Prevalence of Chagas disease in the Latin American immigrant population in a primary health centre in Barcelona (Spain)

doi:10.1016/j.actatropica.2009.07.014

Acta Tropica

Volume 112, Issue 2, November 2009, Pages 228-230

https://doi.org/10.1016/j.actatropica.2009.07.014 Get rights and content

Abstract

A cross-sectional descriptive study was carried out to detect the seroprevalence of chagasic infection in children and women of child-bearing age in a primary care health centre in Barcelona (Spain). Serological screening was performed with an immunochromatography (IC) test (Stat Pak Chagas de Chembio^®) and all positive and doubtful results were confirmed by two ELISA tests using recombinant and whole Trypanosoma cruzi antigens. Prevalence of 4.3% was detected in the child-bearing age group women.

General practitioners and paediatricians are concerned by Chagas disease, now an emergent health disease in non-endemic countries.

Introduction

The epidemiology of Chagas disease has undergone important modifications in recent decades as a consequence of the control programmes carried out in endemic areas that reduced vectorial transmission as well as transfusional transmission. The chronic nature of the disease and the change of patterns of internal migrations and migrations from America to other continents has also influenced this epidemiological change. Chagas disease is no longer limited exclusively to the poor rural areas of Latin America, but now affects urban areas in both endemic and non-endemic countries.

There were more than 1,800,000 Latin American immigrants registered in Spain in 2008 (Instituto Nacional de Estadística, 2008). Those infected with Trypanosoma cruzi could, with time, develop heart conditions, gastrointestinal complaints and, in the case of immunological suppression, neurological disorders. Despite the absence of the vector, it would be possible for T. cruzi to be spread in non-endemic areas by means of contaminated blood products (Piron et al., 2008) and by mother-to-child transmission.

Successful etiological treatment of CD has been reported in newborn babies and in the paediatric population (under 15 years old), with a lower incidence of side effects than in adults.

The aim of this study was to find out the prevalence of chagasic infection in children and women of child-bearing age originally from endemic areas, attended in the paediatric department of a Primary Health Care Centre in Barcelona (Spain).

Section snippets

Patients and methods

The study was carried out over a yearly period from March 2006 to March 2007.

Two population groups were studied: women of child-bearing age (15–45 years old) and the paediatric immigrant population (0–14 years old), from Latin America or born in Spain with their mothers coming from endemic areas, attended in the Consorci d’Atenció Primària de Salut de l’Eixample (CAPse). In the last cases, blood screening was only carried out if the mother had tested positive for T. cruzi infection or if

Results

A total of 224 samples were analysed. 108 samples were collected from children aged between 0 and 14 years, with a mean age of 8.3 (ranging from 2 months to 14 years), and 116 samples from women of child-bearing age, with a mean age of 30.0 (ranging from 15 to 45 years). 36% (108/300) of Latin American paediatric people attended at CAPse were studied.

We obtained 25/224 (11.2%) samples reactive using the ICT testing. In the paediatric group, 13/108 (12.0%) were reactive by ICT, but only 3 of

Discussion

Studies published to date have looked into the prevalence of chagasic infection in the paediatric population and in women of child-bearing age in Latin America (Tortova et al., 2000, Vera et al., 1998, Biancardi et al., 2003) in endemic countries, but no research on it had been conducted in primary care in Europe.

Since the year 2000 (Instituto Nacional de Estadística, 2008), there has been a major increase in the number of Latin American immigrants in Catalonia (Spain) and (according to the

Acknowledgements

To Dr. Pedro Albajar-Viñas and to Dr. Héctor Freilij for their advice and help in the design of this study.

To Dr Jaume Benavent, coordinator of the Consorci d́Atenció Primària de ĺEixample, for his support in carrying out this study in a primary health care centre.

