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Atero N, Torres M, Domínguez A, Diethelm-Varela B, Córdova-Bührle F, Mardones FO. Spatio-temporal distribution of hospitalizations for chronic Chagas disease and risk factors associated with in-hospital mortality and surgical intervention in Chile. PLoS Negl Trop Dis 2024; 18:e0012124. [PMID: 38662649 PMCID: PMC11045106 DOI: 10.1371/journal.pntd.0012124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Chagas disease (CD) is a neglected parasitic zoonotic disease that affects over 6 million people worldwide. We conducted a retrospective study to analyze the spatiotemporal trends and risk factors for hospitalization rates of CD with cardiac and digestive diagnoses in Chile. We used the Mann-Kendall analysis for temporal trends, Global Moran's Index, and Local Indicators of Spatial Association to identify spatial autocorrelation, and regression models to determine the risk factors associated with in-hospital mortality and surgical intervention. Between 2010 and 2020, a total of 654 hospitalizations were reported, corresponding to 527 individuals. The hospitalization rate steadily decreased over the years (t = -0.636; p = 0.009). The Global Moran's I for the study period showed a positive spatial autocorrelation for hospitalization municipality and for residence municipality of CD patients (I = 0.25, p<0.001 and I = 0.45, p<0.001 respectively), indicating a clustering of hospitalizations in northern municipalities. The most frequent diagnosis was a chronic CD with digestive system involvement (55.8%) followed by a chronic CD with heart involvement (44.2%). The highest percentage of hospital discharges was observed among males (56.9%) and in the 60-79 age group (52.7%). In-hospital mortality risk was higher with increasing age (OR = 1.04), and in patients with cardiac involvement (OR = 2.3), whereas factors associated with the risk of undergoing a surgical intervention were sex (OR = 1.6) and diagnosis of CD with digestive involvement (OR = 4.4). The findings of this study indicate that CD is still a significant public health burden in Chile. Efforts should focus on improving access to timely diagnoses and treatment, reducing disease progression and hospitalization burden, and supporting clinicians in preventing complications and deaths.
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Affiliation(s)
- Nicolhole Atero
- Escuela de Medicina Veterinaria, Facultad de Agronomía e Ingeniería Forestal, Facultad de Ciencias Biológicas y Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marisa Torres
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Angélica Domínguez
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Cancer Prevention and Control (CECAN), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Benjamín Diethelm-Varela
- Escuela de Medicina Veterinaria, Facultad de Agronomía e Ingeniería Forestal, Facultad de Ciencias Biológicas y Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Córdova-Bührle
- Escuela de Medicina Veterinaria, Facultad de Agronomía e Ingeniería Forestal, Facultad de Ciencias Biológicas y Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Dirección de Transferencia y Desarrollo, Vicerrectoría de Investigación, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando O. Mardones
- Escuela de Medicina Veterinaria, Facultad de Agronomía e Ingeniería Forestal, Facultad de Ciencias Biológicas y Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Baldoni NR, de Oliveira-da Silva LC, Gonçalves ACO, Quintino ND, Ferreira AM, Bierrenbach AL, Padilha da Silva JL, Pereira Nunes MC, Ribeiro ALP, Oliveira CDL, Sabino EC, Cardoso CS. Gastrointestinal Manifestations of Chagas Disease: A Systematic Review with Meta-Analysis. Am J Trop Med Hyg 2024; 110:10-19. [PMID: 38052078 DOI: 10.4269/ajtmh.23-0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/20/2023] [Indexed: 12/07/2023] Open
Abstract
The aims of this study were to estimate the prevalence of gastrointestinal manifestations among individuals with positive serology for Chagas disease (ChD) and to describe the clinical gastrointestinal manifestations of the disease. A systematic review with meta-analysis was conducted based on the criteria and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Scopus, Virtual Health Library, Web of Science, and Embase databases were used to search for evidence. Two reviewers independently selected eligible articles and extracted data. RStudio® software was used for the meta-analysis. For subgroup analysis, the studies were divided according to the origin of the individuals included: 1) individuals from health units were included in the health care service prevalence analysis, and 2) individuals from the general population were included in the population prevalence analysis. A total of 2,570 articles were identified, but after removal of duplicates and application of inclusion criteria, 24 articles were included and 21 were part of the meta-analysis. Most of the studies were conducted in Brazil. Radiological diagnosis was the most frequent method used to identify the gastrointestinal clinical form. The combined effect of meta-analysis studies showed a prevalence of gastrointestinal manifestations in individuals with ChD of 12% (95% CI, 8.0-17.0%). In subgroup analysis, the prevalence for studies involving health care services was 16% (95% CI, 11.0-23.0%), while the prevalence for population-based studies was 9% (95% CI, 5.0-15.0%). Megaesophagus and megacolon were the main forms of ChD presentation in the gastrointestinal form. The prevalence of gastrointestinal manifestations of ChD was 12%. Knowing the prevalence of ChD in its gastrointestinal form is an important step in planning health actions for these patients.
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Affiliation(s)
- Nayara Ragi Baldoni
- University of Itaúna, Itaúna, Brazil
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
| | | | - Ana Carolina Oliveira Gonçalves
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
| | - Nayara Dornela Quintino
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
- Divinópolis Regional Health Superintendence/Minas Gerais State Health Secretariat (SES-MG), Belo Horizonte, Brazil
| | | | - Ana Luiza Bierrenbach
- Teaching and Research Institute of Sírio-Libanês Hospital, São Paulo, Brazil
- Graduate Program, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | | | | | | | - Claudia Di Lorenzo Oliveira
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
| | - Ester Cerdeira Sabino
- Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo, Brazil
| | - Clareci Silva Cardoso
- Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil
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Laynez-Roldán P, Losada-Galván I, Posada E, de la Torre Ávila L, Casellas A, Sanz S, Subirà C, Rodriguez-Valero N, Camprubí-Ferrer D, Vera I, Roldán M, Aldasoro E, Oliveira-Souto I, Calvo-Cano A, Valls ME, Álvarez-Martínez MJ, Gállego M, Abras A, Ballart C, Muñoz J, Gascón J, Pinazo MJ. Characterization of Latin American migrants at risk for Trypanosoma cruzi infection in a non-endemic setting. Insights into initial evaluation of cardiac and digestive involvement. PLoS Negl Trop Dis 2023; 17:e0011330. [PMID: 37440480 DOI: 10.1371/journal.pntd.0011330] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/24/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Trypanosoma cruzi causes Chagas disease (CD), a potentially fatal disease characterized by cardiac disorders and digestive, neurological or mixed alterations. T. cruzi is transmitted to humans by the bite of triatomine vectors; both the parasite and disease are endemic in Latin America and the United States. In the last decades, population migration has changed the classic epidemiology of T. cruzi, contributing to its global spread to traditionally non-endemic countries. Screening is recommended for Latin American populations residing in non-endemic countries. METHODS The present study analyzes the epidemiological characteristics of 2,820 Latin American individuals who attended the International Health Service (IHS) of the Hospital Clinic de Barcelona between 2002 and 2019. The initial assessment of organ damage among positive cases of T. cruzi infection was analyzed, including the results of electrocardiogram (ECG), echocardiogram, barium enema and esophagogram. RESULTS Among all the screened individuals attending the clinic, 2,441 (86.6%) were born in Bolivia and 1,993 (70.7%) were female. Of individuals, 1,517 (81.5%) reported previous exposure to the vector, which is a strong risk factor associated with T. cruzi infection; 1,382 individuals were positive for T. cruzi infection. The first evaluation of individuals with confirmed T. cruzi infection, showed 148 (17.1%) individuals with Chagasic cardiomyopathy, the main diagnostic method being an ECG and the right bundle branch block (RBBB) for the most frequent disorder; 16 (10.8%) individuals had a normal ECG and were diagnosed of Chagasic cardiomyopathy by echocardiogram. CONCLUSIONS We still observe many Latin American individuals who were at risk of T. cruzi infection in highly endemic areas in their countries of origin, and who have not been previously tested for T. cruzi infection. In fact, even in Spain, a country with one of the highest proportion of diagnosis of Latin American populations, T. cruzi infection remains underdiagnosed. The screening of Latin American populations presenting with a similar profile as reported here should be promoted. ECG is considered necessary to assess Chagasic cardiomyopathy in positive individuals, but echocardiograms should also be considered as a diagnostic approach given that it can detect cardiac abnormalities when the ECG is normal.
