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Estimation of the morbidity and mortality of congenital Chagas disease: A systematic review and meta-analysis. PLoS Negl Trop Dis 2022; 16:e0010376. [DOI: 10.1371/journal.pntd.0010376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/17/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Chagas disease is caused by the parasite Trypanosoma cruzi which can be transmitted from mother to baby during pregnancy. There is no consensus on the proportion of infected infants with clinical signs of congenital Chagas disease (cCD). The objective of this systematic review is to determine the burden of cCD. Articles from journal inception to 2020 reporting morbidity and mortality associated with cCD were retrieved from academic search databases. Observational studies, randomized-control trials, and studies of babies diagnosed with cCD were included. Studies were excluded if they were case reports or series, without original data, case-control without cCD incidence estimates, and/or did not report number of participants. Two reviewers screened articles for inclusion. To determine pooled proportion of infants with cCD with clinical signs, individual clinical signs, and case-fatality, random effects meta-analysis was performed. We identified 4,531 records and reviewed 4,301, including 47 articles in the narrative summary and analysis. Twenty-eight percent of cCD infants showed clinical signs (95% confidence interval (CI) = 19.0%, 38.5%) and 2.2% of infants died (95% CI = 1.3%, 3.5%). The proportion of infected infants with hepatosplenomegaly was 12.5%, preterm birth 6.0%, low birth weight 5.8%, anemia 4.9%, and jaundice 4.7%. Although most studies did not include a comparison group of non-infected infants, the proportion of infants with cCD with clinical signs at birth are comparable to those with congenital toxoplasmosis (10.0%-30.0%) and congenital cytomegalovirus (10.0%-15.0%). We conclude that cCD burden appears significant, but more studies comparing infected mother-infant dyads to non-infected ones are needed to determine an association of this burden to cCD.
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Llenas-García J, Wikman-Jorgensen P, Gil-Anguita C, Ramos- Sesma V, Torrús-Tendero D, Martínez-Goñi R, Romero-Nieto M, García-Abellán J, Esteban-Giner MJ, Antelo K, Navarro-Cots M, Buñuel F, Amador C, García-García J, Gascón I, Telenti G, Fuentes-Campos E, Torres I, Gimeno-Gascón A, Ruíz-García MM, Navarro M, Ramos-Rincón JM. Chagas disease screening in pregnant Latin American women: Adherence to a systematic screening protocol in a non-endemic country. PLoS Negl Trop Dis 2021; 15:e0009281. [PMID: 33760816 PMCID: PMC8021187 DOI: 10.1371/journal.pntd.0009281] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/05/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chagas disease (CD) is a chronic parasitic disease caused by Trypanosoma cruzi and is endemic to continental Latin America. In Spain, the main transmission route is congenital. We aimed to assess adherence to regional recommendations of universal screening for CD during pregnancy in Latin American women in the province of Alicante from 2014 to 2018. METHODOLOGY/PRINCIPAL FINDINGS Retrospective quality study using two data sources: 1) delivery records of Latin American women that gave birth in the 10 public hospitals of Alicante between January 2014 and December 2018; and 2) records of Chagas serologies carried out in those centers between May 2013 and December 2018. There were 3026 deliveries in Latin American women during the study period; 1178 (38.9%) underwent CD serology. Screening adherence ranged from 17.2% to 59.3% in the different health departments and was higher in Bolivian women (48.3%). Twenty-six deliveries (2.2%) had a positive screening; CD was confirmed in 23 (2%) deliveries of 21 women. Bolivians had the highest seroprevalence (21/112; 18.7%), followed by Colombians (1/333; 0.3%) and Ecuadorians (1/348; 0.3%). Of 21 CD-positive women (19 Bolivians, 1 Colombian, 1 Ecuadorian), infection was already known in 12 (57.1%), and 9 (42.9%) had already been treated. Only 1 of the 12 untreated women (8.3%) was treated postpartum. Follow-up started in 20 of the 23 (87.0%) neonates but was completed only in 11 (47.8%); no cases of congenital transmission were detected. Among the 1848 unscreened deliveries, we estimate 43 undiagnosed cases of CD and 1 to 2 undetected cases of congenital transmission. CONCLUSIONS/SIGNIFICANCE Adherence to recommendations of systematic screening for CD in Latin American pregnant women in Alicante can be improved. Strategies to strengthen treatment of postpartum women and monitoring of exposed newborns are needed. Currently, there may be undetected cases of congenital transmission in our province.
