Association of HLA-B*35 and moderate or severe cutaneous reactions secondary to benznidazole treatment in chronic Chagas disease patients

OBJECTIVES

Benznidazole is the first line treatment for Chagas disease. Adverse events appear in more than 50% of patients, leading to discontinuation in approximately 15%. Cutaneous reactions are one of the most frequent adverse events. HLA-genotyping previous studies identified an association between cutaneous reactions to benznidazole and carrying the specific allele HLA-B*35:05. We designed the present study to prospectively confirm this association.

METHODS

This is a prospective observational study including Chagas disease patients aged 18 years or more who accepted to receive benznidazole treatment following current guidelines. Allele genotyping of HLA-B was determined in all patients. Clinical and analytical follow-up was performed at days 0, 7, 14, 30 and 60 of treatment.

RESULTS

Two-hundred and seven patients were included. Seventy percent were female with a mean age of 45.1 (SD ±9.86) years mainly from Bolivia (92.8%). In 102 (49.3%) cases a cutaneous reaction was diagnosed. Forty-eight (46.6%) were classified as mild, 37 (35.9%) as moderate and 18 (17.5%) as severe. Thirty-two (15.4%) patients had to definitively interrupt the treatment due to a cutaneous reaction. Female sex (OR 4.49; 95%CI 1.62-12.47), new-onset eosinophilia prior to cutaneous symptoms (OR 2.55; 95%CI 1.2-5.43) and carrying the HLA-B*35 allelic group (OR 2.58; 95%CI 1.2-5.51) were all predictors of moderate to severe cutaneous reactions. No statistical significance was found when the specific allele HLA-B*35:05 was analyzed.

CONCLUSIONS

Patients carrying the HLA-B*35 allelic group are at higher risk of moderate to severe reactions when taking benznidazole treatment.

Refugee Escape Room©: a new gamification tool to deepen learning about Migration and Health

Background

The aim of gamification is to provide an experiential exercise that invokes emotions to deepen learning. MyHealth project is interested in developing tools that facilitate healthcare access to newly arrived immigrants in Europe. One important barrier is the low levels of intercultural competency among healthcare professionals and the pervasiveness of negative health-related stereotypes.

Methods

We aim to demonstrate the educational value and social impact of the Refugee Escape Room©, to 1) raise awareness about the social and health challenges faced by vulnerable migrants and 2) provide an effective intercultural competence and self-efficacy training for hosting community. The game was created in 2017 by healthcare professionals and university students with personal migratory experience. It is divided in two parts. The first part addresses knowledge gaps about relevant aspects of Migration and Health. The second part is a fictional border control exercise with multiple bureaucratic challenges that participants, organized as “families”, must overcome to succeed. A pre-post pilot was executed to test for tool effectiveness. The piloting phase involved carrying out multiple instances of the activity for separate target groups. A questionnaire was developed with items related to knowledge, self-efficacy and intercultural competence. The questionnaire was filled by participants at baseline and post intervention to assess for statistically significant changes in all outcomes.

Results

while the piloting phase is still ongoing preliminary results show a high level of acceptability and engagement with the tool.

Conclusions

Refugee Escape Room© is a newly created tool that posits as a promising awareness-raising, competency-building gamification tool that is easily adaptable to multiple settings and participants.

Key messages

Gamification provides an experiential exercise that invokes emotions to deepen learning. Refugee Escape Room© is a promising tool for raising awareness about challenges faced by vulnerable migrants.

Persistent infectious and tropical diseases in immigrant correctional populations

A number of infectious diseases amongst travelers and the immigrant populations are a major public health concern. Some have a long incubation period or remain asymptomatic or paucisymptomatic for many years before leading to significant clinical manifestations and/or complications. HIV, hepatitis B and C, tuberculosis or latent syphilis are among the most significant persistent diseases in migrants. Schistosomiasis and strongyloidiasis, for instance, are persistent helminthic infections that may cause significant morbidity, particularly in patients co-infected with HIV, hepatitis B and C. Chagas disease, which was initially confined to Latin America, must also now be considered in immigrants from endemic countries. Visceral leishmaniasis and malaria are other examples of parasitic diseases that must be taken into account by physicians treating incarcerated migrants. The focus of this review article is on the risk of neglected tropical diseases in particularly vulnerable correctional populations and on the risk of infectious diseases that commonly affect migrants but which are often underestimated.

[Diagnosis and treatment of imported eosinophilia in travellers and immigrants: Recommendations of the Spanish Society of Tropical Medicine and International Health (SEMTSI)]

According to published data, prevalence of imported eosinophilia among travellers and immigrants is set between 8% and 28.5%. Etiological diagnosis is often troublesome, and depending on the depth of the study and on the population analyzed, a parasitic cause is identified in 17% to 75.9% of the individuals. Among the difficulties encountered to compare studies are the heterogeneity of the studied populations, the type of data collection (prospective/retrospective) and different diagnostic protocols. In this document the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported eosinophilia are detailed.