부산대학교 도서관

Background: Trypanosoma cruzi causes Chagas disease (CD), a potentially fatal disease characterized by cardiac disorders and digestive, neurological or mixed alterations. T. cruzi is transmitted to humans by the bite of triatomine vectors; both the parasite and disease are endemic in Latin America and the United States. In the last decades, population migration has changed the classic epidemiology of T. cruzi, contributing to its global spread to traditionally non-endemic countries. Screening is recommended for Latin American populations residing in non-endemic countries. Methods: The present study analyzes the epidemiological characteristics of 2,820 Latin American individuals who attended the International Health Service (IHS) of the Hospital Clinic de Barcelona between 2002 and 2019. The initial assessment of organ damage among positive cases of T. cruzi infection was analyzed, including the results of electrocardiogram (ECG), echocardiogram, barium enema and esophagogram. Results: Among all the screened individuals attending the clinic, 2,441 (86.6%) were born in Bolivia and 1,993 (70.7%) were female. Of individuals, 1,517 (81.5%) reported previous exposure to the vector, which is a strong risk factor associated with T. cruzi infection; 1,382 individuals were positive for T. cruzi infection. The first evaluation of individuals with confirmed T. cruzi infection, showed 148 (17.1%) individuals with Chagasic cardiomyopathy, the main diagnostic method being an ECG and the right bundle branch block (RBBB) for the most frequent disorder; 16 (10.8%) individuals had a normal ECG and were diagnosed of Chagasic cardiomyopathy by echocardiogram. Conclusions: We still observe many Latin American individuals who were at risk of T. cruzi infection in highly endemic areas in their countries of origin, and who have not been previously tested for T. cruzi infection. In fact, even in Spain, a country with one of the highest proportion of diagnosis of Latin American populations, T. cruzi infection remains underdiagnosed. The screening of Latin American populations presenting with a similar profile as reported here should be promoted. ECG is considered necessary to assess Chagasic cardiomyopathy in positive individuals, but echocardiograms should also be considered as a diagnostic approach given that it can detect cardiac abnormalities when the ECG is normal. Author summary: Trypanosoma cruzi is a protozoan infection that can be transmitted to humans by triatomine insects, endemic from 21 Latin American countries. It can also be transmitted vertically (mother to child) and by blood transfusions, among other less frequent methods. T. cruzi infection is called Chagas Disease (CD) when causing organ damage, such as Chagasic cardiomyopathy (CC) and digestive involvement in 30–40% of cases. The large migration flows from Latin America to Europe have globalized the distribution of T. cruzi infection. Thus, screening is recommended for Latin Americans living in non-endemic countries. We have retrospectively analyzed the epidemiologic characteristics of individuals from endemic countries screened for T. cruzi infection in Barcelona over 17 years, revealing a great number of working-age women coming from highly endemic areas for T. cruzi infection, which reflect the migration movements of the last decades and help us to focus the screening and health promotion programs. We have also analyzed the initial organ damage assessment, which revealed a great proportion of right bundle branch block and left anterior fascicular block, considered typical CD lesions (although unspecific). We also found an important proportion of patients with an altered echocardiogram but having a normal ECG, which reinforces the echocardiogram as an essential test for the assessment of CC. [ABSTRACT FROM AUTHOR]