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Cited by (29)

A global systematic review of Chagas disease prevalence among migrants
2016, Acta Tropica
Citation Excerpt :
Although Australia, Japan, Italy, Portugal, and the United Kingdom are part of the top 10 destination countries for Latin American migrants, we did not find any qualifying studies from these countries. Within Spain, 7 of the 12 studies with prevalence estimates of Chagas disease in migrants were similar to the highest countrywide estimate (Del Pino and Coll, 2006; Giménez-Martí et al., 2006; Munoz-Vilches et al., 2012; Paricio-Talayero et al., 2008; Roca et al., 2011; Santiago et al., 2012; Soriano Arandes et al., 2009), two were lower (Piron et al., 2008; Ramos et al., 2012a), and three(Avila Arzanegui et al., 2013; Barona-Vilar et al., 2012; Lucas and Barba, 2009) were higher (Fig. 2). One additional study was conducted in Spain, but its results are not summarized here because it was a non-representative sample of only Bolivian and Paraguayan participants (Ramos et al., 2012b).
Human migration has been identified as a potential factor for increased Chagas disease risk and has transformed the disease from a Latin American problem to a global one. We conducted a systematic review of the scientific literature between 2004–2014 in order to: summarize recent seroprevalence estimates of Chagas disease among Latin American migrants, in both endemic and non-endemic settings; compare seroprevalence estimates in migrants to countrywide prevalence estimates; and identify risk factors for Chagas disease among migrants. A total of 320 studies were screened and 23 studies were included. We found evidence that the prevalence of Chagas disease is higher than expected in some migrant groups and that reliance on blood donor screening prevalence estimates underestimates the burden of disease. Overall there is a dearth of high quality epidemiologic studies on the prevalence of Chagas disease in migrants, especially among intra-regional migrants within Latin America. Given that this zoonotic disease cannot likely be eradicated, improved surveillance and reporting is vital to continuing control efforts. More accurate health surveillance of both Latin American migrants and the Chagas disease burden will help countries appropriately scale up their response to this chronic disease. Overall, improved estimates of Chagas disease among migrants would likely serve to highlight the real need for better screening, diagnostics, and treatment of individuals living with the disease.
Consensus document for the detection and management of Chagas disease in primary health care in a non-endemic areas
2015, Atencion Primaria
La tripanosomiasis americana o enfermedad de Chagas es una enfermedad infecciosa endémica en América Latina continental, causada por el protozoo Trypanosoma cruzi. En las últimas décadas, debido a los movimientos poblacionales, se ha expandido más allá de las zonas endémicas, siendo España el país europeo con más inmigrantes latinoamericanos.
Durante años puede permanecer asintomática, pero cuando se manifiesta clínicamente puede ser grave (miocardiopatía dilatada, megacolon, megaesófago), así como, debido a su transmisión vertical, la detección en embarazadas es una alta prioridad.
Se han elaborado guías de detección de Trypanosoma cruzi en circunstancias específicas (bancos de sangre, maternidades, coinfección con el VIH, trasplante de órganos); pero detectamos falta de información dirigida a los profesionales de atención primaria. Para facilitar la detección y manejo de esta enfermedad se consideró la necesidad de realizar este documento, redactado y consensuado por médicos de familia, pediatras de atención primaria y especialistas en salud internacional.
Chagas disease is caused by the protozoan Trypanosoma cruzi. Although it is commonly transmitted by an insect vector in continental Latin-America, in recent decades, due migration, has been diagnosed in other countries such Spain, the European country with a largest immigrant population of Latin American. For a long time, the patient remains asymptomatic, but some years after this stage, the symptoms can be serious (dilated cardiomyopathy, megacolon, megaesophagus). In addition, detection in pregnant women has a high priority because of the route of vertical transmission.
Several specific guidelines about Chagas disease has been developed on the Banks of blood, maternal hospitals, HIV co-infection, organ transplant. But due to the detection of lack of information to primary care professionals, we consider to will be useful this document written and agreed to by family phisicians, pediatricians and specialists in International Health.
Heart rate variability: Analysis of time-domain indices in patients with chronic Chagas disease before and after an exercise program
2013, Revista Portuguesa de Cardiologia
A doença de Chagas (DC) é uma infeção causada pelo flagelado Trypanosoma cruzi, transmitida por insetos do género Triatoma.
