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Liu Z, Vucetich S, DeToy K, Duran Saucedo G, Verastegui M, Carballo-Jimenez P, Mercado-Saavedra BN, Tinajeros F, Malaga-Machaca ES, Marcus R, Gilman RH, Bowman NM, McCall LI. Small molecule biomarkers predictive of Chagas disease progression. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.13.24307310. [PMID: 38798659 PMCID: PMC11118624 DOI: 10.1101/2024.05.13.24307310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Chagas disease (CD) is a neglected tropical disease caused by the parasitic protozoan Trypanosoma cruzi. However, only 20% to 30% of infected individuals will progress to severe symptomatic cardiac manifestations. Current treatments are benznidazole and nifurtimox, which are poorly tolerated regimens. Developing a biomarker to determine the likelihood of patient progression would be helpful for doctors to optimize patient treatment strategies. Such a biomarker would also benefit drug discovery efforts and clinical trials. In this study, we combined untargeted and targeted metabolomics to compare serum samples from T. cruzi-infected individuals who progressed to severe cardiac disease, versus infected individuals who remained at the same disease stage (non-progressors). We identified four unannotated biomarker candidates, which were validated in an independent cohort using both untargeted and targeted analysis techniques. Overall, our findings demonstrate that serum small molecules can predict CD progression, offering potential for clinical monitoring.
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Andrade MV, Noronha KVMDS, de Souza A, Motta-Santos AS, Braga PEF, Bracarense H, de Miranda MCC, Nascimento BR, Molina I, Martins-Melo FR, Perel P, Geissbühler Y, Quijano M, Machado IE, Ribeiro ALP. The economic burden of Chagas disease: A systematic review. PLoS Negl Trop Dis 2023; 17:e0011757. [PMID: 37992061 DOI: 10.1371/journal.pntd.0011757] [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: 07/17/2023] [Revised: 12/06/2023] [Accepted: 10/29/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Chagas disease (CD) is a neglected disease affecting millions worldwide, yet little is known about its economic burden. This systematic review is part of RAISE project, a broader study that aims to estimate the global prevalence, mortality, and health and economic burden attributable to chronic CD and Chronic Chagas cardiomyopathy. The objective of this study was to assess the main costs associated with the treatment of CD in both endemic and non-endemic countries. METHODS An electronic search of the Medline, Lilacs, and Embase databases was conducted until 31st, 2022, to identify and select economic studies that evaluated treatment costs of CD. No restrictions on place or language were made. Complete or partial economic analyses were included. RESULTS Fifteen studies were included, with two-thirds referring to endemic countries. The most commonly investigated cost components were inpatient care, exams, surgeries, consultation, drugs, and pacemakers. However, significant heterogeneity in the estimation methods and presentation of data was observed, highlighting the absence of standardization in the measurement methods and cost components. The most common component analyzed using the same metric was hospitalization. The mean annual hospital cost per patient ranges from $25.47 purchasing power parity US dollars (PPP-USD) to $18,823.74 PPP-USD, and the median value was $324.44 PPP-USD. The lifetime hospital cost per patient varies from $209,44 PPP-USD for general care to $14,351.68 PPP-USD for patients with heart failure. DISCUSSION Despite the limitations of the included studies, this study is the first systematic review of the costs of CD treatment. The findings underscore the importance of standardizing the measurement methods and cost components for estimating the economic burden of CD and improving the comparability of cost components magnitude and cost composition analysis. Finally, assessing the economic burden is essential for public policies designed to eliminate CD, given the continued neglect of this disease.
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Affiliation(s)
- Mônica Viegas Andrade
- Department of Economics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Aline de Souza
- Faculty of Economic Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - André Soares Motta-Santos
- Center for Health Technology Assessment, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Center for Development and Regional Planning, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Henrique Bracarense
- Faculty of Economic Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Bruno Ramos Nascimento
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Israel Molina
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | | | - Isis Eloah Machado
- Department of Family Medicine, Mental and Collective Health, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Antônio Luiz Pinho Ribeiro
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Brito SPDS, Lima MDS, Ferreira AF, Ramos AN. [Hospital admissions due to neglected tropical diseases in Piauí, in the Northeast region of Brazil: costs, time trends, and spatial patterns, 2001-2018]. CAD SAUDE PUBLICA 2022; 38:e00281021. [PMID: 36169444 DOI: 10.1590/0102-311xpt281021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
To characterize the magnitude of hospital admissions and costs of patients with neglected tropical diseases, their time trends, and spatial patterns in Piauí, in the Northeast Region of Brazil, in 2001-2018. Ecological study of mixed designs, with calculation of relative risk (RR), time-trend analysis by Poisson regression, and inflection points, using data from neglected tropical diseases Hospital Admission Authorizations available in the Hospital Information System of the Brazilian Unified National Health System (SIH/SUS). Data showed 49,832 hospital admissions due to neglected tropical diseases in the period (rate: 86.70/100,000 inhabitants; 95%CI: 83.47; 89.93); of these, dengue (78.2%), leishmaniasis (8.6%), and leprosy (6.4%). The total cost was BRL 34,481,815.43, 42.8% of which referred to medium complexity cases. Higher risks of hospitalization occurred among people ≥ 60 years (RR = 1.8; 95%CI: 1.5; 2.2), mixed race/color (RR = 1.7; 95%CI: 1.1; 2.4), residents of municipalities presenting medium social vulnerability (RR = 1.5; 95% CI: 1.3; 1.6), and population size (RR = 1.6; 95%CI: 1.4; 1.9). The time trend showed a reduction in hospital admissions due to neglected tropical diseases, 2003-2018 (annual percent change - APC: -10.3; 95%CI: -14.7; -5.6). The spatial pattern showed clusters with higher rates of hospital admission in border municipalities located south of the Mid-north macroregion, north of the Semiarid macroregion, and south of the Cerrados macroregion. Piauí remains with high hospital admission rates and costs for neglected tropical diseases. Despite the reduction in time trends, knowledge burden, population groups, and municipalities at greater risk and vulnerability reinforce the importance of monitoring and strengthening control actions to maintain the reduction of the burden and costs of hospital admission due to neglected tropical diseases in the state.
