to Argentina. In the USA, less than 1% of domestic cases have been identified and less than 0.3% of total cases have received treatment. Little is known about affected immigrant Latin American communities. A prospective study was conducted to assess knowledge about Chagas disease among the Latin American community living in the Greater New Orleans area. Participants answered a baseline questionnaire, viewed a short educational video presentation, completed a post-presentation questionnaire, and were screened with an FDA-approved blood rapid diagnostic test (RDT). A total of 154 participants from 18 Latin American countries (n = 138) and the USA (n = 16) were enrolled and screened for Trypanosoma cruzi infection. At baseline, 57% of the participants knew that Chagas disease is transmitted through an insect vector, and 26% recognized images of the vector. Following the administration of an educational intervention, the participants' knowledge regarding vector transmission increased to 91% and 35% of participants were able to successfully identify images of the vector. Five participants screened positive for T. cruzi infection, indicating a 3.24% [95%CI: 1.1-7.5%] prevalence of Trypanosoma cruzi infection within the Latin American community of the New Orleans area. Results highlight the urgent need for improving access to education and diagnostics of Chagas disease.
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Affiliation(s)
- Claudia Herrera
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Kerlly J. Bernabé
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Eric Dumonteil
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - James DeCuir
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Julie M. Thompson
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Mariana Avendano
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Weihong Tu
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Maxwell M. Leonhardt
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.M.L.); (B.A.N.)
| | - Bianka A. Northland
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.M.L.); (B.A.N.)
| | - Jynx Frederick
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Bryn Prieto
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA;
| | - Angel Paternina-Caicedo
- Department of Epidemiology, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA;
| | - Emma Ortega
- Office of Public Health-Infectious Disease Epidemiology, Louisiana Department of Health, New Orleans, LA 70802, USA;
| | - Maria Fonseca
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA; (M.F.); (M.H.); (M.E.)
| | - Marcela Hincapie
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA; (M.F.); (M.H.); (M.E.)
| | - Margarita Echeverri
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA; (M.F.); (M.H.); (M.E.)
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Dumonteil E, Tu W, Desale H, Goff K, Marx P, Ortega-Lopez J, Herrera C. Immunoglobin and T cell receptor repertoire changes induced by a prototype vaccine against Chagas disease in naïve rhesus macaques. RESEARCH SQUARE 2023:rs.3.rs-3453582. [PMID: 37961272 PMCID: PMC10635379 DOI: 10.21203/rs.3.rs-3453582/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
A vaccine against Trypanosoma cruzi, the agent of Chagas disease, would be an excellent additional tool for disease control. A recombinant vaccine based on Tc24 and TSA1 parasite antigens was found to be safe and immunogenic in naïve macaques. Here we performed a transcriptomic analysis of PBMC responses to vaccination, to shed light on the immunogenicity of this vaccine and guide the optimization of doses and formulation. RNA-sequencing analysis indicated a clear transcriptomic response of PBMCs from macaques after three vaccine doses, with the up-regulation of several immune cell activation pathways and a broad non-polarized immune profile. Analysis of the IgG repertoire showed that it had a rapid turnover with novel IgGs produced following each vaccine dose, while the TCR repertoire presented several persisting clones that were expanded after each vaccine dose. These data suggest that three vaccine doses may be needed for optimum immunogenecity and support the further evaluation of the protective efficacy of this vaccine.
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6
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Proaño A, Dumonteil E, Herrera C. Chagas Disease Diagnostic Testing in Two Academic Hospitals in New Orleans, Louisiana: A Call to Action. Trop Med Infect Dis 2023; 8:tropicalmed8050277. [PMID: 37235325 DOI: 10.3390/tropicalmed8050277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Chagas disease, caused by the protozoa parasite Trypanosoma cruzi, is an anthropozoonosis that represents a major public health problem in the Americas, affecting 7 million people with at least 65 million at risk. We sought to assess the intensity of disease surveillance based on diagnostic test requests from hospitals in New Orleans, Louisiana. We extracted information from send-out labs at two major tertiary academic hospitals in New Orleans, Louisiana, USA, from 1 January 2018 to 1 December 2020. We found that in these three years there were 27 patients for whom Chagas disease testing was ordered. Most of these patients were male (70%), with a median age of 40 years old, and their most common ethnical background was Hispanic (74%). These findings demonstrate undertesting of this neglected disease in our region. Given the low Chagas disease surveillance, we need to increase awareness, health promotion, and education among healthcare workers.
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Affiliation(s)
- Alvaro Proaño
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Eric Dumonteil
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Claudia Herrera
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
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7
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Ávila MR, Figueiredo PHS, Lima VP, de Oliveira LFL, de Oliveira LFF, Silva WT, Trede Filho RG, de Carvalho Bastone A, Lacerda ACR, Mendonça VA, Mediano MFF, Costa HS. The prognostic value of the Incremental Shuttle Walk Test in Chagas cardiomyopathy. Disabil Rehabil 2022; 44:7516-7521. [PMID: 34613873 DOI: 10.1080/09638288.2021.1986580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To verify the value of the Incremental Shuttle Walk Test (ISWT) distance to identify patients with Chagas cardiomyopathy (ChC) at risk of adverse cardiovascular events. METHODS Fifty-two patients with ChC (51 ± 6 years) were evaluated by ISWT, echocardiography, Cardiopulmonary Exercise Testing, and Human Activity Profile (HAP) Questionnaire. Patients were prospectively followed for 44 ± 10 months. The combined endpoint was cardiac death/heart transplant/stroke. The prognostic value of ISWT was verified by the Cox regression, and the ISWT was adjusted for age, sex, left ventricular ejection fraction (LVEF), and minute ventilation/carbon dioxide production relationship (VE/VCO2 slope). RESULTS At the final follow-up, 11 patients (21%) had experienced the endpoint event. When adjusted for age, sex, LVEF, and VE/VCO2 slope, only ISWT distance (HR 0.99, 95% confidence interval (CI): 0.98-0.99; p = 0.026) and VE/VCO2 slope (HR 0.93, 95% CI: 0.87-0.99; p = 0.044) remained as independent predictors of adverse cardiovascular events in patients with ChC. The optimal cutoff point for identifying poor prognosis was the ISWT distance less than 440 m (AUC = 0.72). There was a significant difference (p = 0.032) in the number of events between the groups with low ISWT distance (≤440 m) and high (>440 m) ISWT distance. CONCLUSIONS The ISWT is a valuable tool with potential value in the prognostic evaluation of patients with ChC.Implications for rehabilitationPatients with Chagas cardiomyopathy showed functional impairment since the early stages of heart disease.The Incremental Shuttle Walk Test (ISWT) can be a valuable and inexpensive tool in the risk stratification of the patients.The ISWT distance is an independent predictor of adverse cardiovascular event.The ISWT distance of 440m is the optimal cut-off point in the identification of patients at risk for adverse cardiovascular events.