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Affiliation(s)
- Pedro Laynez-Roldán
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Irene Losada-Galván
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elizabeth Posada
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Leonardo de la Torre Ávila
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Aina Casellas
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Sergi Sanz
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Carme Subirà
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rodriguez-Valero
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Camprubí-Ferrer
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Vera
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Roldán
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Edelweiss Aldasoro
- The International Foundation for Integrated Care (IFIC), Schiphol, The Netherlands
| | - Inés Oliveira-Souto
- Department of Infectious Diseases, Tropical Medicine & International Health Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Antonia Calvo-Cano
- Department of Infectious Pathology, Badajoz University Hospital, Badajoz, Spain
| | - Maria-Eugenia Valls
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic, Barcelona, Spain
| | - Míriam J Álvarez-Martínez
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic, Barcelona, Spain
| | - Montserrat Gállego
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Parasitology section, Departament of Biology, Health and Environment, Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Spain
- Center for Network Biothecnological Research in Infectious Diseases (CIBERISCIII), Madridy, Spain
| | - Alba Abras
- Genetic Area, Department of Biology, Universitat de Girona, Campus Montilivi, Girona, Spain
| | - Cristina Ballart
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Parasitology section, Departament of Biology, Health and Environment, Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Spain
| | - José Muñoz
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Joaquim Gascón
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Center for Network Biothecnological Research in Infectious Diseases (CIBERISCIII), Madridy, Spain
| | - Maria-Jesus Pinazo
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Center for Network Biothecnological Research in Infectious Diseases (CIBERISCIII), Madridy, Spain
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Beatty NL, Alcala RF, Luque NA, Radetic M, Joshi-Guske P, Alakrad E, Forsyth CJ, Hamer DH. Case Report: Chagas Disease in a Traveler Who Developed Esophageal Involvement Decades after Acute Infection. Am J Trop Med Hyg 2023; 108:543-547. [PMID: 36646072 PMCID: PMC9978553 DOI: 10.4269/ajtmh.22-0461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/29/2022] [Indexed: 01/18/2023] Open
Abstract
Travelers to Chagas disease endemic regions of Latin America may be at risk for Trypanosoma cruzi infection. We report a 67-year-old woman who screened positive for T. cruzi infection while donating blood. The patient had a history of an unusual febrile illness and marked swelling of the face sustained at age 10 after camping in northern Mexico that led to a 3-week hospitalization without a diagnosis. More than 4 decades later, rapid diagnostic tests and commercial and confirmatory serology for Chagas disease were all positive for T. cruzi infection. On evaluation, the patient described a progressive chronic cough, gastroesophageal reflux, and dysphagia for > 10 years. There was no evidence of any cardiac complications. However, esophageal manometry demonstrated significant dysmotility, with 90% of swallows being ineffective with evidence of esophageal pressurization and retrograde peristalsis in several swallows, suggesting early autonomic disruption due to Chagas disease esophagopathy. In this report, we highlight the importance of travel-related Chagas disease among travelers to endemic regions and the need to further identify potential risks of transmission among this at-risk population.
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Affiliation(s)
- Norman L. Beatty
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Address correspondence to Norman L. Beatty, Division of Infectious Diseases and Global Medicine, University of Florida, 1600 SW Archer Rd., PO Box 100289, Gainesville, FL 32610. E-mail:
| | - Rodrigo F. Alcala
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Nelson A. Luque
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Mark Radetic
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Priti Joshi-Guske
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Eyad Alakrad
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | | | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Center for Emerging Infectious Disease Research and Policy, Boston University, Boston, Massachusetts
- National Emerging Infectious Disease Laboratory, Boston University, Boston, Massachusetts
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Ramírez-Olivencia G, Arsuaga M, Torrús D, Belhassen-Garcia M, Rodríguez-Guardado A, Herrero-Mendoza M, Mateo-Maestre M, Campos-Rivas R, Membrillo-de Novales F. Prevalencia de alteraciones digestivas asociadas a Chagas importado (estudio PADChI): un estudio observacional. Rev Clin Esp 2023. [DOI: 10.1016/j.rce.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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França IRDE, Caldas EADEL, Barros MF, Silva JTDDA, Pontual JP, Ferraz ÁAB. Peroral endoscopic myotomy for the treatment of achalasia in the Unified Healthcare System (SUS): results of a short-term. Rev Col Bras Cir 2023; 49:e20223244. [PMID: 36629719 PMCID: PMC10578864 DOI: 10.1590/0100-6991e-20223244-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/08/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION achalasia is a chronic disease. Since there is no curative treatment, diagnosed patients have pharmacological and/or surgical techniques available, aimed at minimizing the condition. POEM appears as a promising new type of palliative treatment with good rates of symptom improvement. OBJECTIVE evaluate the profile of POEM at the Clinical Hospital of the Federal University of Pernambuco (HC - UFPE) and correlate it with the world scenario. METHODS data collection was performed retrospectively from September 2017 to October 2019 with all patients undergoing POEM at the HC - UFPE. Sociodemographic, clinical, and hospital variables were evaluated before and three months after the procedure. RESULTS of 27 patients (52.41 ± 19.24 years old) who underwent the procedure, 66.7% had idiopathic etiology and 33.3% had etiology secondary to Chagas disease. 48% patients underwent previous procedures, of which seven used some type of medication for symptom control, two underwent pneumatic endoscopic dilation, and four underwent Heller cardiomyotomy with partial fundoplication. 62.5% of the evaluated patients had type II achalasia before the procedure. Seven (25.9%) patients presented the following adverse events: four presented bleeding, two pneumoperitoneum, and one both complications, all being treated conservatively. The Eckardt score reduced from 8.37 ± 1.45 to 0.85 ± 1.06 (p-value <0.001). CONCLUSION clinical improvement of symptoms and the patient profile followed the worldwide trend, with emphasis on the etiology secondary to Chagas disease, endemic in Brazil. Gastroesophageal reflux remains the main post-operative symptom.