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Affiliation(s)
- Jara Llenas-García
- Internal Medicine Department, Hospital Vega Baja, Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Clinical Medicine Department, University Miguel Hernández, Elche, Spain
- * E-mail:
| | - Philip Wikman-Jorgensen
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Internal Medicine Department, University Hospital San Juan de Alicante, San Juan de Alicante, Spain
| | | | | | - Diego Torrús-Tendero
- Reference Unit of Imported Diseases and International Health, Alicante General University Hospital, Alicante, Spain
- Biomedical and Health Research Institute of Alicante (ISABIAL), Alicante, Spain
- Parasitology Area, University Miguel Hernández, Elche, Spain
| | | | - Mónica Romero-Nieto
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Clinical Medicine Department, University Miguel Hernández, Elche, Spain
- Internal Medicine Department, Elda General University Hospital, Elda, Spain
| | - Javier García-Abellán
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Infectious Diseases Unit. Elche General University Hospital, Elche, Spain
| | | | | | - María Navarro-Cots
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Microbiology Department, Hospital Vega Baja, Orihuela, Spain
| | - Fernando Buñuel
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Microbiology Department, University Hospital San Juan de Alicante, San Juan de Alicante, Spain
| | - Concepción Amador
- Internal Medicine Department, Hospital Marina Baixa, Villajoyosa, Spain
| | | | - Isabel Gascón
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Microbiology Department, Elda General University Hospital, Elda, Spain
| | - Guillermo Telenti
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Infectious Diseases Unit. Elche General University Hospital, Elche, Spain
| | | | | | - Adelina Gimeno-Gascón
- Biomedical and Health Research Institute of Alicante (ISABIAL), Alicante, Spain
- Microbiology Department, Alicante General University Hospital, Alicante, Spain
| | - María Montserrat Ruíz-García
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Microbiology Department, Elche General University Hospital, Elche, Spain
| | - Miriam Navarro
- Department of Public Health, Science History and Gynaecology, University Miguel Hernández, Elche, Spain
| | - José-Manuel Ramos-Rincón
- Clinical Medicine Department, University Miguel Hernández, Elche, Spain
- Reference Unit of Imported Diseases and International Health, Alicante General University Hospital, Alicante, Spain
- Biomedical and Health Research Institute of Alicante (ISABIAL), Alicante, Spain
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Colombo V, Giacomelli A, Casazza G, Galimberti L, Bonazzetti C, Sabaini F, Ridolfo AL, Antinori S. Trypanosoma cruzi infection in Latin American pregnant women living outside endemic countries and frequency of congenital transmission: a systematic review and meta-analysis. J Travel Med 2021; 28:5908540. [PMID: 32946555 DOI: 10.1093/jtm/taaa170] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chagas disease, as a consequence of globalization and immigration, is no more restricted to Central and Latin America. Therefore, congenital transmission represents a growing public health concern in non-endemic countries. METHODS The aim of this study was to assess the prevalence of Trypanosoma cruzi infection in pregnant Latin American (LA) women living outside endemic countries and the rate of congenital transmission. Data were extracted from studies indexed in PubMed, Scopus, Embase, Lilacs and SciELO databases without language restriction. Two investigators independently collected data on study characteristics, diagnosis, prevalence of infection in pregnant women and congenital infection rate. The data were pooled using a random effects model. RESULTS The search identified 1078 articles of which 29 were eligible regarding prevalence of T. cruzi infection among pregnant women and 1795 articles of which 32 were eligible regarding the congenital transmission rate. The estimated pooled prevalence of T. cruzi infection in LA pregnant women was 4.2% [95% confidence interval (CI): 3.0-5.5]. The prevalence of T. cruzi infection in pregnant women from Bolivia was 15.5% (95% CI: 11.7-19.7) and 0.5% (95% CI: 0.2-0.89) for those coming from all other LA countries. The estimated global rate of congenital transmission was 3.5% (95% CI: 2.5-4.5); excluding poor-quality studies, the rate of congenital transmission was 3.8% (95% CI: 2.4-5.1). CONCLUSIONS Prevalence of Chagas disease among LA pregnant women living outside endemic countries is high, particularly in Bolivian women. The rate of vertical transmission of T. cruzi infection is similar to the rate reported in South and Central American countries.
