Abstract
BackgroundThe highly complex and largely neglected Chagas disease (CD) has become a global health problem due to population movements between Latin America and non-endemic countries, as well as non-vectorial transmission routes. Data on CD testing and treatment from routine patient care in Germany of almost two decades was collected and analysed.MethodsGerman laboratories offering diagnostics for chronic Trypanosoma cruzi (T. cruzi) infection in routine patient care were identified. All retrievable data on tests performed during the years of 2000–2018 were analysed. Additional clinical information regarding patients diagnosed with CD was collected through questionnaires.ResultsFive German laboratories with diagnostics for T. cruzi infection in routine patient care were identified. Centres in Hamburg and Munich offered two independent serological tests to confirm the CD diagnosis, as recommended by WHO during the entire time period 2000–2018. Overall, a total of n = 10,728 independent tests involving n = 5991 individuals were identified with a progressive increase in testing rates over time, only n = 130 (16.0%) of the tested individuals with known nationality came from CD endemic countries. Of all test units conducted at the included institutes, a total of n = 347/10,728 (3.2%) tests on CD were positive, of which n = 200/347 (57.6%) were ELISA, n = 133/347 (38.3%) IFT, n = 10/347 (2.9%) PCR, and n = 4/347 (1.2%) RDT. Of the n = 5991 individuals only n = 81 (1.4%) with chronic infection were identified, n = 52 females and n = 28 males. Additional clinical information could only be collected from n = 47.ConclusionThe results of this study give insight into the deployment of screening, detection, diagnosis, and treatment of T. cruzi over the last two decades in Germany and existing deficits therein; the creation of guidelines for Germany could be a step forward to improve the existing gaps.
Highlights
The highly complex and largely neglected Chagas disease (CD) has become a global health problem due to population movements between Latin America and non-endemic countries, as well as non-vectorial transmission routes
Of all test units conducted at the included institutes, a total of n = 347/10,728 (3.2%) tests on CD were positive, of which n = 200/ 347 (57.6%) were Enzymelinked immunosorbent assays (ELISA), n = 133/347 (38.3%) immunofluorescence tests (IFT), n = 10/347 (2.9%) Polymerase chain reaction (PCR), and n = 4/347 (1.2%) rapid diagnostic tests (RDT)
All belong to medical centres specialised in tropical medicine and tests offered were quality controlled according to the respective German regulations and existing laboratory standards for routine patient care
Summary
The highly complex and largely neglected Chagas disease (CD) has become a global health problem due to population movements between Latin America and non-endemic countries, as well as non-vectorial transmission routes. Chagas disease (CD) —a highly complex parasitic disease caused by Trypanosoma cruzi (T. cruzi) infection— can lead to chronic morbidity, complications, and premature death with all associated socio-economic effects. Estimates by WHO state that there are between 6 and 7 million infected individuals world-wide, mostly in Latin American (LA) countries [1]. The initial acute phase of CD is followed by chronic infection. Vectorial transmission accounts for most infections in LA. Population movements between endemic and non-endemic areas as well as nonvectorial transmission routes expanded the geographical distribution of CD, with some 400,000 infected persons living all over the world [2]
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