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Affiliation(s)
- Igor Rabelo DE França
- - Universidade Federal de Pernambuco, Departamento de Cirurgia - Recife - PE - Brasil
| | | | | | | | - João Paulo Pontual
- - Universidade Federal de Pernambuco, Departamento de Cirurgia - Recife - PE - Brasil
| | - Álvaro A B Ferraz
- - Universidade Federal de Pernambuco, Departamento de Cirurgia - Recife - PE - Brasil
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González-Guzmán S, González-Cano P, Bagu ET, Vázquez-Vega S, Martínez-Salazar M, Juárez-Montiel M, Gutiérrez-Hoya A, Crescencio-Trujillo JA, Sánchez-Montes S, Fernández-Figueroa E, Contreras-López EA, Guerra-Márquez Á, Arroyo-Anduiza CI, Ángeles-Márquez LE, Rodríguez-Trejo E, Bekker-Méndez C, Guerra-Castillo FX, Regalado-Santiago C, Tesoro-Cruz E, Oviedo N, Victoria-Jardón AM, Bautista-Olvera J, García-Ramírez P, Vázquez-Meraz JE, Contreras-Lozano MC, Castillo-Flores VS, Guevara-Reyes R, Girón-Sánchez AR, Arenas-Luis HD, Pecero-Hidalgo MJ, Ríos-Antonio E, Ramírez-Pereda N, Martínez-Mora A, Paredes-Cervantes V. Seroprevalence of Trypanosoma cruzi in Eight Blood Banks in Mexico. Arch Med Res 2022; 53:625-633. [PMID: 36109203 DOI: 10.1016/j.arcmed.2022.08.007] [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: 04/12/2022] [Revised: 07/16/2022] [Accepted: 08/19/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The true prevalence of Chagas disease in Mexico is unknown. However, it has been estimated that 1.1-4 million people are infected with Trypanosoma cruzi, which represents a potential risk for transmission of the disease via contaminated blood. AIM OF THE STUDY To determine the Chagas disease seroprevalence in donors from eight blood banks in the north of Mexico City, and the northeast of the State of Mexico. STUDY DESIGN AND METHODS Serum samples from blood donors (n = 515,038) were tested to detect the presence of anti-Trypanosoma cruzi antibodies in eight blood banks. The serologic screening test was performed in each of the blood banks. To confirm the seropositive blood donors, only two out of the eight blood banks used a test with a different principle with the aim of identifying anti-Trypanosoma cruzi antibodies. All tests were validated by the Mexican Institute for Epidemiological Diagnosis and Reference. RESULTS One thousand two hundred and ten blood donors were seropositive for Trypanosoma cruzi, which represents a 0.23% seroprevalence (95% CI 0.22-0.25%). Of the seropositive blood donors, 97.03 % resided in the northeast area of the State of Mexico, Mexico City, and southern part of the State of Hidalgo. CONCLUSIONS Active transmission of Chagas disease may be occurring in non-endemic regions in the northeast of the State of Mexico.
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Affiliation(s)
- Saúl González-Guzmán
- Banco Central de Sangre, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México; Hospital Regional de Alta Especialidad de Zumpango, Estado de México, México
| | - Patricia González-Cano
- Departamento de Farmacobiología, Universidad de La Cañada, Teotitlán de Flores Magón, Oaxaca, México
| | - Edward T Bagu
- Sanford School of Medicine School, University of South Dakota, Vermillion, South Dakota, USA
| | - Salvador Vázquez-Vega
- Unidad de Investigación Epidemiológica y Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Martha Martínez-Salazar
- División Atención Oncológica Pediátrica, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Margarita Juárez-Montiel
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Adriana Gutiérrez-Hoya
- Cátedra-CONACyT. Unidad de Diferenciación Celular e Investigación del Cáncer, Facultad de Estudios Superiores, Zaragoza, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Sokani Sánchez-Montes
- Centro de Medicina Tropical, Universidad Nacional Autónoma de México, Ciudad de México, México; Facultad de Ciencias Biológicas y Agropecuarias, Universidad Veracruzana, Veracruz, México
| | - Edith Fernández-Figueroa
- Departamento de Genómica Poblacional, Genómica Computacional y Biología integrativa. Instituto Nacional De Medicina Genómica, Ciudad de México, México
| | - Erik A Contreras-López
- Hospital General de Zona #25, Instituto Mexicano del Seguro Social, Ciudad de México, México; Hospital General Tacuba, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Ciudad de México, México
| | - Ángel Guerra-Márquez
- Banco Central de Sangre, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Carla I Arroyo-Anduiza
- Banco Central de Sangre, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Laura E Ángeles-Márquez
- Banco Central de Sangre, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Eduardo Rodríguez-Trejo
- Banco Central de Sangre, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Carolina Bekker-Méndez
- Unidad de Investigación Médica en Inmunología e Infectología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Francisco X Guerra-Castillo
- Unidad de Investigación Médica en Inmunología e Infectología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Emiliano Tesoro-Cruz
- Unidad de Investigación Médica en Inmunología e Infectología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Norma Oviedo
- Unidad de Investigación Médica en Inmunología e Infectología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | | | | | - José E Vázquez-Meraz
- Banco de Sangre Regional Ecatepec Las Américas, Ecatepec Estado de México, México
| | | | | | | | | | - H D Arenas-Luis
- Hospital Regional de Alta Especialidad de Zumpango, Estado de México, México
| | | | - Emiliano Ríos-Antonio
- Departamento de Farmacobiología, Universidad de La Cañada, Teotitlán de Flores Magón, Oaxaca, México
| | - Natividad Ramírez-Pereda
- Departamento de Farmacobiología, Universidad de La Cañada, Teotitlán de Flores Magón, Oaxaca, México
| | - Adalberto Martínez-Mora
- Departamento de Farmacobiología, Universidad de La Cañada, Teotitlán de Flores Magón, Oaxaca, México
| | - Vladimir Paredes-Cervantes
- Unidad de Investigación Médica en Inmunología e Infectología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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FRANÇA IGORRABELODE, CALDAS EDUARDAAUGUSTADELUCENA, BARROS MARCELLAFERREIRA, SILVA JOSETARCÍSIODIASDA, PONTUAL JOÃOPAULO, FERRAZ ÁLVAROAB. Miotomia endoscópica peroral para o tratamento de acalásia no Sistema Único de Saúde (SUS): resultados de seguimento no curto-prazo. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RESUMO Introdução: a acalasia é uma doença crônica. Por não haver tratamento curativo, os pacientes diagnosticados dispõem de técnicas farmacológicas e/ou cirúrgicas, visando minimizar o quadro. A POEM surge como um novo tipo de tratamento paliativo promissor com boas taxas de melhora dos sintomas. Objetivo: avaliar o perfil das POEM realizadas no Hospital das Clínicas da Universidade Federal de Pernambuco (HC - UFPE) e correlacioná-lo com o cenário mundial. Métodos: a coleta de dados foi realizada retrospectivamente no período de setembro de 2017 a outubro de 2019 com todos os pacientes submetidos a POEM no HC - UFPE. Variáveis sociodemográficas, clínicas e hospitalares foram avaliadas antes e três meses após o procedimento. Resultados: total de 27 pacientes (52,41 ± 19,24 anos) que realizaram o procedimento, 66,7% com etiologia idiopática e 33,3% com etiologia secundária à doença de Chagas. 