Estudos têm demonstrado o resultado benéfico da prática de exercícios em portadores de insuficiência cardíaca (IC), o seu efeito de redução do tónus simpático e o aumento do tónus parassimpático relacionado com a redução dos níveis de epinefrina e noraepinefrina. Este estudo teve como objetivos: detetar pacientes com cardiopatia chagásica crónica (CCC) com disautonomia através do Holter 24 h, a função autonómica após reabilitação, a redução dos níveis de SDNN/d e um aumento dos níveis de pNN50/d e pNN50/noite, bem como de rMSSD/d e noite. Foi feita uma intervenção tipo antes e depois com avaliação dos índices de domínios do tempo da variabilidade da frequência cardíaca (VFC) antes e ao final do programa de exercícios. Foram estudados 18 pacientes, sendo cinco homens, com CCC e idade média de 57,33 ± 9,73 anos, no ambulatório de DC do Instituto Nacional de Cardiologia (INC) entre abril de 2009 e novembro de 2010. Os exercícios foram: atividade aeróbica em esteira rolante e exercícios contrarresistidos com duração de 60 min e frequência de três vezes por semana. Os valores de SDNN, pNN50 e rMSSD avaliados mostram-se quase inalterados sem significância estatística (p > 0,05). Concluímos que os valores dos parâmetros de VFC em portadores de CCC não se alteraram antes e após a intervenção com um programa de reabilitação cardíaca de seis meses.
Chagas disease (CD) is an infection caused by the protozoan flagellate Trypanosoma cruzi, and transmitted by insects of the genera Triatoma, Rhodnius and Panstrongylus. The heart is affected to varying degrees by inflammatory and destructive lesions in atrial and ventricular myocardial fibers. Several studies have demonstrated the benefits of exercise in patients with congestive heart failure (CHF), including reduced sympathetic tone and increased parasympathetic tone, the result of reduced epinephrine and norepinephrine levels, both at rest and during exercise, including at submaximal levels. It has been hypothesized that the increase in sympathetic arousal during exercise improves peripheral muscle metabolism.
The objectives of this study were to select patients with chronic Chagas cardiomyopathy (CCC) with dysautonomia on 24-h Holter monitoring, assess autonomic function after rehabilitation, and determine whether it resulted in reduced daytime levels of SDNN and increased daytime and nighttime levels of pNN50 and rMSSD.
We analyzed time-domain indices of heart rate variability through 24-h Holter monitoring before and after a supervised exercise program. We studied 18 CCC patients (five men), mean age 57.33±9.73 years, followed at the CD outpatient clinic of the National Institute of Cardiology and IPEC/Fiocruz in Rio de Janeiro, Brazil, between April 2009 and November 2010. The following tests were used to assess the severity of CCC: clinical examination, functional evaluation by cardiopulmonary stress testing, electrocardiogram and conventional Doppler echocardiography. The exams were performed within a month of the start and end of the exercise program, which consisted of 60-min sessions of aerobic exercise on a treadmill and resistance training three times a week for six months. The goal was to reach the patients’ heart rate target zone during training, and their rating of perceived exertion was assessed by the modified Borg scale.
There were no statistically significant differences (p>0.05) in SDNN, pNN50 and rMSSD, probably due to the large standard deviation observed, patients’ poor adherence to the program and their low socioeconomic status, resulting in a small sample, and the short duration of the program.
Heart rate variability parameters in patients with CCC did not undergo statistically significant changes after a six-month cardiac rehabilitation program.
Bolivian migrants with Chagas disease in Barcelona, Spain: A qualitative study of dietary changes and digestive problems
2011, International Health
Citation Excerpt :
In such areas, in the absence of the disease vector, transmission can occur through blood transfusion,4 organ or tissue donation5 or from mother to child.6 Chagas disease and its non-vector transmission has been described in Barcelona6–8 and in other European cities with immigrant populations from endemic areas.9 After the acute phase that normally passes unnoticed, Chagas disease begins an initially asymptomatic chronic phase.
Due to international migration, Chagas disease, endemic in Latin America, has become more common in non-endemic areas. Chronic Chagas disease can cause damage to the digestive system leading to constipation. However, a range of factors influences constipation and a better understanding of the role of non-Chagas related factors is required to improve management of Chagas-related digestive problems. This study explores perceptions of constipation and changes in food and exercise habits amongst Bolivians in Barcelona, Spain. Bolivian migrants attending the Tropical Medicine Unit (Hospital Clínic, Barcelona) were interviewed about their food habits in Spain and Bolivia, migratory experience, work and leisure activities. Chagas seropositive participants also received radiological examinations. Bolivian migrants experienced dietary changes, influenced by work-related factors, which included reductions in quantities of food and liquid consumed. Almost half the participants reported changes in digestive rhythm since arriving in Spain. Constipation, which was common, in some cases was only recounted during interviews. Bolivian migrants’ constipation may be associated with chronic Chagas disease or migration-related dietary changes. Careful questioning using the Rome III criteria is however required to ensure its diagnosis. Radiological studies are also required to confirm the role of Chagas disease and identify potentially serious intestinal damage.
Use of an immunochromatographic test for Trypanosoma cruzi infection screening in a pediatric population
2011, Enfermedades Infecciosas y Microbiologia Clinica
Prevalence of Trypanosoma cruzi infection in pregnant Latin American women and congenital transmission rate in a non-endemic area: The experience of the Valencian Health Programme (Spain)
2012, Epidemiology and Infection