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Affiliation(s)
- Matheus Ribeiro Ávila
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.,Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Vanessa Pereira Lima
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.,Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Luciano Fonseca Lemos de Oliveira
- Department of Physiotherapy, School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Lucas Frois Fernandes de Oliveira
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Whesley Tanor Silva
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Renato Guilherme Trede Filho
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.,Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Alessandra de Carvalho Bastone
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.,Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Ana Cristina Rodrigues Lacerda
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.,Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Vanessa Amaral Mendonça
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.,Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | | | - Henrique Silveira Costa
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.,Postgraduate Course of Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
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Batista C. A glimmer of hope for a neglected disease - How Chagas disease associative movement is driving progress towards disease control and elimination. Mem Inst Oswaldo Cruz 2022; 117:e220083chgsb. [PMID: 36287431 PMCID: PMC9590315 DOI: 10.1590/0074-02760220083chgsb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Carolina Batista
- Head of Global Health Affairs, Baraka Impact Finance. Former International Board Member, Médecins Sans Frontières (MSF),+ Corresponding author:
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Our Current Understanding of Chagas Disease and Trypanosoma cruzi Infection in the State of Florida — an Update on Research in this Region of the USA. CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose of Review
Chagas disease (CD) is a neglected tropical disease caused by the protozoan parasite, Trypanosoma cruzi. Parasite transmission primarily occurs through direct interaction with an infected triatomine insect vector (kissing bug), but other routes are known. We aim to review the literature and discuss the unique circumstances of CD in the US state of Florida.
Recent Findings
Florida is home to naturally occurring kissing bugs that are invading homes and harbor T. cruzi. The state is also home to a diverse population of immigrants from Chagas-endemic regions in Latin America. In the USA, Florida is the state with the third highest estimated burden of CD, although the true prevalence is unknown.
Summary
Chagas disease is a chronic infection that often remains silent for decades. Those who manifest chronic disease may eventually die from debilitating cardiac and/or gastrointestinal manifestations. Florida is an opportune region of the USA for the study of CD, due to the existence of endemic transmission cycles in addition to the burden among people born in Chagas-endemic regions.
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10
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Damasceno RF, Sabino EC, Ribeiro ALP, Ferreira AM, de Oliveira-da Silva LC, Oliveira CDL, Cardoso CS, Vieira TM, Haikal DSA. Failure to use health services by people with Chagas disease: Multilevel analysis of endemic area in Brazil. PLoS Negl Trop Dis 2022; 16:e0010785. [PMID: 36121849 PMCID: PMC9522310 DOI: 10.1371/journal.pntd.0010785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/29/2022] [Accepted: 09/03/2022] [Indexed: 02/01/2023] Open
Abstract
This study aimed to assess the prevalence of non-use of health services in the last year by people with Chagas disease (CD) in an endemic area in Brazil and the contextual and individual factors associated with this non-use. This is a multilevel study that considered contextual and individual data. Contextual data were collected from official publicly accessible databases of the Brazilian government, at the municipal level. The individual data came from the first follow-up of a Brazilian cohort that assessed patients with CD in 21 municipalities in endemic area for the disease. The sample consisted of 1,160 individuals with CD. The dependent variable "use of health services in the last year" was categorized as yes vs. no. The analysis was performed using Poisson regression with robust variance. The prevalence of non-use of health services in the last year was 23.5% (IC95%: 21.1-25.9). The contextual factor "larger population" (PR: 1.6; 95% CI = 1.2-2.0) and individual factors related to the lower severity of the disease as a functional class without limitations (PR: 1.6; 95% CI = 1.2-2.1) and unaltered N-terminal pro b-type natriuretic peptide levels (PR: 2.2; 95% CI = 1.3-3.6) increased the prevalence of non-use of the health service in the last year by people with CD. The results of this study showed that individual determinants are not isolated protagonists of the non-use of health services in the last year by people with CD, which reinforces the need for public policies that consider the contextual determinants of the use of health services by populations affected by the disease.
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Affiliation(s)
- Renata Fiúza Damasceno
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
- * E-mail:
| | | | - Antonio Luiz Pinho Ribeiro
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ariela Mota Ferreira
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | | | - Cláudia Di Lorenzo Oliveira
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health–Centro Oeste Campus, Divinópolis, Minas Gerais, Brazil
| | - Clareci Silva Cardoso
- Federal University of São João del-Rey, Research Group in Epidemiology and New Technologies in Health–Centro Oeste Campus, Divinópolis, Minas Gerais, Brazil
| | - Thallyta Maria Vieira
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Desirée Sant’ Ana Haikal
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
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Irish A, Whitman JD, Clark EH, Marcus R, Bern C. Updated Estimates and Mapping for Prevalence of Chagas Disease among Adults, United States. Emerg Infect Dis 2022; 28:1313-1320. [PMID: 35731040 PMCID: PMC9239882 DOI: 10.3201/eid2807.212221] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Geographic scale estimates of disease in older Latin America–born US residents may be useful for prevention and early recognition of chronic sequelae. We combined American Community Survey data with age-specific Trypanosoma cruzi prevalence derived from US surveys and World Health Organization reports to yield estimates of Chagas disease in the United States, which we mapped at the local level. In addition, we used blood donor data to estimate the relative prevalence of autochthonous T. cruzi infection. Our estimates indicate that 288,000 infected persons, including 57,000 Chagas cardiomyopathy patients and 43,000 infected reproductive-age women, currently live in the United States; 22–108 congenital infections occur annually. We estimated ≈10,000 prevalent cases of locally acquired T. cruzi infection. Mapping shows marked geographic heterogeneity of T. cruzi prevalence and illness. Reliable demographic and geographic data are key to guiding prevention and management of Chagas disease. Population-based surveys in high prevalence areas could improve the evidence base for future estimates. Knowledge of the demographics and geographic distribution of affected persons may aid practitioners in recognizing Chagas disease.
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Mahoney West H, Milliren CE, Manne-Goehler J, Davis J, Gallegos J, Perez JH, Köhler JR. Effect of clinician information sessions on diagnostic testing for Chagas disease. PLoS Negl Trop Dis 2022; 16:e0010524. [PMID: 35709253 PMCID: PMC9242495 DOI: 10.1371/journal.pntd.0010524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 06/29/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chagas disease is a potentially life-threatening neglected disease of poverty that is endemic in continental Latin America. Caused by Trypanosoma cruzi (T. cruzi), it is one of six parasitic diseases in the United States targeted by the Centers for Disease Control as a public health problem in need of action. An estimated 300,000 people are infected with T. cruzi in the United States (US). Although its morbidity, mortality and economic burden are high, awareness of Chagas disease is lacking among many healthcare providers in the US. The purpose of this analysis is to determine if the number of diagnostic tests performed at a community health center serving an at-risk population for Chagas disease increased after information sessions. A secondary aim was to determine if there was a difference by provider type, i.e., nurse practitioner vs. physician, or by specialty in the number of patients screened. Methodology/Principal findings We conducted a retrospective data analysis of the number of Chagas serology tests performed at a community health center before and after information sessions for clinicians. A time series analysis was conducted focusing on the Adult and Family Medicine Departments at East Boston Neighborhood Health Center (EBNHC). Across all departments there were 1,957 T. cruzi tests performed before the sessions vs. 2,623 after the sessions. Interrupted time series analysis across departments indicated that testing volume was stable over time prior to the sessions (pre-period slope = +4.1 per month; p = 0.12), followed by an immediate shift after the session (+51.6; p = 0.03), while testing volume remained stable over time after the session (post-period slope = -6.0 per month; p = 0.11). Conclusion/Significance In this study, Chagas testing increased after information sessions. Clinicians who began testing their patients for Chagas disease after learning of the importance of this intervention added an extra, potentially time-consuming task to their already busy workdays without external incentives or recognition. Chagas disease is a potentially fatal neglected disease of poverty. It is endemic in continental Latin America with an estimated 300,000 cases in the United States, primarily among low-income people who have immigrated to the US from Latin America. Few Chagas screening programs have been established in the US. Existing recommendations for Chagas disease testing and treatment are rarely followed for many reasons including a paucity of knowledge among providers. We aimed to determine if the number of Chagas tests performed increased after information sessions at a community health center. A secondary aim was to determine if there was a difference in number of tests performed by provider type. We found that the number of T. cruzi serologies performed in the ten months after information sessions increased significantly over that in the ten preceding months. Chagas testing increased across departments, though Chagas diagnostics were an extra and unmitigated time burden on clinicians. Increasing provider knowledge is a major step to increase diagnosis and treatment of this neglected disease, when clinicians are motivated by their inherent prosocial preferences including altruism i.e., by the positive impact of their work on patients’ lives.