48% tinham sido submetidos a procedimentos prévios, dos quais sete usaram algum tipo de medicamento para controle dos sintomas, dois foram submetidos à dilatação endoscópica pneumática e quatro à cardiomiotomia a Heller com fundoplicatura parcial. 62,5% dos pacientes avaliados tinham acalasia tipo ii antes do procedimento. Sete (25,9%) apresentaram eventos adversos: quatro sangramentos, dois pneumoperitônio e um ambas as complicações, todos foram tratados de forma conservadora. O escore de Eckardt reduziu de 8,37 ± 1,45 para 0,85 ± 1,06 (valor de p<0,001). Conclusão: melhora clínica e o perfil dos pacientes acompanhou a tendência mundial, destaque para a etiologia secundária à doença de Chagas, endêmica no Brasil. O refluxo gastroesofágico continua sendo o principal sintoma pós-operatório.
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9
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Álvarez-Hernández DA, García-Rodríguez-Arana R, Ortiz-Hernández A, Álvarez-Sánchez M, Wu M, Mejia R, Martínez-Juárez LA, Montoya A, Gallardo-Rincon H, Vázquez-López R, Fernández-Presas AM. A systematic review of historical and current trends in Chagas disease. Ther Adv Infect Dis 2021; 8:20499361211033715. [PMID: 34408874 PMCID: PMC8365018 DOI: 10.1177/20499361211033715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/01/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction Chagas disease (CD) is caused by Trypanosoma cruzi. When acquired, the disease develops in stages. For diagnosis, laboratory confirmation is required, and an extensive assessment of the patient's health should be performed. Treatment consists of the administration of trypanocidal drugs, which may cause severe adverse effects. The objective of our systematic review was to analyze data contained in the CD published case reports to understand the challenges that patients and clinicians face worldwide. Materials and methods We performed a systematic review following the PRISMA guidance. PubMed database was explored using the terms 'American trypanosomiasis' or 'Chagas disease'. Results were limited to human case reports written in English or Spanish. A total of 258 reports (322 patients) were included in the analysis. Metadata was obtained from each article. Following this, it was analyzed to obtain descriptive measures. Results From the sample, 56.2% were males and 43.8% were females. Most cases were from endemic countries (85.4%). The most common clinical manifestations were fever during the acute stage (70.0%), dyspnea during the chronic stage in its cardiac form (53.7%), and constipation during the chronic stage in its digestive form (73.7%). Most patients were diagnosed in the chronic stage (72.0%). Treatment was administered in 56.2% of cases. The mortality rate for the acute stage cases was 24.4%, while for the chronic stage this was 28.4%. Discussion CD is a parasitic disease endemic to Latin America, with increasing importance due to human and vector migration. In this review, we report reasons for delays in diagnosis and treatment, and trends in medical practices. Community awareness must be increased to improve CD's diagnoses; health professionals should be appropriately trained to detect and treat infected individuals. Furthermore, public health policies are needed to increase the availability of screening and diagnostic tools, trypanocidal drugs, and, eventually, vaccines.
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Affiliation(s)
| | | | - Alejandro Ortiz-Hernández
- Faculty of Health Sciences, Autonomous University of San Luis Potosi, Centro, San Luis Potosi, Mexico
| | - Mariana Álvarez-Sánchez
- Faculty of Health Sciences, Anahuac University Mexico - North Campus, Huixquilucan, Mexico State, Mexico
| | - Meng Wu
- Department of Infectious Diseases, Rheumatology & Infectious Diseases PLLC, Houston, TX, USA
| | - Rojelio Mejia
- Laboratory of Human Parasitology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Alejandra Montoya
- Department of Digital Health, Carlos Slim Foundation, Miguel Hidalgo, Mexico City, Mexico
| | - Héctor Gallardo-Rincon
- Direction of Operational Solutions, Carlos Slim Foundation, Miguel Hidalgo, Mexico City, Mexico
| | - Rosalino Vázquez-López
- Faculty of Health Sciences, Anahuac University Mexico - North Campus, Huixquilucan, Mexico State, Mexico
| | - Ana-María Fernández-Presas
- Faculty of Health Sciences, Anahuac University Mexico - North Campus, Huixquilucan, Mexico State, Mexico
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10
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Choudhury SD. Nano-Medicines a Hope for Chagas Disease! Front Mol Biosci 2021; 8:655435. [PMID: 34141721 PMCID: PMC8204082 DOI: 10.3389/fmolb.2021.655435] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Chagas disease, is a vector-mediated tropical disease whose causative agent is a parasitic protozoan named Trypanosoma cruzi. It is a very severe health issue in South America and Mexico infecting millions of people every year. Protozoan T. cruzi gets transmitted to human through Triatominae, a subfamily of the Reduviidae, and do not have any effective treatment or preventative available. The lack of economic gains from this tropical parasitic infection, has always been the reason behind its negligence by researchers and drug manufacturers for many decades. Hence there is an enormous requirement for more efficient and novel strategies to reduce the fatality associated with these diseases. Even, available diagnosis protocols are outdated and inefficient and there is an urgent need for rapid high throughput diagnostics as well as management protocol. The current advancement of nanotechnology in the field of healthcare has generated hope for better management of many tropical diseases including Chagas disease. Nanoparticulate systems for drug delivery like poloxamer coated nanosuspension of benzimidazole have shown promising results in reducing toxicity, elevating efficacy and bioavailability of the active compound against the pathogen, by prolonging release, thereby increasing the therapeutic index. Moreover, nanoparticle-based drug delivery has shown promising results in inducing the host’s immune response against the pathogen with very few side effects. Besides, advances in diagnostic assays, such as nanosensors, aided in the accurate detection of the parasite. In this review, we provide an insight into the life cycle stages of the pathogen in both vertebrate host and the insect vector, along with an overview of the current therapy for Chagas disease and its limitations; nano carrier-based delivery systems for antichagasic agents, we also address the advancement of nano vaccines and nano-diagnostic techniques, for treatment of Chagas disease, majorly focusing on the novel perspectives in combating the disease.