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Affiliation(s)
- Sheila Paloma de Sousa Brito
- Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brasil.,Coordenação de Sistemas de Informação, Universidade Federal do Piauí, Picos, Brasil
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Keogh A, Ferguson W, Nolder D, Doyle E, McEntagart N. Vertical Transmission of Trypanosoma Cruzi in a Non-Endemic Country: Histology of the Infected Placenta. Pediatr Dev Pathol 2021; 24:559-563. [PMID: 34369222 DOI: 10.1177/10935266211012192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chagas disease, once confined to rural Latin America is an increasing public health concern in non-endemic countries due to population movements. Here we present an unexpected finding of a placenta infected with T. cruzi from a Brazilian woman residing in Ireland. Histology of the placenta showed a lymphocytic chorioamnionitis with multinucleated giant cells (MNGCs) as well as cord vasculitis and funisitis. Amastigotes of trypanosomiasis were found in both cord and membranes. The placenta parenchyma, however, had no villitis or amastigotes and maturation was appropriate for gestation. To date, there have been few reported cases of vertical transmission in non-endemic countries. We discuss the histological findings and review the literature on potential modes of transmission from mother to fetus.
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Affiliation(s)
- Anna Keogh
- Department of Histopathology, Rotunda Hospital, Dublin, Ireland
| | - Wendy Ferguson
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
| | - Debbie Nolder
- Diagnostic Parasitology Laboratory, London School of Tropical Medicine and Hygiene, London, UK
| | - Emma Doyle
- Department of Histopathology, Rotunda Hospital, Dublin, Ireland
| | - Noel McEntagart
- Department of Histopathology, Rotunda Hospital, Dublin, Ireland
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Ramos-Rincon JM, Llenas-García J, Pinargote-Celorio H, Sánchez-García V, Wikman-Jorgensen P, Navarro M, Gil-Anguita C, Ramos-Sesma V, Torrus-Tendero D. Chagas Disease-Related Mortality in Spain, 1997 to 2018. Microorganisms 2021; 9:microorganisms9091991. [PMID: 34576886 PMCID: PMC8469044 DOI: 10.3390/microorganisms9091991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background. Chagas disease (CD) is associated with excess mortality in infected people in endemic countries, but little information is available in non-endemic countries. The aim of the study was to analyze mortality in patients admitted to the hospital with CD in Spain. Methods. A retrospective, observational study using the Spanish National Hospital Discharge Database. We used the CD diagnostic codes of the 9th and 10th International Classification of Diseases to retrieve CD cases from the national public registry from 1997 to 2018. Results. Of the 5022 hospital admissions in people with CD, there were 56 deaths (case fatality rate (CFR) 1.1%, 95% confidence interval (CI) 0.8%, 1.4%), 20 (35.7%) of which were considered directly related to CD. The median age was higher in those who died (54.5 vs. 38 years; p < 0.001). The CFR increased with age, peaking in the 70–79-year (7.9%, odds ratio (OR) 6.27, 95% CI 1.27, 30.90) and 80–89-year (16.7%, OR 14.7, 95% CI 2.70, 79.90) age groups. Men comprised a higher proportion of those who died compared to survivors (50% vs. 22.6%; p < 0.001). Non-survivors were more likely to have neoplasms (19.6% vs. 3.4%; p < 0.001), heart failure (17.9% vs. 7.2%; p = 0.002), diabetes (12.5% vs. 3.7%; p = 0.001), chronic kidney failure (8.9% vs. 1.6%; p < 0.001), and HIV (8.9% vs. 0.8%; p < 0.001). In the multivariable analysis, the variables associated with mortality were age (adjusted OR (aOR) 1.05; 95% CI: 1.03, 1.07), male sex (aOR 1.79, 95% CI 1.03, 3.14), cancer (aOR: 4.84, 95% CI 2.13, 11.22), and HIV infection (aOR 14.10 95% CI 4.88, 40.73). Conclusions. The case fatality rate of CD hospitalization was about 1%. The mortality risk increased with age, male sex, cancer, and HIV infection.