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Affiliation(s)
- Helen Mahoney West
- Division of Infectious Disease Boston Children’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Carly E. Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | | | - Jillian Davis
- East Boston Neighborhood Health Center, Boston, Massachusetts, United States of America
| | - Jaime Gallegos
- East Boston Neighborhood Health Center, Boston, Massachusetts, United States of America
| | - Juan Huanuco Perez
- East Boston Neighborhood Health Center, Boston, Massachusetts, United States of America
| | - Julia R. Köhler
- Division of Infectious Disease Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
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Monroy MC, Penados D, Pineda J, Ruiz EL, Agreda EO, Alcantara B, Rodas A, Lange K, Weinberg D, Bazzani R, Marchiol A, Herazo R, Agrelo RS, Abril M, Chuit R. A multidisciplinary, collaborative, inter-agency and comprehensive approach for the control of Chagas Disease as a public health problem in Guatemala. Acta Trop 2022; 225:106157. [PMID: 34634265 DOI: 10.1016/j.actatropica.2021.106157] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
The Pan American Health Organization (PAHO) has defined Chagas Disease hotspots in Central America associated with the vector Triatoma spp. Triatoma dimidiata is a native vector adapted to multiple environments, including intra-domestic and peri-domestic habitats. A multi-institutional project named "Alliances for the elimination of Chagas in Central America" was created to help reduce the incidence of the disease in the region. Activities performed in the field as part of the project included aspects of vector surveillance and control, improvement of houses, diagnosis and treatment of individuals, health promotion, training of human resources and identification of access barriers to diagnosis and treatment. As a base line study, eleven villages, comprised of 1,572 households, were entomologically evaluated (83.4% overall participation); five were found to have very high infestation rates (>20%), three had high infestation rates (8-20%) and three had low-infestation rates (<8%), coinciding with the category of infestation-risk of the houses within each village. Serological tests were carried out in 812 people (>80% participation) in two of the 11 villages and none of the 128 children tested, less than 5 years of age, were positive for Trypanosoma cruzi infection. Community participation in all the activities was high (>70%). The collaboration between several subnational, national, and international institutions, each with specific roles, promoted community participation in the activities of vector control and patient care, thus, establishing a baseline to continue implementing and monitoring project progress.
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Sanmartino M, Forsyth CJ, Avaria A, Velarde-Rodriguez M, Gómez i Prat J, Albajar-Viñas P. The multidimensional comprehension of Chagas disease. Contributions, approaches, challenges and opportunities from and beyond the Information, Education and Communication field. Mem Inst Oswaldo Cruz 2022; 117:e200460. [DOI: 10.1590/0074-02760200460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/13/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
| | | | | | - Mar Velarde-Rodriguez
- Swiss Tropical and Public Health Institute, Switzerland; University of Basel, Switzerland
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The Importance of Screening for Chagas Disease Against the Backdrop of Changing Epidemiology in the USA. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:185-193. [PMID: 36105114 PMCID: PMC9463514 DOI: 10.1007/s40475-022-00264-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
Purpose of Review This review seeks to identify factors contributing to the changing epidemiology of Chagas disease in the United States of America (US). By showcasing screening programs for Chagas disease that currently exist in endemic and non-endemic settings, we make recommendations for expanding access to Chagas disease diagnosis and care in the US. Recent Findings Several factors including but not limited to increasing migration, climate change, rapid population growth, growing urbanization, changing transportation patterns, and rising poverty are thought to contribute to changes in the epidemiology of Chagas disease in the US. Outlined are some examples of successful screening programs for Chagas disease in other countries as well as in some areas of the US, notably those which focus on screening high-risk populations and are linked to affordable and effective treatment options. Summary Given concerns that Chagas disease prevalence and even risk of transmission may be increasing in the US, there is a need for improving detection and treatment of the disease. There are many successful screening programs in place that can be replicated and/or expanded upon in the US. Specifically, we propose integrating Chagas disease into relevant clinical guidelines, particularly in cardiology and obstetrics/gynecology, and using advocacy as a tool to raise awareness of Chagas disease.
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Mercado-Saavedra B, Ribas E, Detoy K. What's new in academic international medicine? The perils of neglecting diseases. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2022. [DOI: 10.4103/ijam.ijam_47_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Miranda-Arboleda AF, Zaidel EJ, Marcus R, Pinazo MJ, Echeverría LE, Saldarriaga C, Sosa Liprandi Á, Baranchuk A. Roadblocks in Chagas disease care in endemic and nonendemic countries: Argentina, Colombia, Spain, and the United States. The NET-Heart project. PLoS Negl Trop Dis 2021; 15:e0009954. [PMID: 34968402 PMCID: PMC8717966 DOI: 10.1371/journal.pntd.0009954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Chagas disease (CD) is endemic in Latin America; however, its spread to nontropical areas has raised global interest in this condition. Barriers in access to early diagnosis and treatment of both acute and chronic infection and their complications have led to an increasing disease burden outside of Latin America. Our goal was to identify those barriers and to perform an additional analysis of them based on the Inter American Society of Cardiology (SIAC) and the World Heart Federation (WHF) Chagas Roadmap, at a country level in Argentina, Colombia, Spain, and the United States, which serve as representatives of endemic and nonendemic countries. Methodology and principal findings This is a nonsystematic review of articles published in indexed journals from 1955 to 2021 and of gray literature (local health organizations guidelines, local policies, blogs, and media). We classified barriers to access care as (i) existing difficulties limiting healthcare access; (ii) lack of awareness about CD and its complications; (iii) poor transmission control (vectorial and nonvectorial); (iv) scarce availability of antitrypanosomal drugs; and (v) cultural beliefs and stigma. Region-specific barriers may limit the implementation of roadmaps and require the application of tailored strategies to improve access to appropriate care. Conclusions Multiple barriers negatively impact the prognosis of CD. Identification of these roadblocks both nationally and globally is important to guide development of appropriate policies and public health programs to reduce the global burden of this disease. Chagas disease (CD) has been described as an epidemic in Latin America, but its geographical influence is global. One of the biggest challenges in providing care for patients with CD is to improve access to early diagnosis and treatment in order to avoid chronic cardiovascular and gastrointestinal complications. However, different roadblocks interfere with the optimal care of these patients, which facilitates disease progression. While some barriers to care are global in scope, there are additionally national and even local obstacles for patients with CD. Appropriate delineation of these barriers will allow for the development of targeted interventions to improve the outlook for CD patients in both endemic and nonendemic countries alike.
