RESUMO
A number of infectious diseases amongst travelers and the immigrant populations are a major public health concern. Some have a long incubation period or remain asymptomatic or paucisymptomatic for many years before leading to significant clinical manifestations and/or complications. HIV, hepatitis B and C, tuberculosis or latent syphilis are among the most significant persistent diseases in migrants. Schistosomiasis and strongyloidiasis, for instance, are persistent helminthic infections that may cause significant morbidity, particularly in patients co-infected with HIV, hepatitis B and C. Chagas disease, which was initially confined to Latin America, must also now be considered in immigrants from endemic countries. Visceral leishmaniasis and malaria are other examples of parasitic diseases that must be taken into account by physicians treating incarcerated migrants. The focus of this review article is on the risk of neglected tropical diseases in particularly vulnerable correctional populations and on the risk of infectious diseases that commonly affect migrants but which are often underestimated.
Assuntos
Doenças Transmissíveis/epidemiologia , Emigrantes e Imigrantes , Doenças Negligenciadas/epidemiologia , Prisioneiros , Saúde Global , HumanosRESUMO
According to the WHO, chronic Chagas disease (CD) diagnosis is based on two serological techniques. To establish a definitive diagnosis, the results must be concordant. In cases of discordances, the WHO proposes repeating serology in a new sample, and if results remain inconclusive, a confirmatory test should be performed. This study, conducted at two Tropical Medicine Units in Europe over 4 years, aims to assess the diagnostic yield of TESA- (trypomastigote excreted-secreted antigens) blot as a confirmatory technique in patients with inconclusive and discordant results. Of 4939 individuals screened, 1124 (22.7%) obtained positive results and 165 (3.3%) discordant results. Serology was repeated in 88/165 sera and discrepancies were solved in 25/88 (28.4%) cases. Patients without a definitive diagnosis were classified in two different groups: Group 1, including patients with inconclusive results despite retesting (n = 63), and Group 2, including patients with discordant results not retested (n = 77). TESA-blot was performed for all of Group 1 and 39/77 of Group 2 and was positive for 33/63 (52.4%) and 21/39 (53.8%), respectively. Analysis of Group 1 results showed a moderate agreement between results of the ELISA based on native antigen and TESA-blot (κ 0.53). In contrast, a clear disagreement was observed between the ELISA based on recombinant antigens and TESA-blot (κ <0). A sizeable proportion of patients are suspected to have CD with inconclusive results or in whom re-testing is not feasible. TESA-blot was positive in half of these patients, highlighting the need for a confirmatory assay in European centres caring for exposed individuals.
Assuntos
Doença de Chagas/sangue , Doença de Chagas/diagnóstico , Adulto , Idoso , Algoritmos , Biomarcadores , Doença de Chagas/epidemiologia , Doença de Chagas/parasitologia , Doença Crônica , Tomada de Decisão Clínica , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Testes Sorológicos , Espanha/epidemiologia , Adulto JovemRESUMO
Several infectious diseases may remain a- or pauci-symptomatic for many years before causing major clinical manifestations. Migrants are particularly vulnerable to several persistent infectious diseases due to exposure in their country of origin and their specific living conditions. This article emphasizes neglected parasitic diseases among migrants, such as schistosomiasis, strongyloidiasis and Chagas disease. In the case of co-infection with HIV, hepatitis B and C, some of these persistent parasitosis may induce more significant morbidity. These aspects are particularly important to know as these diseases, both viral and parasitic, are particularly common among migrants.
Assuntos
Doenças Transmissíveis/epidemiologia , Doenças Negligenciadas/epidemiologia , Doenças Parasitárias/epidemiologia , Migrantes , Coinfecção , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Doenças Negligenciadas/parasitologia , Doenças Parasitárias/parasitologiaRESUMO
We performed a critical study of conventional serology, followed by supplementary serological, parasitological, and molecular tests, to assess the response to etiologic treatment of Chagas' disease. A group of 94 Chagas' disease patients treated with benznidazole at least 10 years earlier were evaluated from the laboratory and clinical points of view. When conventional serology (enzyme-linked immunosorbent assay [ELISA], indirect immunofluorescence [IIF], and indirect hemagglutination [IHA]) and classic criteria (consistent results with any two of the three tests) or more rigorous criteria (consistent results from the three tests) were used, 10.6% and 8.5% of patients were considered treated and cured (TC) by classic and rigorous criteria, respectively. Patients were then evaluated using supplementary (recombinant ELISA and Trypanosoma cruzi excreted-secreted antigen blotting [TESA-blot]), parasitological (hemoculture), and molecular (PCR) tests. The results of recombinant ELISA were similar to those with the rigorous criterion (three consistent test results). The TESA-blot group showed a higher percentage (21.3%) of negative results than the groups defined by either cure criterion. Hemoculture and PCR gave negative results for all treated and cured (TC) patients, regardless of the criterion used. Recombinant ELISA and TESA-blot tests showed negative results for 70% and 87.5% of the patients categorized as TC by the classic and three-test criteria, respectively. For patients with discordant conventional serology, the supplementary serological and molecular tests were the decisive factor in determining therapeutic failure. Clinical evaluation showed that 62.5% of TC patients presented with the indeterminate form of the disease. Additionally, treated patients with negative TESA-blot results should be reevaluated later with all methodologies used here to verify whether TESA-blot is a reliable way to determine early parasitological cure of Chagas' disease.