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Acta Tropica

Abstract

Introduction

Section snippets

Patients and methods

Results

Discussion

Acknowledgements

References (21)

Congenital Chagas disease: diagnostic and clinical aspects in an area without vectorial transmission, Bermejo, Bolivia

Acta Trop.

Epidemiological evaluation of Chagas disease in a rural area of southern Bolivia

Trans. R. Soc. Trop. Med. Hyg.

Chagas’ disease diagnosis: a multicentric evaluation of Chagas Stat-Pak, a rapid immunochromatographic assay with recombinant proteins of Trypanosoma cruzi

Diag. Microbiol. Infect. Dis.

Congenital Trypanosoma cruzi infection in a non-endemic area

Trans. R. Soc. Trop. Med. Hyg.

Seroprevalencia de la enfermedad de Chagas en 17 parajes del “Monte Impenetrable” de la provincia de Chaco

Medicina (Buenos Aires)

Enfermedad de Chagas, transmisión maternofetal y experiencia recogida en nuestro centro

Enf. Emerg.

The impact of Chagas disease control in Latin America

Mem. Inst. Oswaldo Cruz

Características clínicas de pacientes infectados por Trypanosoma cruzi

Enf. Emerg.

Prevalence and vertical transmission of Trypanosoma cruzi infection among pregnant Latin American Women attending 2 maternity clinics in Barcelona, Spain

Clin. Infect. Dis.

Cited by (29)

A global systematic review of Chagas disease prevalence among migrants

Consensus document for the detection and management of Chagas disease in primary health care in a non-endemic areas

Heart rate variability: Analysis of time-domain indices in patients with chronic Chagas disease before and after an exercise program

Bolivian migrants with Chagas disease in Barcelona, Spain: A qualitative study of dietary changes and digestive problems

Use of an immunochromatographic test for Trypanosoma cruzi infection screening in a pediatric population

Prevalence of Trypanosoma cruzi infection in pregnant Latin American women and congenital transmission rate in a non-endemic area: The experience of the Valencian Health Programme (Spain)

Short communicationPrevalence of Chagas disease in the Latin American immigrant population in a primary health centre in Barcelona (Spain)

Abstract

Introduction

Section snippets

Patients and methods

Results

Discussion

Acknowledgements

Acta Trop.

Trans. R. Soc. Trop. Med. Hyg.

Diag. Microbiol. Infect. Dis.

Trans. R. Soc. Trop. Med. Hyg.

Seroprevalencia de la enfermedad de Chagas en 17 parajes del “Monte Impenetrable” de la provincia de Chaco

Medicina (Buenos Aires)

Enfermedad de Chagas, transmisión maternofetal y experiencia recogida en nuestro centro

Enf. Emerg.

The impact of Chagas disease control in Latin America

Mem. Inst. Oswaldo Cruz

Características clínicas de pacientes infectados por Trypanosoma cruzi

Enf. Emerg.

Prevalence and vertical transmission of Trypanosoma cruzi infection among pregnant Latin American Women attending 2 maternity clinics in Barcelona, Spain

Clin. Infect. Dis.

Short communication
Prevalence of Chagas disease in the Latin American immigrant population in a primary health centre in Barcelona (Spain)