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Affiliation(s)
- Andrés F. Miranda-Arboleda
- Cardiology Department, Pablo Tobón Uribe Hospital, Medellín, Colombia
- Division of Cardiology, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada
| | - Ezequiel José Zaidel
- Cardiology Department, Sanatorio Güemes, and School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- * E-mail:
| | - Rachel Marcus
- LASOCHA, Washington, DC, United States of America
- Medstar Union Memorial Hospital, Baltimore, Maryland, United States of America
| | | | | | - Clara Saldarriaga
- Cardiology Service, Clínica CardioVID, Universidad de Antioquia, Medellín, Colombia
| | - Álvaro Sosa Liprandi
- Cardiology Department, Sanatorio Güemes, and School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Adrián Baranchuk
- Division of Cardiology, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada
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Ramos-Sesma V, Navarro M, Llenas-García J, Gil-Anguita C, Torrus-Tendero D, Wikman-Jorgensen P, García-López M, Amador-Prous C, Ventero-Martín MP, Guevara-Hernández P, Garijo-Saiz A, Sanchez-Sanchez A, Bernal-Alcaraz C, Pujades-Tarraga AI, Muñoz-Perez R, Flores-Chávez M, Ramos-Rincón JM. Community-based screening of Chagas disease among Latin American migrants in a non-endemic country: an observational study. Infect Dis Poverty 2021; 10:117. [PMID: 34526137 PMCID: PMC8441044 DOI: 10.1186/s40249-021-00897-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chagas disease is a parasitic disease endemic to Latin America, but it has become a disease of global concern due to migration flows. Asymptomatic carriers may host the parasite for years, without knowing they are infected. The aim of this study is to assess prevalence of Chagas disease and evaluate the participants' level of knowledge between Latin American migrants attending a community-based screening campaign. METHODS Three community-based campaigns were performed in Alicante (Spain) in 2016, 2017 and 2018, including educational chats and blood tests for Trypanosoma cruzi serology. Participants completed a questionnaire assessing knowledge about the mechanisms of transmission, disease presentation, diagnosis, and treatment. People seropositive for T. cruzi underwent diagnostic confirmation by two different tests. Results were analyzed by multivariable logistic regression and expressed as adjusted odds ratios (aORs), adjusting for age, sex, and time in Spain. RESULTS A total of 596 participants were included in the study; 17% were aged under 18 years. Prevalence in adults was 11% [54/496; 95% confidence interval (CI): 8.3-14.5%] versus 0% among children. All but one case were in Bolivians. Diagnosis was independently associated with having been born in Bolivia (aOR: 102, 95% CI: 13-781) and a primary school-level education (aOR: 2.40, 95% CI: 1.14-5.06). Of 54 people diagnosed with Chagas disease (most of whom were asymptomatic), 42 (77.7%) returned to the clinic at least once, and 24 (44.4%) received treatment. Multivariable analysis showed that coming from Argentina (aOR: 13, 95% CI: 1.61-1188) or Bolivia (aOR: 1.90, 95% CI: 1.19-3.39) and having received information about Chagas disease in Spain (aOR: 4.63, 95% CI: 2.54-8.97) were associated with a good level of knowledge on the disease. Having primary level studies (aOR: 0.59, 95% CI: 0.34-0.98) and coming from Ecuador (aOR: 4.63, 95% CI: 2.52-847) were independently associated with a lower level of knowledge. CONCLUSIONS Community-based interventions are a good strategy for diagnosing neglected diseases such as Chagas disease in non-endemic countries and for identifying and treating infected, asymptomatic individuals.
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Affiliation(s)
| | - Miriam Navarro
- Public Health, Science History and Gynecology Department, Universidad Miguel Hernández de Elche, Alicante, Spain
- Epidemiology Unit Public Health Center of Elche, Alicante, Spain
| | - Jara Llenas-García
- Internal Medicine Department, Hospital Vega Baja de Orihuela (Alicante, Spain)-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Alicante, Spain
- Clinical Medicine Department, University Miguel Hernández of Elche, Sant Joan d'Alacant, Spain
| | - Concepción Gil-Anguita
- Internal Medicine Department, Hospital Marina BaixaLa Vila Joiosa (Alicante, Spain)-FISABIO, Alicante, Spain
| | - Diego Torrus-Tendero
- Internal Medicine Department, General University Hospital of Alicante-Biomedical and Health Research Institute of Alicante (ISABIAL), Alicante, Spain
- Parasitology Area, University Miguel Hernández of Elche, Sant Joan d'Alacant, Spain
| | - Philip Wikman-Jorgensen
- Internal Medicine Department, University Hospital of Sant Joan, (Sant Joan d'Alacant, Spain)- FISABIO, Alicante, Spain
| | - María García-López
- Internal Medicine Department, Hospital Vega Baja de Orihuela (Alicante, Spain)-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Alicante, Spain
| | - Concepción Amador-Prous
- Internal Medicine Department, Hospital Marina BaixaLa Vila Joiosa (Alicante, Spain)-FISABIO, Alicante, Spain
| | | | - Pedro Guevara-Hernández
- Internal Medicine Department, Hospital Vega Baja de Orihuela (Alicante, Spain)-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Alicante, Spain
| | - Ana Garijo-Saiz
- Internal Medicine Department, Hospital Marina BaixaLa Vila Joiosa (Alicante, Spain)-FISABIO, Alicante, Spain
| | - Ares Sanchez-Sanchez
- Pediatric Department, General University Hospital of Alicante-ISABIAL, Alicante, Spain
| | - Cristina Bernal-Alcaraz
- Internal Medicine Department, Hospital Vega Baja de Orihuela (Alicante, Spain)-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Alicante, Spain
| | - Ana-Isabel Pujades-Tarraga
- Internal Medicine Department, Hospital Marina BaixaLa Vila Joiosa (Alicante, Spain)-FISABIO, Alicante, Spain
| | - Roser Muñoz-Perez
- Digestive Service, General University Hospital of Alicante-ISABIAL, Alicante, Spain
| | - María Flores-Chávez
- Reference and Research Laboratory in Parasitology, National Center of Microbiology/Mundo Sano Foundation, Madrid, Spain
| | - José-Manuel Ramos-Rincón
- Clinical Medicine Department, University Miguel Hernández of Elche, Sant Joan d'Alacant, Spain.
- Internal Medicine Department, General University Hospital of Alicante-Biomedical and Health Research Institute of Alicante (ISABIAL), Alicante, Spain.
