A new study of almost 3,000 Latin Americans who visited the Hospital Clínico over 17 years shows that 47% were infected with the parasite that causes the disease and more than 10% had heart lesions
A high percentage of people in Latin America are infected with the parasite that causes Chagas disease. This is the conclusion of an analysis of nearly 3,000 people from countries where the disease is endemic and who attended the International Health Service of the Hospital Clínic of Barcelona, over a period of 17 years. The study, published in PLOS Neglected Tropical Diseases , has been led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by the la Caixa Foundation.”
It is estimated that about 7 million people in the world are infected with Trypanosoma cruzi, the parasite that causes Chagas disease. Although the vector that transmits the parasite (the bedbug) is endemic in 21 Latin American countries, the parasite has spread worldwide due to migratory flows.
In non-endemic countries, the parasite can be transmitted vertically, from mother to child or, less frequently, through blood or organ donations. In 30-40% of cases, the infection ends up damaging the heart and digestive system, causing Chagas disease.
“For this reason, it is recommended that Latin Americans who arrive in the country take a test to treat them if they are infected and, in the case of women of childbearing age, to prevent vertical transmission of the parasite,” explains Irene Losada, coordinator of the Initiative. Chagas and first co-author of the study, along with Pedro Laynez-Roldán, ISGlobal researcher and doctor at the Clínic International Health Service.
This retrospective study describes one of the largest samples of people at risk of infection in a non-endemic country: 2,820 Latin Americans, the vast majority from Bolivia, who attended the International Health Service of the Hospital Clínic of Barcelona between 2002 and 2019. Of the total Of the people analyzed, almost half (47%) were infected by T. cruzi and 17% had cardiac lesions typical of the disease.
Although an electrocardiogram was sufficient to detect lesions in most cases , an echocardiogram was required in 10% of cases. “These results reinforce the importance of echocardiograms in the initial evaluation of patients with T. cruzi infection,” says Laynez-Roldán.
A problem of underdiagnosis
The authors note that many people arriving from highly endemic regions of Latin America, such as Bolivia, have never been tested before. “The infection is clearly underdiagnosed even in Spain, one of the European countries with the highest diagnostic coverage,” warns María Jesús Pinazo, last author of the study, former researcher at ISGlobal and currently at the DNDi.
The majority of cases are women of working age, which reflects the migratory flows of recent years, allowing for better targeting of detection and prevention programs.
Conclusions We still observed many Latin American individuals who were at risk for T. cruzi 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 proportions of diagnosis of the Latin American population with T. cruzi, the infection remains underdiagnosed. The detection of Latin American populations that present a profile similar to that reported here should be promoted. ECG is considered necessary to evaluate Chagas cardiomyopathy in positive individuals, but echocardiograms should also be considered as a diagnostic approach as they can detect cardiac abnormalities when the ECG is normal. |