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Affiliation(s)
- Valeria Colombo
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Andrea Giacomelli
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giovanni Casazza
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Laura Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Cecilia Bonazzetti
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Federico Sabaini
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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Basile L, Ciruela P, Requena-Méndez A, Vidal MJ, Dopico E, Martín-Nalda A, Sulleiro E, Gascon J, Jané M. Epidemiology of congenital Chagas disease 6 years after implementation of a public health surveillance system, Catalonia, 2010 to 2015. ACTA ACUST UNITED AC 2020; 24. [PMID: 31266591 PMCID: PMC6607740 DOI: 10.2807/1560-7917.es.2019.24.26.19-00011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Chagas disease is endemic in Latin America and affects 8 million people worldwide. In 2010, Catalonia introduced systematic public health surveillance to detect and treat congenital Chagas disease. Aim The objective was to evaluate the health outcomes of the congenital Chagas disease screening programme during the first 6 years (2010–2015) after its introduction in Catalonia. Methods In a surveillance system, we screened pregnant women and newborns and other children of positive mothers, and treated Chagas-positive newborns and children. Diagnosis was confirmed for pregnant women and children with two positive serological tests and for newborns with microhaematocrit and/or PCR at birth or serology at age 9 months. Results From 2010 to 2015, the estimated screening coverage rate increased from 68.4% to 88.6%. In this period, 33,469 pregnant women were tested for Trypanosoma cruzi and 937 positive cases were diagnosed. The overall prevalence was 2.8 cases per 100 pregnancies per year (15.8 in Bolivian women). We followed 82.8% of newborns until serological testing at age 9–12 months and 28 were diagnosed with Chagas disease (congenital transmission rate: 4.17%). Of 518 siblings, 178 (34.3%) were tested and 14 (7.8%) were positive for T. cruzi. Having other children with Chagas disease and the heart clinical form of Chagas disease were maternal risk factors associated with congenital T. cruzi infection (p < 0.05). Conclusion The increased screening coverage rate indicates consolidation of the programme in Catalonia. The rate of Chagas disease congenital transmission in Catalonia is in accordance with the range in non-endemic countries.
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Affiliation(s)
- Luca Basile
- Public Health Agency of Catalonia, Barcelona, Spain
| | - Pilar Ciruela
- CIBER Epidemiology and Public Health CIBERESP, Carlos III Health Institute, Madrid, Spain.,Public Health Agency of Catalonia, Barcelona, Spain
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | | | - Eva Dopico
- Laboratori Clínic de l'Hospitalet, Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Martín-Nalda
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elena Sulleiro
- Microbiology Department, Hospital Universitari Vall d'Hebron (HUVH), PROSICS Barcelona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Joaquim Gascon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | - Mireia Jané
- CIBER Epidemiology and Public Health CIBERESP, Carlos III Health Institute, Madrid, Spain.,Public Health Agency of Catalonia, Barcelona, Spain
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Velasco M, Gimeno-Feliú LA, Molina I, Salas-Coronas J, Solà I, Monge-Maillo B, Torrús-Tendero D, Caylà J, de Guzmán EN, Arellano JLP, Pérez-Molina JA. Screening for Trypanosoma cruzi infection in immigrants and refugees: Systematic review and recommendations from the Spanish Society of Infectious Diseases and Clinical Microbiology. Euro Surveill 2020; 25:1900393. [PMID: 32127121 PMCID: PMC7055039 DOI: 10.2807/1560-7917.es.2020.25.8.1900393] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundChagas disease has spread beyond its original borders on the American continent with migration. It can be transmitted from mother to child, through organ transplantation and transfusion of blood and blood products. It is necessary to determine when to screen for this infection.AimOur objective was to evaluate the appropriateness of screening for Trypanosoma cruzi infection in Latin American migrants and their descendants.MethodsWe reviewed the literature using rigorous criteria. The quality of evidence was ranked according to the GRADE classification. An evidence to decision framework was adopted to provide information on the most relevant aspects necessary to formulate recommendations.ResultsThe 33 studies evaluated revealed a prevalence of T. cruzi infection among Latin American migrants in Europe of 6.08% (95% confidence interval (CI): 3.24-9.69; 28 studies). Vertical transmission occurred in three of 100 live births (95% CI: 1-6; 13 studies). The prevalence of cardiovascular disease was 19% (95% CI: 13-27; nine studies), including only 1% severe cardiac events (95% CI: 0-2; 11 studies). The overall quality of evidence was low because of risk of bias in the studies and considerable heterogeneity of the evaluated populations. The recommendations took into account economic studies on the value of screening strategies and studies on acceptability of screening and knowledge of the disease in the affected population.ConclusionsWe identified five situations in which screening for T. cruzi infection is indicated. We recommend screening persons from endemic areas and children of mothers from these areas.
