Date Published: December 11, 2014
Publisher: Public Library of Science
Author(s): Federico Gobbi, Andrea Angheben, Mariella Anselmi, Chiara Postiglione, Ernestina Repetto, Dora Buonfrate, Stefania Marocco, Stefano Tais, Andrea Chiampan, Paride Mainardi, Zeno Bisoffi, Ricardo E. Gürtler. http://doi.org/10.1371/journal.pntd.0003361
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.
Partial Text: 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 . Current data indicate that between 7 and 8 million people are infected in this area . Other authors suppose that in North America (Canada, USA, Mexico) there might be many more infected subjects than it was previously estimated (1 to 6 million people) , therefore global estimations should be revised. In endemic countries, T. cruzi infection is usually transmitted through contact with faeces of blood-sucking triatomines, rarely after oral ingestion of food contaminated by triatomines faeces. Other non-vectorial routes of transmission are transplacentary, blood transfusion and organ/tissue transplantation .
During the 9–year period, 332 patients were included in this study. Characteristics of the patients are described in table 1. The majority of the patients were women (73.9%) and the mean age was 41.8 years (range 11–71). Sixty-one per cent of the patients reported living in rural areas and 73.2% in mud houses, while 6.9% of them reported history of blood transfusion in endemic countries. Ninety-seven percent of the patients came from rural high-prevalence Bolivian environments, especially from Santa Cruz and Cochabamba Departments.
In our study we present 332 patients with CD who attended our Centre in a 9-year period. This represents the largest cohort of T. cruzi infected patients reported in Italy, taking into account that currently around 360 patients have been diagnosed and eventually treated in the whole of Italy (Non Endemic Country – “NEC” Initiative; meeting in Florence 2013).