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Geographic variations in test reactivity for the serological diagnosis of Trypanosoma cruzi infection. J Clin Microbiol 2021; 59:e0106221. [PMID: 34469183 PMCID: PMC8601237 DOI: 10.1128/jcm.01062-21] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chagas disease is a neglected disease caused by Trypanosoma cruzi parasites. Most diagnosis is based on serological tests, but the lack of a gold standard test complicates the measurement of test performance. To overcome this limitation, we used samples from a cohort of well-characterized T. cruzi-infected women to evaluate the reactivity of two rapid diagnostic tests and one enzyme-linked immunosorbent assay (ELISA). Our cohort was derived from a previous study on congenital transmission of T. cruzi and consisted of 481 blood/plasma samples from Argentina (n = 149), Honduras (n = 228), and Mexico (n = 104), with at least one positive T. cruzi PCR. Reactivity of the three tests ranged from 70.5% for the Wiener ELISA to 81.0% for the T-Detect and 90.4% for the Stat-Pak rapid tests. Test reactivity varied significantly among countries and was highest in Argentina and lowest in Mexico. When considering at least two reactive serological tests to confirm seropositivity, over 12% of T. cruzi infection cases from Argentina were missed by serological tests, over 21% in Honduras, and an alarming 72% in Mexico. Differences in test performance among countries were not due to differences in parasitemia, but differences in antibody levels against ELISA antigens were observed. Geographic differences in T. cruzi parasite strains as well as genetic differences among human populations both may contribute to the discrepancies in serological testing. Improvements in serological diagnostics for T. cruzi infections are critically needed to ensure an optimum identification of cases.
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Social determinants in the access to health care for Chagas disease: A qualitative research on family life in the "Valle Alto" of Cochabamba, Bolivia. PLoS One 2021; 16:e0255226. [PMID: 34383775 PMCID: PMC8360591 DOI: 10.1371/journal.pone.0255226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Chagas disease is caused by the Trypanosoma cruzi infection. It is a neglected tropical disease with considerable impact on the physical, psychological, familiar, and social spheres. The Valle Alto of Cochabamba is a hyperendemic region of Bolivia where efforts to control the transmission of the disease have progressed over the years. However, many challenges remain, above all, timely detection and health-care access. Methods Following the Science Shop process, this bottom-up research emerged with the participation of the civil society from Valle Alto and representatives of the Association of Corazones Unidos por el Chagas from Cochabamba. The aim of this study is to explore the social determinants in the living realities of those affected by Chagas disease or the silent infection and how families in the Valle Alto of Cochabamba cope with it. An interdisciplinary research team conducted a case study of the life stories of three families using information from in-depth interviews and performed a descriptive qualitative content analysis and triangulation processes. Findings Findings provide insights into social circumstances of the research subjects’ lives; particularly, on how exposure to Trypanosoma cruzi infection affects their daily lives in terms of seeking comprehensive health care. Research subjects revealed needs and shared their experiences, thus providing an understanding of the complexity of Chagas disease from the socioeconomic, sociocultural, political, and biomedical perspectives. Results enlighten on three dimensions: structural, psychosocial, and plural health system. The diverse perceptions and attitudes toward Chagas within families, including the denial of its existence, are remarkable as gender and ethnocultural aspects. Findings support recommendations to various stakeholders and translation materials. Conclusions Intersectional disease management and community involvement are essential for deciding the most appropriate and effective actions. Education, detection, health care, and social programs engaging family units ought to be the pillars of a promising approach.
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Moreno Peniche B. The Politics of (Non)endemicity: Chagas Disease in the United States. Med Anthropol 2021; 40:497-510. [PMID: 34121533 DOI: 10.1080/01459740.2021.1933483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chagas disease (CD) is a vector-borne parasitic disease endemic to Latin America. The US has established populations of vectors, parasites, and animal hosts, but because of the low frequency of locally acquired human infections CD is not classified as endemic there. I present a narrative review of the literature of autochthonous cases of CD in the US and analyze it with a co-productionist framework focused on material politics. I underscore the need for an ethnographic approach to the category of endemicity as not only an issue of knowledge and evidence but also as a practiced condition infused with power.
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Nolan MS, Murray KO, Mejia R, Hotez PJ, Villar Mondragon MJ, Rodriguez S, Palacios JR, Murcia Contreras WE, Lynn MK, Torres ME, Monroy Escobar MC. Elevated Pediatric Chagas Disease Burden Complicated by Concomitant Intestinal Parasites and Malnutrition in El Salvador. Trop Med Infect Dis 2021; 6:tropicalmed6020072. [PMID: 34067079 PMCID: PMC8167768 DOI: 10.3390/tropicalmed6020072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 12/28/2022] Open
Abstract
The eradication of the vector Rhodnius prolixus from Central America was heralded as a victory for controlling transmission of Trypanosoma cruzi, the parasite that causes Chagas disease. While public health officials believed this milestone achievement would effectively eliminate Chagas disease, case reports of acute vector transmission began amassing within a few years. This investigation employed a cross-sectional serosurvey of children either presenting with fever for clinical care or children living in homes with known triatomine presence in the state of Sonsonate, El Salvador. Over the 2018 calendar year, a 2.3% Chagas disease seroprevalence among children with hotspot clustering in Nahuizalco was identified. Positive serology was significantly associated with dogs in the home, older participant age, and a higher number of children in the home by multivariate regression. Concomitant intestinal parasitic infection was noted in a subset of studied children; 60% having at least one intestinal parasite and 15% having two or more concomitant infections. Concomitant parasitic infection was statistically associated with an overall higher parasitic load detected in stool by qPCR. Lastly, a four-fold higher burden of stunting was identified in the cohort compared to the national average, with four-fifths of mothers reporting severe food insecurity. This study highlights that polyparasitism is common, and a systems-based approach is warranted when treating Chagas disease seropositive children.
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Affiliation(s)
- Melissa S. Nolan
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.K.L.); (M.E.T.)
- Department of Pediatrics, Section of Tropical Medicine, National School of Tropical Medicine, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (K.O.M.); (R.M.); (P.J.H.); (M.J.V.M.)
- Correspondence: ; Tel.: +1-803-777-8932
| | - Kristy O. Murray
- Department of Pediatrics, Section of Tropical Medicine, National School of Tropical Medicine, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (K.O.M.); (R.M.); (P.J.H.); (M.J.V.M.)
| | - Rojelio Mejia
- Department of Pediatrics, Section of Tropical Medicine, National School of Tropical Medicine, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (K.O.M.); (R.M.); (P.J.H.); (M.J.V.M.)
| | - Peter J. Hotez
- Department of Pediatrics, Section of Tropical Medicine, National School of Tropical Medicine, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (K.O.M.); (R.M.); (P.J.H.); (M.J.V.M.)
| | - Maria Jose Villar Mondragon
- Department of Pediatrics, Section of Tropical Medicine, National School of Tropical Medicine, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (K.O.M.); (R.M.); (P.J.H.); (M.J.V.M.)
| | - Stanley Rodriguez
- Center of Health Investigation and Discovery (CENSALUD), University of El Salvador, San Salvador, El Salvador; (S.R.); (J.R.P.)
| | - Jose Ricardo Palacios
- Center of Health Investigation and Discovery (CENSALUD), University of El Salvador, San Salvador, El Salvador; (S.R.); (J.R.P.)
| | | | - M. Katie Lynn
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.K.L.); (M.E.T.)
| | - Myriam E. Torres
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.K.L.); (M.E.T.)