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Affiliation(s)
- Jose-Manuel Ramos-Rincon
- Internal Medicine Department, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, 03010 Alicante, Spain;
- Clinical Medicine Department, Miguel Hernández University of Elche, 03550 Alicante, Spain
- Correspondence:
| | - Jara Llenas-García
- Internal Medicine Department, Hospital Vega Baja, Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 03314 Alicante, Spain;
| | - Hector Pinargote-Celorio
- Internal Medicine Department, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, 03010 Alicante, Spain;
| | - Veronica Sánchez-García
- Dermatology Service, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, 03010 Alicante, Spain;
| | - Philip Wikman-Jorgensen
- Internal Medicine Department, Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), University Hospital of Sant Joan, 03550 Alicante, Spain;
| | - Miriam Navarro
- Epidemiology Unit, Public Health Center of Elche, 03302 Alicante, Spain;
- Department of Public Health, Science History and Gynecology, Miguel Hernández University of Elche, 03550 Alicante, Spain
| | - Concepción Gil-Anguita
- Internal Medicine Department, Hospital Marina Baixa—Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 03570 Alicante, Spain;
| | | | - Diego Torrus-Tendero
- Infectious Diseases Unit, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, 03010 Alicante, Spain;
- Parasitology Area, Miguel Hernández University of Elche, 03550 Alicante, Spain
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Stillwaggon E, Perez-Zetune V, Bialek SR, Montgomery SP. Congenital Chagas Disease in the United States: Cost Savings through Maternal Screening. Am J Trop Med Hyg 2018; 98:1733-1742. [PMID: 29714163 PMCID: PMC6086189 DOI: 10.4269/ajtmh.17-0818] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors through transfusions, transplants, insect feces in food, and from mother to child during gestation. Congenital infection could perpetuate Chagas disease indefinitely, even in countries without vector transmission. An estimated 30% of infected persons will develop lifelong, potentially fatal, cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment of Chagas disease in the United States. We constructed a decision-analytic model to find the lower cost option, comparing costs of testing and treatment, as needed, for mothers and infants with the lifetime societal costs without testing and the consequent morbidity and mortality due to lack of treatment or late treatment. We found that maternal screening, infant testing, and treatment of Chagas disease in the United States are cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence above 0.06% compared with no screening program. Newly approved diagnostics make universal screening cost saving with maternal prevalence as low as 0.008%. The present value of lifetime societal savings due to screening and treatment is about $634 million saved for every birth year cohort. The benefits of universal screening for T. cruzi as part of routine prenatal testing far outweigh the program costs for all U.S. births.
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Affiliation(s)
| | - Victoria Perez-Zetune
- International Finance Division, Board of Governors of the Federal Reserve System, Washington, District of Columbia
| | - Stephanie R Bialek
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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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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Chagas Disease in the Mediterranean Area. CURRENT TROPICAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40475-017-0123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abras A, Gállego M, Llovet T, Tebar S, Herrero M, Berenguer P, Ballart C, Martí C, Muñoz C. Serological Diagnosis of Chronic Chagas Disease: Is It Time for a Change? J Clin Microbiol 2016; 54:1566-1572. [PMID: 27053668 PMCID: PMC4879299 DOI: 10.1128/jcm.00142-16] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/18/2016] [Indexed: 01/18/2023] Open
Abstract
Chagas disease has spread to areas that are nonendemic for the disease with human migration. Since no single reference standard test is available, serological diagnosis of chronic Chagas disease requires at least two tests. New-generation techniques have significantly improved the accuracy of Chagas disease diagnosis by the use of a large mixture of recombinant antigens with different detection systems, such as chemiluminescence. The aim of the present study was to assess the overall accuracy of a new-generation kit, the Architect Chagas (cutoff, ≥1 sample relative light units/cutoff value [S/CO]), as a single technique for the diagnosis of chronic Chagas disease. The Architect Chagas showed a sensitivity of 100% (95% confidence interval [CI], 99.5 to 100%) and a specificity of 97.6% (95% CI, 95.2 to 99.9%). Five out of six false-positive serum samples were a consequence of cross-reactivity with Leishmania spp., and all of them achieved results of <5 S/CO. We propose the Architect Chagas as a single technique for screening in blood banks and for routine diagnosis in clinical laboratories. Only gray-zone and positive sera with a result of ≤6 S/CO would need to be confirmed by a second serological assay, thus avoiding false-positive sera and the problem of cross-reactivity with Leishmania species. The application of this proposal would result in important savings in the cost of Chagas disease diagnosis and therefore in the management and control of the disease.
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Affiliation(s)
- Alba Abras
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Montserrat Gállego
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Teresa Llovet
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Silvia Tebar
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Mercedes Herrero
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pere Berenguer
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Ballart
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Carmen Martí
- Unitat de Microbiologia, Hospital General de Granollers, Granollers, Spain
| | - Carmen Muñoz
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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