Research and Reports in Tropical Medicine (Jul 2022)
Diagnosis and Clinical Management of Chagas Disease: An Increasing Challenge in Non-Endemic Areas
Abstract
Cristina Suárez,1,2 Debbie Nolder,1,3 Ana García-Mingo,1,4 David AJ Moore,1,5,6 Peter L Chiodini1,5,7 1UK Chagas Hub, London, UK; 2Department of Infection, Barts Health NHS Trust, London, UK; 3Diagnostic Parasitology Laboratory, London School of Hygiene & Tropical Medicine, London, UK; 4Microbiology Department, Whittington Health NHS Trust, London, UK; 5Hospital for Tropical Diseases, University College London Hospitals NHS Trust;, London, UK; 6Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; 7London School of Hygiene and Tropical Medicine, London, UKCorrespondence: Cristina Suárez, Barts Health NHS Trust, Royal London Hospital, Department of Infection, Pharmacy & Pathology Building – 3rd floor, 80 Newark Street, London, E1 2ES, UK, Tel +44 20 3246 0302, Email [email protected]: Chagas disease (CD) is caused by the parasite Trypanosoma cruzi, and it is endemic in Central, South America, Mexico and the South of the United States. It is an important cause of early mortality and morbidity, and it is associated with poverty and stigma. A third of the cases evolve into chronic cardiomyopathy and gastrointestinal disease. The infection is transmitted vertically and by blood/organ donation and can reactivate with immunosuppression. Case identification requires awareness and screening programmes targeting the population at risk (women in reproductive age, donors, immunocompromised patients). Treatment with benznidazole or nifurtimox is most effective in the acute phase and prevents progression to chronic phase when given to children. Treating women antenatally reduces but does not eliminate vertical transmission. Treatment is poorly tolerated, contraindicated during pregnancy, and has little effect modifying the disease in the chronic phase. Screening is easily performed with serology. Migration has brought the disease outside of the endemic countries, where the transmission continues vertically and via blood and tissue/organ donations. There are more than 32 million migrants from Latin America living in non-endemic countries. However, the infection is massively underdiagnosed in this setting due to the lack of awareness by patients, health authorities and professionals. Blood and tissue donation screening policies have significantly reduced transmission in endemic countries but are not universally established in the non-endemic setting. Antenatal screening is not commonly done. Other challenges include difficulties accessing and retaining patients in the healthcare system and lack of specific funding for the interventions. Any strategy must be accompanied by education and awareness campaigns directed to patients, professionals and policy makers. The involvement of patients and their communities is central and key for success and must be sought early and actively. This review proposes strategies to address challenges faced by non-endemic countries.Keywords: Trypanosoma cruzi, antenatal, transplant, migrant, screening, prevention