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11
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Dantas RO. Management of Esophageal Dysphagia in Chagas Disease. Dysphagia 2021; 36:517-522. [PMID: 33855597 DOI: 10.1007/s00455-021-10297-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
Chagas disease, caused by the infection of the protozoan parasite Trypanosoma cruzi, has clinical consequences in the heart and digestive tract. The most important changes in the digestive tract occur in the esophagus (megaesophagus) and colon (megacolon). Esophageal dysfunction in Chagas disease results from damage of the esophageal myenteric plexus, with loss of esophageal peristalsis, partial or absent lower esophageal sphincter relaxation, and megaesophagus, which characterizes secondary esophageal achalasia. The treatment options for the disease are similar to those for idiopathic achalasia, consisting of diet and behavior changes, drugs, botulinum toxin, peroral endoscopic myotomy (POEM), pneumatic dilation of the lower esophageal sphincter, laparoscopic Heller myotomy, and esophagectomy. Chagas disease causes a life-threatening cardiopathy, and this should be considered when choosing the most appropriate treatment for the disease. While some options are palliative, for temporary relief of dysphagia (such as drugs, botulinum toxin, and pneumatic dilation), other therapies provide a long-term benefit. In this case, POEM stands out as a modern and successful strategy, with good results in more than 90% of the patients. Esophagectomy is the option in Chagas disease patients with advanced megaesophagus, despite the increased risk of complications. In these cases, peroral endoscopic myotomy may be an option, which needs further evaluation.
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Affiliation(s)
- Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Campus da USP, Ribeirão Preto, SP, Brazil.
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12
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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: 26] [Impact Index Per Article: 6.5] [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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Monje-Rumi MM, Floridia-Yapur N, Zago MP, Ragone PG, Pérez Brandán CM, Nuñez S, Barrientos N, Tomasini N, Diosque P. Potential association of Trypanosoma cruzi DTUs TcV and TcVI with the digestive form of Chagas disease. INFECTION GENETICS AND EVOLUTION 2020; 84:104329. [PMID: 32339759 DOI: 10.1016/j.meegid.2020.104329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 11/28/2022]
Abstract
The relationship among genetic diversity of Trypanosoma cruzi and clinical forms of Chagas disease remain elusive. In order to assess the possible association between different T. cruzi Discrete Typing Units (DTUs) and the clinical pictures of the disease, 205 chronic patients from Salta province, Argentina, were analysed. One hundred and twenty-two of these patients were clinically categorized as: cardiac 38.5% (47/122), digestive 15% (18/122), cardio-digestive 16% (20/122) and asymptomatic 30% (37/122). From each patient, blood samples were taken for both, Polymerase Chain Reaction (PCR) targeting kDNA and blood culture analyses. The presence of T. cruzi kDNA was detected in 43% (88/205) of the patients. T. cruzi DTUs were identified in 74% (65/88) of the kDNA positive patients by PCR-hybridization using specific probes. We detected the presence of DTUs TcI, TcII, TcV and TcVI. Single infections (i.e. presence of only one DTU in the sample) were detected in 38.64% of the samples (34/88), while mixed infections were 35.23% (31/88). TcV was the most prevalent DTU (60.3%- 53/88). The association analyses showed, for the first time to the best of our knowledge, that TcV and TcVI were associated with the digestive form of Chagas Disease (Fisher p = .0001).
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Affiliation(s)
- M M Monje-Rumi
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Salta, Argentina. Av. Bolivia, 5150 Salta, Argentina
| | - N Floridia-Yapur
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Salta, Argentina. Av. Bolivia, 5150 Salta, Argentina
| | - M P Zago
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Salta, Argentina. Av. Bolivia, 5150 Salta, Argentina
| | - P G Ragone
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Salta, Argentina. Av. Bolivia, 5150 Salta, Argentina
| | - C M Pérez Brandán
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Salta, Argentina. Av. Bolivia, 5150 Salta, Argentina
| | - S Nuñez
- Servicio de Cardiología, Hospital San Bernardo, Av. José Tobias 69, Salta, Argentina
| | - N Barrientos
- Servicio de Cardiología, Hospital San Bernardo, Av. José Tobias 69, Salta, Argentina
| | - N Tomasini
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Salta, Argentina. Av. Bolivia, 5150 Salta, Argentina
| | - P Diosque
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Salta, Argentina. Av. Bolivia, 5150 Salta, Argentina.
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Ventura-Garcia L, Muela-Ribera J, Martínez-Hernáez A. Chagas, Risk and Health Seeking among Bolivian Women in Catalonia. Med Anthropol 2020; 40:541-556. [PMID: 32058805 DOI: 10.1080/01459740.2020.1718125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this article, we explore relationships between risk and emotions among Bolivian women living with Chagas disease, and the implications of this for their diagnosis and treatment in Catalonia, Spain. Here, risk is a social phenomenon, while emotions are conceived as embedded in the sociocultural and relational world. Emotions play key risk-related roles as both a cause and consequence of Chagas disease, are the basis of health practices, and allow us to link risk to wider social inequalities. The way we conceive emotions is crucial both theorically and practically.
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Affiliation(s)
- Laia Ventura-Garcia
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | - Joan Muela-Ribera
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
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Barros FD, Soares JCDA, Barros FPD, Sangenis LHC, Silva GMSD, Fonseca ABM, Hasslocher-Moreno AM, Sousa ASD, Saraiva RM, Mediano MFF. Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas disease. Rev Soc Bras Med Trop 2019; 52:e20180258. [PMID: 30843966 DOI: 10.1590/0037-8682-0258-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 01/25/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The diagnosis and classification of megaesophagus can be challenging in patients with Chagas disease. The present study aimed to evaluate the agreement between upper endoscopies and esophagographies for the diagnosis and classification of megaesophagus in Chagas disease. METHODS A cross-sectional study of 50 patients with Chagas disease with upper digestive symptoms was undertaken. Esophagography and upper endoscopy exams were performed to compare diagnoses. Statistical analysis included sensitivity and specificity used to evaluate the diagnostic accuracy of upper endoscopies, and measures of agreement: linearly weighted Kappa (κw) and Cohen`s classical Kappa (κ) coefficients with 95% confidence intervals (95% CI). RESULTS Twenty-three patients (46%) were diagnosed with megaesophagus by esophagography. The upper endoscopy sensitivity and specificity for megaesophagus diagnosis were 100% and 33.3%, respectively. Regarding megaesophagus classifications, there was a substantial agreement between the two exams (κw = 0.622; 95% CI: 0.498 to 0.746). Within megaesophagus groups, agreement for group I was slight (κ = 0.096; 95% CI: 0.000 to 0.403); for group II, substantial (κ = 0.703; 95% CI: 0.456 to 0.950); and for groups III and IV, inconclusive (κ = 0.457; 95% CI: 0.000 to 0.967; κ = 0.540; 95% CI: 0.035 to 1.000, respectively). CONCLUSIONS Upper endoscopy has a high sensitivity, but a low specificity to diagnose megaesophagus. Agreement between the two exams varies depending on the megaesophagus grade. Thus, upper endoscopy can be used in the diagnostic workup of a possible Chagas disease megaesophagus, but all identified cases should undergo esophagography.