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Affiliation(s)
- María Velasco
- Infectious and Tropical Medicine Section, Internal Medicine Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Luis Andrés Gimeno-Feliú
- San Pablo Health Centre, Zaragoza, Spain,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza. EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Israel Molina
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Begoña Monge-Maillo
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Diego Torrús-Tendero
- Referral Unit for Imported Infections and International Health. Infectious Diseases Unit, Hospital General Universitario de Alicante. Parasitology Area, Miguel Hernández University, Alicante, Spain
| | - Joan Caylà
- Fundació de la Unitat d'Investigació en Tuberculosis (FuiTB), TB Research Unit, Barcelona, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - JL Pérez Arellano
- Infectious Diseases and Tropical Medicine Unit, Hospital Insular de Las Palmas. Las Palmas de Gran Canaria, Spain,Medical and Surgical Sciences Department. Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jose A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Suescún SH, García C, Valdivieso S. Prevalencia de anticuerpos contra Trypanosoma cruzi en mujeres embarazadas de zonas endémicas del departamento de Boyacá, Colombia. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n4a01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Antinori S, Galimberti L, Bianco R, Grande R, Galli M, Corbellino M. Chagas disease in Europe: A review for the internist in the globalized world. Eur J Intern Med 2017; 43:6-15. [PMID: 28502864 DOI: 10.1016/j.ejim.2017.05.001] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 02/08/2023]
Abstract
Chagas disease (CD) or American trypanosomiasis identified in 1909 by Carlos Chagas, has become over the last 40years a global health concern due to the huge migration flows from Latin America to Europe, United States, Canada and Japan. In Europe, most migrants from CD-endemic areas are concentrated in Spain, Italy, France, United Kingdom and Switzerland. Pooled seroprevalence studies conducted in Europe show an overall 4.2% prevalence, with the highest infection rates observed among individuals from Bolivia (18.1%). However, in most European countries the disease is neglected with absence of screening programmes and low access to diagnosis and treatment. Physicians working in Europe should also be aware of the risk of autochthonous transmission of Trypanosoma cruzi to newborns by their infected mothers and to recipients of blood or transplanted organs from infected donors. Finally, physicians should be able to recognize and treat the most frequent and serious complications of chronic Chagas disease, namely cardiomyopathy, megacolon and megaesophagus. This review aims to highlights the problem of CD in Europe by reviewing papers published by European researchers on this argument, in order to raise the awareness of internists who are bound to increasingly encounter patients with the disease in their routine daily activities.
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Affiliation(s)
- Spinello Antinori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy.
