Abstract
BackgroundChagas disease (CD) is endemic in Central and South America, Mexico and even in some areas of the United States. However, cases have been increasingly recorded also in non-endemic countries. The estimated number of infected people in Europe is in a wide range of 14000 to 181000 subjects, mostly resident in Spain, Italy and the United Kingdom.Methodology/Principal FindingsRetrospective, observational study describing the characteristics of patients with CD who attended the Centre for Tropical Diseases (Negrar, Verona, Italy) between 2005 and 2013. All the patients affected by CD underwent chest X-ray, ECG, echocardiography, barium X-ray of the oesophagus and colonic enema. They were classified in the indeterminate, cardiac, digestive or mixed category according to the results of the screening tests. Treatment with benznidazole (or nifurtimox in case of intolerance to the first line therapy) was offered to all patients, excluding the ones with advanced cardiomiopathy, pregnant and lactating women. Patients included were 332 (73.9% women). We classified 68.1% of patients as having Indeterminate Chagas, 11.1% Cardiac Chagas, 18.7% as Digestive Chagas and 2.1% as Mixed Form. Three hundred and twenty-one patients (96.7%) were treated with benznidazole, and most of them (83.2%) completed the treatment. At least one adverse effect was reported by 27.7% of patients, but they were mostly mild. Only a couple of patients received nifurtimox as second line treatment.Conclusions/SignificanceOur case series represents the largest cohort of T. cruzi infected patients diagnosed and treated in Italy. An improvement of the access to diagnosis and cure is still needed, considering that about 9200 infected people are estimated to live in Italy. In general, there is an urgent need of common guidelines to better classify and manage patients with CD in non-endemic countries.
Highlights
Chagas disease (CD) is a protozoan zoonosis caused by Trypanosoma cruzi (T.cruzi), with a widespread distribution from the South of the United States to Mexico, Central and South America [1]
T. cruzi infection is usually transmitted through contact with faeces of blood-sucking triatomines, rarely after oral ingestion of food contaminated by triatomines faeces
Ninety-seven percent of the patients came from rural high-prevalence Bolivian environments, especially from Santa Cruz and Cochabamba Departments
Summary
Chagas disease (CD) is a protozoan zoonosis caused by Trypanosoma cruzi (T.cruzi), with a widespread distribution from the South of the United States to Mexico, Central and South America [1]. The acute phase is followed by a chronic stage, corresponding to an indeterminate form, lasting long-life in around 60–70% of patients. During this phase patients are clinically silent: after 10 to 30 years, around 30–40% of infected people will develop symptomatic chronic CD, which is mainly characterized by cardiac and gastrointestinal disorders [1]. Chagas disease (CD) is endemic in Central and South America, Mexico and even in some areas of the United States. The estimated number of infected people in Europe is in a wide range of 14000 to 181000 subjects, mostly resident in Spain, Italy and the United Kingdom
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