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Affiliation(s)
- Fernando de Barros
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | | | - Fernando Prado de Barros
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | | | | | | | | | - Andrea Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.,Instituto Nacional de Cardiologia, Ministério da Saúde, Rio de Janeiro, RJ, Brasil
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Nunes MCP, Beaton A, Acquatella H, Bern C, Bolger AF, Echeverría LE, Dutra WO, Gascon J, Morillo CA, Oliveira-Filho J, Ribeiro ALP, Marin-Neto JA. Chagas Cardiomyopathy: An Update of Current Clinical Knowledge and Management: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e169-e209. [DOI: 10.1161/cir.0000000000000599] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background:
Chagas disease, resulting from the protozoan
Trypanosoma cruzi
, is an important cause of heart failure, stroke, arrhythmia, and sudden death. Traditionally regarded as a tropical disease found only in Central America and South America, Chagas disease now affects at least 300 000 residents of the United States and is growing in prevalence in other traditionally nonendemic areas. Healthcare providers and health systems outside of Latin America need to be equipped to recognize, diagnose, and treat Chagas disease and to prevent further disease transmission.
Methods and Results:
The American Heart Association and the Inter-American Society of Cardiology commissioned this statement to increase global awareness among providers who may encounter patients with Chagas disease outside of traditionally endemic environments. In this document, we summarize the most updated information on diagnosis, screening, and treatment of
T cruzi
infection, focusing primarily on its cardiovascular aspects. This document also provides quick reference tables, highlighting salient considerations for a patient with suspected or confirmed Chagas disease.
Conclusions:
This statement provides a broad summary of current knowledge and practice in the diagnosis and management of Chagas cardiomyopathy. It is our intent that this document will serve to increase the recognition of Chagas cardiomyopathy in low-prevalence areas and to improve care for patients with Chagas heart disease around the world.
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Zaninotto G, Bennett C, Boeckxstaens G, Costantini M, Ferguson MK, Pandolfino JE, Patti MG, Ribeiro U, Richter J, Swanstrom L, Tack J, Triadafilopoulos G, Markar SR, Salvador R, Faccio L, Andreollo NA, Cecconello I, Costamagna G, da Rocha JRM, Hungness ES, Fisichella PM, Fuchs KH, Gockel I, Gurski R, Gyawali CP, Herbella FAM, Holloway RH, Hongo M, Jobe BA, Kahrilas PJ, Katzka DA, Dua KS, Liu D, Moonen A, Nasi A, Pasricha PJ, Penagini R, Perretta S, Sallum RAA, Sarnelli G, Savarino E, Schlottmann F, Sifrim D, Soper N, Tatum RP, Vaezi MF, van Herwaarden-Lindeboom M, Vanuytsel T, Vela MF, Watson DI, Zerbib F, Gittens S, Pontillo C, Vermigli S, Inama D, Low DE. The 2018 ISDE achalasia guidelines. Dis Esophagus 2018; 31:5087687. [PMID: 30169645 DOI: 10.1093/dote/doy071] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Achalasia is a relatively rare primary motor esophageal disorder, characterized by absence of relaxations of the lower esophageal sphincter and of peristalsis along the esophageal body. As a result, patients typically present with dysphagia, regurgitation and occasionally chest pain, pulmonary complication and malnutrition. New diagnostic methodologies and therapeutic techniques have been recently added to the armamentarium for treating achalasia. With the aim to offer clinicians and patients an up-to-date framework for making informed decisions on the management of this disease, the International Society for Diseases of the Esophagus Guidelines proposed and endorsed the Esophageal Achalasia Guidelines (I-GOAL). The guidelines were prepared according the Appraisal of Guidelines for Research and Evaluation (AGREE-REX) tool, accredited for guideline production by NICE UK. A systematic literature search was performed and the quality of evidence and the strength of recommendations were graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Given the relative rarity of this disease and the paucity of high-level evidence in the literature, this process was integrated with a three-step process of anonymous voting on each statement (DELPHI). Only statements with an approval rate >80% were accepted in the guidelines. Fifty-one experts from 11 countries and 3 representatives from patient support associations participated to the preparations of the guidelines. These guidelines deal specifically with the following achalasia issues: Diagnostic workup, Definition of the disease, Severity of presentation, Medical treatment, Botulinum Toxin injection, Pneumatic dilatation, POEM, Other endoscopic treatments, Laparoscopic myotomy, Definition of recurrence, Follow up and risk of cancer, Management of end stage achalasia, Treatment options for failure, Achalasia in children, Achalasia secondary to Chagas' disease.