| | - Laura Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Roberto Bianco
- Department of Radiology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Romualdo Grande
- Clinical Microbiology, Virology and Bioemergence Diagnostics, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
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Ramos JM, León R, Andreu M, de las Parras ER, Rodríguez-Díaz JC, Esteban Á, Saugar JM, Torrús D. Serological study of Trypanosoma cruzi, Strongyloides stercoralis, HIV, human T cell lymphotropic virus (HTLV) and syphilis infections in asymptomatic Latin-American immigrants in Spain. Trans R Soc Trop Med Hyg 2016; 109:447-53. [PMID: 26065661 DOI: 10.1093/trstmh/trv043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE We aimed to perform a serological screening for T. cruzi, Strongyloides stercoralis, HIV, human T cell lymphotropic virus (HTLV) and syphilis in Latin American immigrants admitted to hospital in Spain. METHODS We have carried out a cross-sectional study of Latin American immigrants admitted to the Hospital General Universitario Alicante (Spain) from June 2012 to May 2014, where screening of Chagas disease, strongyloidiasis, HTLV, HIV and syphilis was performed by serology. RESULTS A total 180 patients were included in the study. Patients' median age was 38 years old, 123 (68.3%; 123/180) were female and 57 (31.7%; 57/180) male. Five of the 180 (2.5%) patients were positive for Chagas disease; associated with knowledge about Chagas disease (p=0.005), previous contact with patients with Chagas disease (p=0.04) and being Bolivian (p<0.001). Forty-two of the 157 (26.8%) patients were positive for Strongyloides serology; associated positively with being male (p<0.001), eosinophilia (p=0.001), hyper-IgE (p<0.001) and being Ecuadorian (p=0.001), and negatively associated with being Colombian (p=0.03). Positive serology of latent syphilis was found in 1.8% (3/171) of patients. Serology of HTLV was negative in all cases. No new cases of HIV infection were diagnosed. CONCLUSIONS We propose that Latin American immigrant patients admitted to hospital in Spain be screened for strongyloidiasis, Chagas disease and syphilis by serology.
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Affiliation(s)
- José M Ramos
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante Spain Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Spain
| | - Rafael León
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante Spain
| | - Mariano Andreu
- Division of Microbiology, Hospital General Universitario de Alicante, Alicante, Spain Department of Microbiology, Universidad de Alicante, Alicante, Spain
| | | | - Juan C Rodríguez-Díaz
- Division of Microbiology, Hospital General Universitario de Alicante, Alicante, Spain Department of Microbiology, Universidad Miguel Hernandez de Elche, Spain
| | - Ángel Esteban
- Department of Clinical Laboratory, Hospital General Universitario de Alicante, Alicante, Spain
| | - José M Saugar
- Service of Parasitology, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Diego Torrús
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante Spain
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Abstract
The constant migration flows have favored the presence of people with Chagas disease in regions traditionally regarded as non-endemic, such as North America, Europe, Asia and Oceania. This has forced both health authorities and professionals to be updated in order to respond to such a demand for assistance. Recent years have led to significant progress in the field of diagnosis and treatment of Chagas disease, one of the most neglected tropical diseases. Recent clinical trials are providing new evidence that makes the management of these patients, a constant challenge for the professionals involved. Innovative diagnostic tools and therapeutic regimens, allow us to face the future of Chagas disease with optimism.
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Rius Gordillo N, Martín Nalda A, Otero Romero S, Soler-Palacín P, Sulleiro Igual E, Espiau Guarner M, Fernández-Polo A, Figueras Nadal C. Imported infectious diseases in tertiary hospitals. An Pediatr (Barc) 2014. [DOI: 10.1016/j.anpede.2013.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Salvador F, Trevióo B, Sulleiro E, Pou D, Sánchez-Montalvá A, Cabezos J, Soriano A, Serre N, Gómez i Prat J, Pahissa A, Molina I. Trypanosoma cruzi infection in a non-endemic country: epidemiological and clinical profile. Clin Microbiol Infect 2014; 20:706-12. [DOI: 10.1111/1469-0691.12443] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/03/2013] [Accepted: 11/04/2013] [Indexed: 11/28/2022]
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Howard EJ, Xiong X, Carlier Y, Sosa-Estani S, Buekens P. Frequency of the congenital transmission of Trypanosoma cruzi: a systematic review and meta-analysis. BJOG 2014; 121:22-33. [PMID: 23924273 PMCID: PMC3914719 DOI: 10.1111/1471-0528.12396] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chagas disease is caused by the parasite Trypanosoma cruzi and is endemic in much of Latin America. With increased globalisation and immigration, it is a risk in any country, partly through congenital transmission. The frequency of congenital transmission is unclear. OBJECTIVE To assess the frequency of congenital transmission of T. cruzi. SEARCH STRATEGY PubMed, Journals@Ovid Full Text, EMBASE, CINAHL, Fuente Academica and BIREME databases were searched using seven search terms related to Chagas disease or T. cruzi and congenital transmission. SELECTION CRITERIA The inclusion criteria were the following: Dutch, English, French, Portuguese or Spanish language; case report, case series or observational study; original data on congenital T. cruzi infection in humans; congenital infection rate reported or it could be derived. This systematic review included 13 case reports/series and 51 observational studies. DATA COLLECTION AND ANALYSIS Two investigators independently collected data on study characteristics, diagnosis and congenital infection rate. The principal summary measure--the congenital transmission rate--is defined as the number of congenitally infected infants divided by the number of infants born to infected mothers. A random effects model was used. MAIN RESULTS The pooled congenital transmission rate was 4.7% (95% confidence interval: 3.9-5.6%). Countries where T. cruzi is endemic had a higher rate of congenital transmission compared with countries where it is not endemic (5.0% versus 2.7%). CONCLUSIONS Congenital transmission of Chagas disease is a global problem. Overall risk of congenital infection in infants born to infected mothers is about 5%. The congenital mode of transmission requires targeted screening to prevent future cases of Chagas disease.