| | - Maria Carlota Monroy Escobar
- Laboratory of Applied Entomology and Parasitology, School of Biology, University of San Carlos, Guatemala City, Guatemala;
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Diaz-Hernandez A, Gonzalez-Vazquez MC, Arce-Fonseca M, Rodriguez-Morales O, Cedilllo-Ramirez ML, Carabarin-Lima A. Risk of COVID-19 in Chagas Disease Patients: What Happen with Cardiac Affectations? BIOLOGY 2021; 10:biology10050411. [PMID: 34066383 PMCID: PMC8148128 DOI: 10.3390/biology10050411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Chagas disease is considered a neglected tropical disease. The acute phase of Chagas disease is characterized by several symptoms: fever, fatigue, body aches, headache and cardiopathy's. Chronic phase could be asymptomatic or symptomatic with cardiac compromise. Since the emergence of the pandemic caused by the SARS-CoV-2 virus, the cardiovascular involvement has been identified as a complication commonly reported in coronavirus disease 2019 (COVID-19). Due to the lack of knowledge of the cardiac affectations that this virus could cause in patients with Chagas disease, the aim of this review is to describe the possible cardiac affectations, as well as the treatment and recommendations that patients with both infections should carry out. METHODS The authors revised the recent and relevant literature concerning the topic and discussed advances and limitations of studies on COVID-19 and their impact in Chagas disease patients, principally with cardiac affectations. RESULTS There currently exists little information about the consequences that Chagas disease patients can suffer when they are infected with COVID-19. CONCLUSIONS This review highlights the emerging challenges of access to medical care and future research needs in order to understand the implications that co-infections (SARS-CoV-2 or other viruses) can generate in Chagas disease-infected people.
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Affiliation(s)
- Alejandro Diaz-Hernandez
- Centro de Investigaciones en Ciencias Microbiológicas, Instituto de Ciencias, Benemérita Universidad Autónoma de Puebla, 14 Sur y Avenida San Claudio, Ciudad Universitaria, Puebla 72570, Mexico; (A.D.-H.); (M.C.G.-V.); (M.L.C.-R.)
| | - Maria Cristina Gonzalez-Vazquez
- Centro de Investigaciones en Ciencias Microbiológicas, Instituto de Ciencias, Benemérita Universidad Autónoma de Puebla, 14 Sur y Avenida San Claudio, Ciudad Universitaria, Puebla 72570, Mexico; (A.D.-H.); (M.C.G.-V.); (M.L.C.-R.)
| | - Minerva Arce-Fonseca
- Departamento de Biología Molecular, Instituto Nacional de Cardiología “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, México City 14080, Mexico; (M.A.-F.); (O.R.-M.)
| | - Olivia Rodriguez-Morales
- Departamento de Biología Molecular, Instituto Nacional de Cardiología “Ignacio Chávez”, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, México City 14080, Mexico; (M.A.-F.); (O.R.-M.)
| | - Maria Lilia Cedilllo-Ramirez
- Centro de Investigaciones en Ciencias Microbiológicas, Instituto de Ciencias, Benemérita Universidad Autónoma de Puebla, 14 Sur y Avenida San Claudio, Ciudad Universitaria, Puebla 72570, Mexico; (A.D.-H.); (M.C.G.-V.); (M.L.C.-R.)
| | - Alejandro Carabarin-Lima
- Centro de Investigaciones en Ciencias Microbiológicas, Instituto de Ciencias, Benemérita Universidad Autónoma de Puebla, 14 Sur y Avenida San Claudio, Ciudad Universitaria, Puebla 72570, Mexico; (A.D.-H.); (M.C.G.-V.); (M.L.C.-R.)
- Correspondence: ; Tel.: +52-222-2295-500 (ext. 3965)
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Valdez Tah AR. Making Sense of Chagas Disease among Mexican Immigrants in California. Med Anthropol 2021; 40:511-524. [PMID: 33798000 DOI: 10.1080/01459740.2021.1894560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mexican immigrants are affected by Chagas disease (CD) in California. It is through the representation of Chagas as a rare disease that participants make sense of the disease. A positive diagnosis has meant the disruption of patients' sense of normality and self-image, as well as their memories of homeland both reproducing and challenging hegemonic and stigmatized ideas of the disease associated with rurality and poverty. Access to treatment and medical care was the major coping mechanism. Health programs on CD should consider the emotional and social impact of the disease on people's self-perceptions to develop better medical care and prevention.
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Affiliation(s)
- Alba R Valdez Tah
- Peninsular Center of Humanities and Social Sciences, Autonomous University of Mexico (Centro Peninsular en Humanidades y Ciencias Sociales, UNAM), Mérida, México
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Forsyth CJ, Hernandez S, Flores CA, Roman MF, Nieto JM, Marquez G, Sequeira J, Sequeira H, Meymandi SK. "You Don't Have a Normal Life": Coping with Chagas Disease in Los Angeles, California. Med Anthropol 2021; 40:525-540. [PMID: 33784220 DOI: 10.1080/01459740.2021.1894559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chagas disease is the neglected tropical disease of greatest public health impact in the United States, where it affects over 300,000 people. Diverse barriers limit healthcare access for affected people; fewer than 1% have obtained testing or treatment. We interviewed 50 people with Chagas disease in Los Angeles, California, and administered a cultural consensus analysis questionnaire. Participants were asked about their experiences and perceptions of Chagas disease, access to healthcare, and strategies for coping with the disease. In participants' narratives, the physical and emotional impacts of the disease were closely interwoven. Participant explanatory models highlight difficulties in accessing care, despite a desire for biomedical treatment. Obtaining testing and treatment for Chagas disease poses substantial challenges for US patients.
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Affiliation(s)
- Colin J Forsyth
- Drugs for Neglected Diseases initiative-North America, New York, New York, USA.,Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Salvador Hernandez
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Carmen A Flores
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Mario F Roman
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - J Maribel Nieto
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Grecia Marquez
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Juan Sequeira
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Harry Sequeira
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Sheba K Meymandi
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
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Mahoney West H, Milliren CE, Vragovic O, Köhler JR, Yarrington C. Perceived barriers to Chagas disease screening among a diverse group of prenatal care providers. PLoS One 2021; 16:e0246783. [PMID: 33635887 PMCID: PMC7909700 DOI: 10.1371/journal.pone.0246783] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/26/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chagas disease is a vector borne infection of poverty endemic to Latin America which affects an estimated 40,000 women of child-bearing age in the United States (US). In the US Chagas disease is concentrated among individuals who have lived in endemic areas. Prenatal diagnosis and treatment are needed to prevent congenital transmission. The objective of this study was to assess perceived barriers to Chagas disease screening among prenatal care providers in Obstetrics/Gynecology and Family Medicine Departments of a tertiary care safety-net hospital caring for a significant at-risk population. METHODOLOGY/PRINCIPAL FINDINGS An anonymous survey was distributed to 178 Obstetrics/Gynecology and Family Medicine practitioners. Of the 66 respondents, 39% thought Chagas screening was very important, and 48% somewhat important as a public health initiative. One third judged screening patients during clinic visits as very important. Most respondents (64%) reported being familiar with Chagas disease. However, only 32% knew how to order a test and only 22% reported knowing what to do if a test was positive. CONCLUSIONS/SIGNIFICANCE These findings will be incorporated into measures to facilitate full implementation of Chagas screening, and can inform initiatives at other centers who wish to address this deeply neglected infection among their patient families. Greater integration of information on Chagas disease screening and treatment in medical and nursing education curricula can contribute to addressing this disease with the focus that its potentially fatal sequelae merit.