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Affiliation(s)
- G Zaninotto
- Department of Surgery and Cancer, Imperial College, London, UK
| | - C Bennett
- Office of Research and Innovation, Royal College of Surgeons in Ireland, Ireland
| | - G Boeckxstaens
- Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - M Costantini
- Department of Surgical, Oncological and Gastroenterologica Sciences, University of Padua, Padua, Italy
| | - M K Ferguson
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - J E Pandolfino
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - M G Patti
- Department of Medicine and Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - U Ribeiro
- Department of Gastroenterology, Division of Surgery, University of Sao Paulo, Sao Paulo, Brazil
| | - J Richter
- Department of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - L Swanstrom
- Institute of Image-Guided Surgery, Strasbourg, France; Interventional Endoscopy and Foregut Surgery, Oregon Health Science University, Portland, Oregon, USA
| | - J Tack
- Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - G Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford Esophageal Multidisciplinary Program in Innovative Research Excellence (SEMPIRE), Stanford University, Stanford, California, USA
| | - S R Markar
- Department of Surgery and Cancer, Imperial College, London, UK
| | - R Salvador
- Department of Surgical, Oncological and Gastroenterologica Sciences, University of Padua, Padua, Italy
| | - L Faccio
- Division of Surgery, Padova University Hospital, Padova, Italy
| | - N A Andreollo
- Faculty of Medical Science, State University of Campinas, Campinas, São Paulo, Brazil
| | - I Cecconello
- Digestive Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - G Costamagna
- Digestive Endoscopy Unit, A. Gemelli Hospital, Catholic University, Rome, Italy
| | - J R M da Rocha
- Department of Gastroenterology, Division of Surgery, University of Sao Paulo, Sao Paulo, Brazil
| | - E S Hungness
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - P M Fisichella
- Department of Surgery, Brigham and Women's Hospital and Boston VA Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - K H Fuchs
- Department of Surgery, AGAPLESION-Markus-Krankenhaus, Frankfurt, Germany
| | - I Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - R Gurski
- Department of Surgery, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - C P Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - F A M Herbella
- Department of Surgery, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - R H Holloway
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, The University of Adelaide, Adelaide, Australia
| | - M Hongo
- Department of Medicine, Kurokawa Hospital, Taiwa, Kurokawa, Miyagi, Japan
| | - B A Jobe
- Esophageal and Lung Institute, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - P J Kahrilas
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - D A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - K S Dua
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - D Liu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - A Moonen
- Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - A Nasi
- Digestive Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - P J Pasricha
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico; Department of Pathophysiology and Transplantation; Università degli Studi, Milan, Italy
| | - S Perretta
- Institute for Image Guided Surgery IHU-Strasbourg, Strasbourg, France
| | - R A A Sallum
- Department of Gastroenterology, Division of Surgery, University of Sao Paulo, Sao Paulo, Brazil
| | - G Sarnelli
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - E Savarino
- Department of Surgical, Oncological and Gastroenterologica Sciences, University of Padua, Padua, Italy
| | - F Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - D Sifrim
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - N Soper
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - R P Tatum
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - M F Vaezi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - M van Herwaarden-Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Vanuytsel
- Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - M F Vela
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - D I Watson
- Department of Surgery, Flinders University, Adelaide, Australia
| | - F Zerbib
- Department of Gastroenterology, University of Bordeaux, Bordeaux, France
| | - S Gittens
- ECD Solutions, Atlanta, Georgia, USA
| | - C Pontillo
- ALMA (Association of patients with achalasia, ONLUS), Naples, Italy
| | - S Vermigli
- ALMA (Association of patients with achalasia, ONLUS), Naples, Italy
| | - D Inama
- ALMA (Association of patients with achalasia, ONLUS), Naples, Italy
| | - D E Low
- Department of Thoracic Surgery Virginia Mason Medical Center, Seattle, Washington, USA
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18
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Duarte JG, Nascimento RD, Martins PR, d'Ávila Reis D. Evaluation of the immunoreactivity of nerve growth factor and tropomyosin receptor kinase A in the esophagus of noninfected and infected individuals with Trypanosoma cruzi. Parasitol Res 2018; 117:1647-1655. [PMID: 29550999 DOI: 10.1007/s00436-018-5838-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/09/2018] [Indexed: 11/30/2022]
Abstract
Megaesophagus is one of the major manifestations of the chronic phase of Chagas disease. Its primary symptom is generally dysphagia due to disturbance in the lower esophageal sphincter. Microscopically, the affected organ presents denervation, which has been considered as consequence of an inflammatory process that begins at the acute phase and persists in the chronic phase. Inflammatory infiltrates are composed of lymphocytes, macrophages, natural killer cells, mast cells, and eosinophils. In this study, we evaluated the immunoreactivity of nerve growth factor (NGF), and of its receptor tropomyosin receptor kinase A (TrkA), molecules that are well known for having a relevant role in neuroimmune communication in the gastrointestinal tract. Esophageal samples obtained via autopsy or surgery procedures from six noninfected individuals, six infected individuals without megaesophagus, and six infected individuals with megaesophagus were analyzed. Infected individuals without megaesophagus presented increased numbers of NGF immunoreactive (IR) mast cells and increased areas of TrkA-IR epithelial cells and inner muscle cells. Infected individuals with megaesophagus showed increased numbers of NGF-IR eosinophils and mast cells, TrkA-IR eosinophils and mast cells, increased area of NGF-IR epithelial cells, and increased areas of TrkA-IR epithelials cells and inner muscle cells. The data presented here point to the participation of NGF and its TrkA receptor in the pathology of chagasic megaesophagus.
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Affiliation(s)
- Jacqueline Garcia Duarte
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rodolfo Duarte Nascimento
- Departamento de Ciências Básicas da Vida, Instituto de Ciências da Vida, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil.
| | - Patrícia Rocha Martins
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Débora d'Ávila Reis
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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19
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Antinori S, Galimberti L, Grande R, Bianco R, Oreni L, Traversi L, Ricaboni D, Bestetti G, Lai A, Mileto D, Gismondo MR, Petullà M, Garelli S, De Maio G, Cogliati C, Torzillo D, Villa AM, Egidi AM, Repetto EC, Ridolfo AL, Corbellino M, Galli M. Chagas disease knocks on our door: a cross-sectional study among Latin American immigrants in Milan, Italy. Clin Microbiol Infect 2018; 24:1340.e1-1340.e6. [PMID: 29555394 DOI: 10.1016/j.cmi.2018.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We aimed to assess the prevalence and risk factors for Chagas disease (CD) in Latin American immigrants and to evaluate the accuracy of diagnostic tests. Moreover, we offered to all positive subjects a complete free-of-charge clinical/instrumental evaluation as well as benznidazole treatment in order to stage the disease and verify drug tolerability. METHODS A cross-sectional survey of CD among Latin Americans living in Milan and its metropolitan area was conducted between July 2013 and July 2014. Blood samples were tested for serologic evidence of CD together with a questionnaire covering demographic and clinical-epidemiological information. RESULTS Forty-eight (9.6%) of the 501 tested subjects were conclusively diagnosed as having CD. The highest prevalence of CD was among those from Bolivia (43/169, 25.4%) and El Salvador (4/68, 5.9%). Older age (adjusted odds ratio (aOR)] 1.05, p =0.004), a Bolivian origin (aOR 8.80; p =0.003), being born in the department of Santa Cruz (aOR 3.72, p =0.047), having lived in mud houses (aOR 2.68; p =0.019), and having an affected relative (aOR 12.77, p =0.001) were independently associated with CD. The ARCHITECT Chagas test showed the highest sensitivity (100%) and specificity (99.8%). Twenty-nine of the subjects with CD (60.4%) underwent disease staging, 10 of whom (35.7%) showed cardiac and/or digestive involvement. Benznidazole treatment was associated with high frequency of adverse reactions (19/27, 70.4%) and permanent discontinuation (8/27, 29.6%). CONCLUSIONS CD is highly prevalent among Bolivians and Salvadorans living in Milan. Regions with a large Latin American immigrant population should implement programmes of active detection and treatment.