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Affiliation(s)
- Elizabeth J. Howard
- Tulane University School of Public Health and Tropical Medicine, Department of Epidemiology, 1440 Canal Street, Suite 2000, New Orleans, LA 70112
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, Department of Epidemiology, 1440 Canal Street, Suite 2022, New Orleans, LA 70112
| | - Yves Carlier
- Université Libre de Bruxelles (ULB), Laboratoire de Parasitologie, Faculté de Médecine (CP 616), Route de Lennik 808, B-1070 Bruxelles, Belgium
- Tulane University School of Public Health and Tropical Medicine, Department of Tropical Medicine, 1440 Canal St., Suite 2210, New Orleans, LA 70112
| | - Sergio Sosa-Estani
- National Institute of Parasitology "Dr. Mario Fatala Chaben" Av. Paseo Colón 568, Buenos Aires, Argentina
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, Department of Epidemiology, 1440 Canal Street, Suite 2430, New Orleans, LA 70112
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Rius Gordillo N, Martín Nalda A, Otero Romero S, Soler-Palacín P, Sulleiro Igual E, Espiau Guarner M, Fernández-Polo A, Figueras Nadal C. [Imported infectious diseases in tertiary hospital]. An Pediatr (Barc) 2013; 81:69-76. [PMID: 24246235 DOI: 10.1016/j.anpedi.2013.10.022] [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: 05/17/2013] [Revised: 09/23/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION An Imported Diseases Clinic was created in the hospital in 2009. The aim of this study was to asses its contribution in terms of capacity, quality of care and teaching offered. PATIENTS AND METHODS A retrospective study was conducted from 2009 to 2011, analyzing: A) development of knowledge by means of protocols and publications created, and subject taught; B) capacity and quality of care offered by the analysis of patients seen, the adequacy of the protocols and accessibility. The patients were classified into 3 groups. Group 1: immigrant patient screening, group 2: patient consultation after tropical or sub-tropical travel, group 3: screening of vertical transmission of imported disease. RESULTS Six protocols have been developed and disseminated on the unit website, as well as 5 scientific publications. A total of 316 patients were evaluated: 191 included in group 1 (29 Adopted and 162 Immigrants), 57 in group 2 (94.7% Visiting Friends and Relatives and 81.5% without a pre-travel consultation). They consulted due to, gastrointestinal symptoms (52.6%) and fever (43.8%), with 68 included in group 3 at risk of imported disease by vertical transmission (62 Trypanosoma cruzi, 1 Human T Lymphotropic Virus and 5 Plasmodium spp.). The overall adherence to the protocols was about 77.1%. DISCUSSION Infectious Diseases Units must adapt to the reality of the population and be flexible in its structure. Periodic assessment of the quality of care offered is essential, as well as an evaluation on the need for additional studies.
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Affiliation(s)
- N Rius Gordillo
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Vall d'Hebron, Barcelona, España
| | - A Martín Nalda
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Vall d'Hebron, Barcelona, España.
| | - S Otero Romero
- Servei de Medicina Preventiva, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Vall d'Hebron, Barcelona, España
| | - P Soler-Palacín
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Vall d'Hebron, Barcelona, España
| | - E Sulleiro Igual
- Servei de Microbiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Vall d'Hebron, Barcelona, España
| | - M Espiau Guarner
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Vall d'Hebron, Barcelona, España
| | - A Fernández-Polo
- Servei de Farmàcia. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Vall d'Hebron, Barcelona, España
| | - C Figueras Nadal
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Vall d'Hebron, Barcelona, España
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