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Affiliation(s)
- Helen Mahoney West
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Simmons University School of Nursing, Boston, Massachusetts, United States of America
- * E-mail:
| | - Carly E. Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Olivera Vragovic
- Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Julia R. Köhler
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Christina Yarrington
- Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Obstetrics/Gynecology, Boston Medical Center, Boston, Massachusetts, United States of America
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Hochberg NS, Wheelock A, Hamer DH, Marcus R, Nolan MS, Meymandi S, Gilman RH. Chagas Disease in the United States: A Perspective on Diagnostic Testing Limitations and Next Steps. Am J Trop Med Hyg 2021; 104:800-804. [PMID: 33534741 DOI: 10.4269/ajtmh.19-0871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
Chagas disease is a neglected tropical disease that affects an estimated 300,000 people in the United States. This perspective piece reviews diagnostic challenges and proposes next steps to address these shortfalls.
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Affiliation(s)
- Natasha S Hochberg
- 1Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.,2Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.,3Center for Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Alyse Wheelock
- 1Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.,3Center for Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Davidson H Hamer
- 1Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.,3Center for Infectious Diseases, Boston Medical Center, Boston, Massachusetts.,4Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Rachel Marcus
- 5Latin American Society of Chagas (LASOCHA), Medstar Union Memorial Hospital, Baltimore, Maryland
| | - Melissa S Nolan
- 6Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,7Department of Pediatrics, Section of Pediatric Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Sheba Meymandi
- 8Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California
| | - Robert H Gilman
- 9Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Schultz J, Hyson P, Chastain DB, Gharamti AA, Franco-Paredes C, Henao-Martínez AF. COVID-19 epidemic in the US-A gateway to screen for tuberculosis, HIV, viral hepatitides, Chagas disease, and other neglected tropical diseases among Hispanics. PLoS Negl Trop Dis 2020; 14:e0008953. [PMID: 33338043 PMCID: PMC7748128 DOI: 10.1371/journal.pntd.0008953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Jonathan Schultz
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, School of Medicine, Aurora, Colorado, United States of America
| | - Peter Hyson
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, School of Medicine, Aurora, Colorado, United States of America
| | - Daniel B. Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, Georgia, United States of America
| | - Amal A. Gharamti
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Carlos Franco-Paredes
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, School of Medicine, Aurora, Colorado, United States of America
- Hospital Infantil de México, Federico Gómez, México City, México
| | - Andrés F. Henao-Martínez
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, School of Medicine, Aurora, Colorado, United States of America
- * E-mail:
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29
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Damasceno RF, Sabino EC, Ferreira AM, Ribeiro ALP, Moreira HF, Prates TEC, Sampaio CA, Haikal DS. Challenges in the care of patients with Chagas disease in the Brazilian public health system: A qualitative study with primary health care doctors. PLoS Negl Trop Dis 2020; 14:e0008782. [PMID: 33166280 PMCID: PMC7676681 DOI: 10.1371/journal.pntd.0008782] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 11/19/2020] [Accepted: 09/08/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Care to patients with Chagas disease (CD) is still a challenge for health systems in endemic and non-endemic countries. In the Brazilian public health system, the expansion of Primary Health Care (PHC) services to remote and disadvantaged areas has facilitated the access of patients with CD to medical care, however this is in a context where care gaps remain, with insufficient public funding and inadequate distribution of services. Considering the need for studies on care to patients with CD in different settings, this study explored the challenges of family doctors to provide care to patients with CD in an endemic region in Brazil with high coverage of public PHC services. METHODS AND FINDINGS This is a qualitative study. A focus group with 15 family doctors was conducted in a municipality participating in a multicenter cohort that monitors almost two thousand patients with CD in an endemic region in Brazil. The data were analyzed using a thematic content analysis technique. The family doctors pointed out the following challenges for care to patients with CD: unsatisfactory medical training (academic education not suitable for the clinical management of the disease, and lack of training on CD in PHC); uncertainties regarding antiparasitic treatment in the chronic phase of the disease; difficulty in patients' access to specialized care when necessary, especially to the cardiologist; and trivialization of the disease by patients as a barrier to seeking care. CONCLUSION The access of CD patients to adequate medical care, even in regions with high coverage of public PHC services, still represents an important challenge for health systems. The results of this study may contribute to the development of strategies to improve the clinical management of CD in PHC.
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Affiliation(s)
- Renata Fiúza Damasceno
- Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
| | - Ester Cerdeira Sabino
- Institute of Tropical Medicine, University of São Paulo (Universidade de São Paulo), São Paulo, São Paulo, Brazil
| | - Ariela Mota Ferreira
- Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Department of Internal Medicine, Federal University of Minas Gerais (Universidade Federal de Minas Gerais), Belo Horizonte, Minas Gerais, Brazil
| | | | - Thalita Emily Cezário Prates
- Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
| | - Cristina Andrade Sampaio
- Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
| | - Desirée Sant´Ana Haikal
- Program in Health Sciences, State University of Montes Claros (Universidade Estadual de Montes Claros), Montes Claros, Minas Gerais, Brazil
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Stigler Granados P, Pacheco GJ, Núñez Patlán E, Betancourt J, Fulton L. Assessing the effectiveness of Chagas disease education for healthcare providers in the United States. BMC Infect Dis 2020; 20:743. [PMID: 33036559 PMCID: PMC7547496 DOI: 10.1186/s12879-020-05474-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chagas disease is a zoonotic infection caused by the parasite Trypanosoma cruzi, which affects an estimated 8-11 million people globally. Chagas disease is almost always associated with poverty in rural areas and disproportionately impacts immigrants from Latin America living in the United States. Approximately 20-30% of people who are infected with Chagas disease will develop a chronic form of the infection that can be fatal if left untreated. Chagas disease is vastly underestimated in the United States, often goes undiagnosed and is not well understood by most U.S. healthcare providers. One of the most important ways at reducing barriers to improving diagnostics of Chagas disease in the U.S. is giving healthcare providers the most up-to-date information and access to leading experts. METHODS An online webinar was conducted for healthcare providers, veterinarians and public health professionals using Chagas disease expert panelists. Pre and post tests were administered to participants (n = 57) to determine the efficacy in raising awareness and to determine key focus areas for improving knowledge. A Wilcoxon rank-sum was used for non-parametric variables equivalent and for questions that assessed knowledge the McNemar's Chi-Square test was used. RESULTS There were statistically significant learning increases in multiple categories including transmission (p = <.001), clinical presentation (p = 0.016), diagnostics (p = <.001), and treatment (p = <.001). CONCLUSION Providing easily accessible learning opportunities using validated testing and evaluations should be further developed for rural healthcare providers in the U.S. as well as healthcare providers serving under represented populations such as immigrants. There is a clear lack of knowledge and awareness surrounding Chagas disease in the United States and just by raising awareness and providing education on the topic, lives will be saved.