Assuntos
Doença de Chagas/diagnóstico , Doença de Chagas/tratamento farmacológico , Monitoramento de Medicamentos/métodos , Técnicas de Diagnóstico Molecular/métodos , Parasitologia/métodos , Trypanosoma cruzi/imunologia , Trypanosoma cruzi/isolamento & purificação , Adolescente , Adulto , Antiprotozoários/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nitroimidazóis/administração & dosagem , Sensibilidade e Especificidade , Testes Sorológicos/métodos , Adulto JovemAssuntos
Doença de Chagas , Emigrantes e Imigrantes , Trypanosoma cruzi , Doença de Chagas/prevenção & controle , Doença de Chagas/transmissão , Doenças Transmissíveis Emergentes , Efeitos Psicossociais da Doença , Europa (Continente)/epidemiologia , Humanos , Perfil de Impacto da Doença , Trypanosoma cruzi/isolamento & purificaçãoRESUMO
Chagas disease, a neglected tropical disease that due to population movements is no longer limited to Latin America, threatens a wide spectrum of people(travellers, migrants, blood or organ recipients,newborns, adoptees) also in non-endemic countries where it is generally underdiagnosed. In Italy, the available epidemiological data about Chagas disease have been very limited up to now, although the country is second in Europe only to Spain in the number of residents from Latin American. Among 867 at-risk subjectsscreened between 1998 and 2010, the Centre for Tropical Diseases in Negrar (Verona) and the Infectious and Tropical Diseases Unit, University of Florence found 4.2% patients with positive serology for Chagas disease (83.4% of them migrants, 13.8% adoptees).No cases of Chagas disease were identified in blood donors or HIV-positive patients of Latin American origin. Among 214 Latin American pregnant women,three were infected (resulting in abortion in one case).In 2005 a case of acute Chagas disease was recorded in an Italian traveller. Based on our observations, we believe that a wider assessment of the epidemiological situation is urgently required in our country and public health measures preventing transmission and improving access to diagnosis and treatment should be implemented.
Assuntos
Doença de Chagas/diagnóstico , Doença de Chagas/etnologia , Emigrantes e Imigrantes/estatística & dados numéricos , Trypanosoma cruzi/isolamento & purificação , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doadores de Sangue/estatística & dados numéricos , Doença de Chagas/epidemiologia , Doença de Chagas/parasitologia , Doença de Chagas/transmissão , Criança , Pré-Escolar , Cromatografia de Afinidade , Ensaio de Imunoadsorção Enzimática , Feminino , Infecções por HIV/complicações , Infecções por HIV/etnologia , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas , Itália/epidemiologia , América Latina/etnologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Vigilância da População , Gravidez , Complicações Parasitárias na Gravidez , Prevalência , Estudos Retrospectivos , Distribuição por Sexo , Trypanosoma cruzi/imunologia , Adulto JovemRESUMO
A study of aggregate data collected from the literature and official sources was undertaken to estimate expected and observed prevalence of Trypanosoma cruzi infection, annual incidence of congenital transmission and rate of underdiagnosis of Chagas disease among Latin American migrants in the nine European countries with the highest prevalence of Chagas disease. Formal and informal data sources were used to estimate the population from endemic countries resident in Europe in 2009, diagnosed cases of Chagas disease and births from mothers originating from endemic countries. By 2009, 4,290 cases had been diagnosed in Europe, compared with an estimated 68,000 to 122,000 expected cases. The expected prevalence was very high in undocumented migrants (on average 45% of total expected cases) while the observed prevalence rate was 1.3 cases per 1,000 resident migrants from endemic countries. An estimated 20 to 183 babies with congenital Chagas disease are born annually in the study countries. The annual incidence rate of congenital transmission per 1,000 pregnancies in women from endemic countries was between none and three cases. The index of under diagnosis of T. cruzi infection was between 94% and 96%. Chagas disease is a public health challenge in the studied European countries. Urgent measures need to be taken to detect new cases of congenital transmission and take care of the existing cases with a focus on migrants without legal residency permit and potential difficulty accessing care.
Assuntos
Doença de Chagas/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Vigilância da População/métodos , Trypanosoma cruzi/isolamento & purificação , Doença de Chagas/prevenção & controle , Doença de Chagas/transmissão , Coleta de Dados , Ensaio de Imunoadsorção Enzimática , Estudos Epidemiológicos , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , América Latina/etnologia , Masculino , Prevalência , Fatores de Risco , Trypanosoma cruzi/imunologiaRESUMO
The intention of this article is not to describe the illness or evaluate the number of cases diagnosed in Spain, Switzerland and Italy, nor to analyse the protocols followed in various centres. The authors rather seek to examine the main technical, local and national challenges involved in the care of patients with Chagas disease. To this end, they review concisely a number of themes which are common to the three countries. These are: the detection of disease; confirmation of the diagnosis; treatment; response to treatment; follow-up; the risk of transmission by transfusion, by organ donation and from mother to child; the psychosocial and socio-economic aspects of Chagas disease outside endemic areas; and what progress needs to be made in improving information about the condition.