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Affiliation(s)
- S Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy.
| | - L Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - R Grande
- Laboratory of Clinical Microbiology, Virology and Bioemergency, ASST Fatebenefratelli Sacco, Milan, Luigi Sacco Hospital, Italy
| | - R Bianco
- Radiology Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - L Oreni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - L Traversi
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - D Ricaboni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - G Bestetti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - A Lai
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - D Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergency, ASST Fatebenefratelli Sacco, Milan, Luigi Sacco Hospital, Italy
| | - M R Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergency, ASST Fatebenefratelli Sacco, Milan, Luigi Sacco Hospital, Italy
| | - M Petullà
- Radiology Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - S Garelli
- II Division of Internal Medicine, ASST Fatebenefratelli Sacco, Milan, Italy
| | - G De Maio
- II Division of Internal Medicine, ASST Fatebenefratelli Sacco, Milan, Italy
| | - C Cogliati
- Médecins San Frontières, Medical Department, Operational Centre Rome, MSF, Italy
| | - D Torzillo
- Médecins San Frontières, Medical Department, Operational Centre Rome, MSF, Italy
| | - A M Villa
- Opera San Francesco per i Poveri, Milan, Italy
| | - A M Egidi
- II Division of Internal Medicine, ASST Fatebenefratelli Sacco, Milan, Italy
| | - E C Repetto
- II Division of Internal Medicine, ASST Fatebenefratelli Sacco, Milan, Italy
| | - A L Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - M Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - M Galli
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
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20
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Panesso-Gómez S, Pavia P, Rodríguez-Mantilla IE, Lasso P, Orozco LA, Cuellar A, Puerta CJ, Mendoza de Molano B, González JM. Trypanosoma cruzi Detection in Colombian Patients with a Diagnosis of Esophageal Achalasia. Am J Trop Med Hyg 2018; 98:717-723. [PMID: 29405099 PMCID: PMC5930867 DOI: 10.4269/ajtmh.17-0417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Achalasia is a motility disorder of the esophagus that might be secondary to a chronic Trypanosoma cruzi infection. Several studies have investigated esophageal achalasia in patients with Chagas disease (CD) in Latin America, but no related studies have been performed in Colombia. The goals of the present study were to determine the presence of anti-T. cruzi antibodies in patients with esophageal achalasia who visited a referral hospital in Bogotá, Colombia, and to detect the presence of the parasite and its discrete typing units (DTUs). This cross-sectional study was conducted in adult patients (18-65 years old) who were previously diagnosed with esophageal achalasia and from whom blood was drawn to assess antibodies against T. cruzi using four different serological tests. Trypanosoma cruzi DNA was detected by conventional polymerase chain reaction (cPCR) and quantitative polymerase chain reaction (qPCR). In total, 38 patients, with an average age of 46.6 years (standard deviation of ±16.2) and comprising 16 men and 22 women, were enrolled. Five (13.15%) patients were found to be positive for anti-T. cruzi antibodies by indirect immunofluorescence assay (IFA), and two patients who were negative according to IFA were reactive by both enzyme-linked immunosorbent assay and immunoblot (5.3%). Parasite DNA was detected in two of these seven patients by cPCR and in one of these by qPCR. The parasite DTU obtained was TcI. In summary, this study identified T. cruzi in Colombian patients with esophageal achalasia, indicating that digestive compromise could also be present in patients with chronic CD.
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Affiliation(s)
- Santiago Panesso-Gómez
- Grupo de Ciencias Básicas Médicas, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Paula Pavia
- Scientific Research Unit, Hospital Militar Central, Bogotá, Colombia
| | | | - Paola Lasso
- Laboratorio de Parasitología Molecular, School of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Luis A Orozco
- Gastrocenter, Investigación y Desarrollo Sistemas Clínicos, Bogotá, Colombia
| | - Adriana Cuellar
- Grupo de Inmunobiología y Biología Celular, School of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Concepción J Puerta
- Laboratorio de Parasitología Molecular, School of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Belén Mendoza de Molano
- Gastroenterology Section, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - John M González
- Grupo de Ciencias Básicas Médicas, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
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21
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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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22
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Lara Romero C, Ferreiro Argüelles B, Romero Pérez E. Acute colonic complications in a patient with Chagas disease. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 108:841. [PMID: 27128343 DOI: 10.17235/reed.2016.4193/2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present the case of a young bolivian woman who suffered two acute and impressive colonic complications due to a Chagasic megacolon.
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Affiliation(s)
- Carmen Lara Romero
- Aparato de Digestivo, Hospital Universitario Virgen de la Victoria, España
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23
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Roure S, Valerio L, Vallès X, Morales B, Garcia-Diaz MI, Pedro-Botet ML, Serra J. Oesophageal motility disorders in infected immigrants with Chagas disease in a non-endemic European area. United European Gastroenterol J 2016; 4:614-20. [PMID: 27536373 DOI: 10.1177/2050640616630856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/11/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Immigration-related new diseases pose a growing challenge for healthcare services in receptor countries. Following Latin American migration, Chagas disease has inevitably appeared in Europe. AIM To determine the prevalence and characteristics of oesophageal motility disorders in immigrants infected with Trypanosoma cruzi, using high resolution oesophageal manometry (HREM). METHODS In all newly-diagnosed cases with chronic Chagas infection referring upper digestive symptoms, a protocolized clinical evaluation and complementary tests including barium oesophagogram and HREM were carried out. As control group, 14 healthy subjects from the same endemic areas were studied with HREM. RESULTS We included 61 patients (46 female, 15 male; age range 26-63 years). Only seven patients (11%) had a minor alteration on barium oesophagogram. By contrast, 23 (37%) patients showed an alteration in oesophageal manometry, mainly minor motility disorders (34%). Only one healthy control (7%) had a minor motility disorder at HREM (p = 0.029 vs. patients). CONCLUSIONS Oesophageal motor disorders in infected immigrants with Chagas disease are common, and mainly characterized by a minor motility disorder that is not detected by barium oesophagogram. Hence, as well as barium oesophagogram examination, HREM should be considered, to assess oesophageal damage in this specific group of patients.
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Affiliation(s)
- Sílvia Roure
- North Metropolitan International Health Unit, Institut Català de la Salut, Universitat Autònoma de Barcelona, Santa Coloma de Gramenet, Spain; Infectious Diseases Unit, Internal Medicine Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Lluís Valerio
- North Metropolitan International Health Unit, Institut Català de la Salut, Universitat Autònoma de Barcelona, Santa Coloma de Gramenet, Spain
| | - Xavier Vallès
- North Metropolitan International Health Unit, Institut Català de la Salut, Universitat Autònoma de Barcelona, Santa Coloma de Gramenet, Spain
| | - Betty Morales
- Motility and Functional Gut Disorders Unit, University Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - M Luisa Pedro-Botet
- Infectious Diseases Unit, Internal Medicine Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jordi Serra
- Motility and Functional Gut Disorders Unit, University Hospital Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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