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Affiliation(s)
- Paula Stigler Granados
- School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX 78666-4606 USA
| | - Gerardo J. Pacheco
- School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX 78666-4606 USA
| | - Evangelina Núñez Patlán
- School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX 78666-4606 USA
| | - Jose Betancourt
- School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX 78666-4606 USA
| | - Lawrence Fulton
- School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX 78666-4606 USA
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Parisi S, Navarro M, Du Plessis JD, Shock JP, Apodaca Michel B, Lucuy Espinoza M, Terán C, Calizaya Tapia NA, Oltmanns K, Baptista Mora A, Saveedra Irala C, Rivera Rojas AA, Rubilar G, Zoller T, Pritsch M. "We have already heard that the treatment doesn't do anything, so why should we take it?": A mixed method perspective on Chagas disease knowledge, attitudes, prevention, and treatment behaviour in the Bolivian Chaco. PLoS Negl Trop Dis 2020; 14:e0008752. [PMID: 33119632 PMCID: PMC7595318 DOI: 10.1371/journal.pntd.0008752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chagas disease (CD) is highly endemic in the Bolivian Chaco. The municipality of Monteagudo has been targeted by national interventions as well as by Médecins Sans Frontières to reduce infection rates, and to decentralize early diagnosis and treatment. This study seeks to determine the knowledge and attitudes of a population with increased awareness and to identify remaining factors and barriers for sustained vector control, health care seeking behaviour, and access, in order to improve future interventions. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional survey was conducted among approximately 10% (n = 669) of the municipality of Monteagudo's households that were randomly selected. Additionally, a total of 14 in-depth interviews and 2 focus group discussions were conducted with patients and key informants. Several attitudes and practices were identified that could undermine effective control against (re-)infection. Knowledge of clinical symptoms and secondary prevention was limited, and revealed specific misconceptions. Although 76% of the participants had been tested for CD, only 18% of those who tested positive concluded treatment with benznidazole (BNZ). Sustained positive serologies after treatment led to perceived ineffectiveness of BNZ. Moreover, access barriers such as direct as well as indirect costs, BNZ stock-outs and a fear of adverse reactions triggered by other community members made patients opt for alternative treatments against CD such as veterinary ivermectin, used by 28% of infected participants in our study. The lack of accessible care for chronic complications as well as socioeconomic consequences, such as the exclusion from both job opportunities and bank loans contributed to the ongoing burden of CD. CONCLUSIONS/SIGNIFICANCE Large scale interventions should be accompanied by operational research in order to identify misconceptions and unintended consequences early on, to generate accessible data for future interventions, and for rigorous evaluation. An integrated, community-based approach tackling social determinants and including both traditional and animal health sectors might help to overcome current barriers and advocate for patients' rights.
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Affiliation(s)
- Sandra Parisi
- Institute of Tropical Medicine and International Health, Charité –Universitätsmedizin Berlin, Berlin, Germany
- DAHW Deutsche Lepra- und Tuberkulosehilfe e. V., Würzburg, Germany
- Department of General Practice, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Miriam Navarro
- Department of Public Health, Science History and Gynecology, Universidad Miguel Hernández, Alicante, Spain
| | | | - Jonathan Phillip Shock
- Department of Maths and Applied Maths, University of Cape Town, Rondebosch, South Africa
| | - Boris Apodaca Michel
- Hospital Dermatológico Monteagudo, Monteagudo, Bolivia
- Fundacion Intercultural NORSUD, Sucre, Bolivia
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Minerva Lucuy Espinoza
- Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Faculty of Medicine, Sucre, Bolivia
| | - Carolina Terán
- Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Faculty of Medicine, Sucre, Bolivia
| | | | - Katharina Oltmanns
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Abundio Baptista Mora
- Fundacion Intercultural NORSUD, Sucre, Bolivia
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
- Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Faculty of Medicine, Sucre, Bolivia
| | - Claudia Saveedra Irala
- Hospital Dermatológico Monteagudo, Monteagudo, Bolivia
- Fundacion Intercultural NORSUD, Sucre, Bolivia
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Angel Alberto Rivera Rojas
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Gonzalo Rubilar
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Thomas Zoller
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Infectious Diseases and Respiratory Medicine, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
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Perez-Zetune V, Bialek SR, Montgomery SP, Stillwaggon E. Congenital Chagas Disease in the United States: The Effect of Commercially Priced Benznidazole on Costs and Benefits of Maternal Screening. Am J Trop Med Hyg 2020; 102:1086-1089. [PMID: 32100696 PMCID: PMC7204569 DOI: 10.4269/ajtmh.20-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors, and through transfusions, transplants, insect feces in food, and mother to child during gestation. 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 for Chagas disease in the United States, including the cost of commercially available benznidazole. We compare costs of testing and treatment for mothers and infants with the lifetime societal costs without testing and consequent morbidity and mortality due to lack of treatment or late treatment. We constructed a decision-analytic model, using one tree that shows the combined costs for every possible mother–child pairing. Savings per birth in a targeted screening program are $1,314, and with universal screening, $105 per birth. At current screening costs, universal screening results in $420 million in lifetime savings per birth-year cohort. We found that a congenital Chagas screening program in the United States is cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence greater than 0.06% compared with no screening program.
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Affiliation(s)
| | - 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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Asymptomatic Strongyloidiasis among Latin American Migrants in Spain: A Community-Based Approach. Pathogens 2020; 9:pathogens9060511. [PMID: 32599871 PMCID: PMC7350301 DOI: 10.3390/pathogens9060511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 02/06/2023] Open
Abstract
Strongyloides stercoralis infection is frequently underdiagnosed since many infections remain asymptomatic. Aim: To estimate the prevalence and characteristics of asymptomatic S. stercoralis infection in Latin American migrants attending a community-based screening program for Chagas disease in Spain. Methodology: Three community-based Chagas disease screening campaigns were performed in Alicante (Spain) in 2016, 2017, and 2018. Serological testing for S. stercoralis infection was performed using a non-automatized IVD-ELISA detecting IgG (DRG Instruments GmbH, Marburg, Germany). Results: Of the 616 migrants from Central and South America who were screened, 601 were included in the study: 100 children and adolescents (<18 years of age) and 501 adults. Among the younger group, 6 participants tested positive (prevalence 6%, 95% confidence interval [CI] 2.5% to 13.1%), while 60 adults did so (prevalence 12%, 95% CI 9.3% to 15.3%). S. stercoralis infection was more common in men than in women (odds ratio adjusted [ORa] 2.28, 95% CI 1.289 to 4.03) and in those from Bolivia (ORa 2.03, 95% CI 1.15 to 3.59). Prevalence increased with age (ORa 1.02, 95% CI 0.99 to 1.05). In contrast, a university education had a protective effect (ORa 0.29, 95% CI 0.31 to 0.88). Forty-one (41/66; 62.1%) of the total cases of S. stercoralis infection were treated at the health care center. Positive stool samples were observed in 19.5% of the followed-up positive cases. Conclusion: Incorporating serological screening for S. stercoralis into community-based screening for Chagas disease is a useful intervention to detect asymptomatic S. stercoralis infection in Central and South American migrants and an opportunity to tackle neglected tropical diseases in a transversal way. The remaining challenge is to achieve patients’ adherence to the medical follow-up.
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