Multicenter epidemiological and clinical study on imported Chagas diseases in Alicante, Spain

Abstract

Recently, there has been an increase in the number of patients with Chagas disease outside of areas that are generally considered endemic. The aim of this investigation is to describe the clinical profile of a series of patients with Chagas disease in Alicante, Spain, which is a province located on the coast of the Mediterranean Sea. This study was performed at four general hospitals in Alicante between January 2002 and May 2011. A total of 128 patients from seven countries were diagnosed with Trypanosoma cruzi. The main country of origin of these patients was Bolivia (n = 101; 78·9%), and the median of age of these patients was 35 years (range: 0-72 years). Four (3·3%) patients were children under 14 years of age, and 81 (63·3%) were female. Polymerase chain reaction (PCR) was used to analyze 106 patients, 66·0% of whom demonstrated positive PCR results. Visceral involvement was diagnosed in 26·8%: 24·1% demonstrated cardiac involvement, 0·9% demonstrated gastrointestinal involvement, 0·9% demonstrated cardiac and gastrointestinal involvement, and 0·9% demonstrated involvement of the central nervous system. Syncope was found to be associated with cardiomyopathy (28·0% versus 5·2%) (odds ratio: 6·5; 95% confidence interval: 1·5-27·1). Seventy-six patients received treatment with benznidazole, of whom 57 (75·0%) completed the treatment course without significant adverse events and 17·1% discontinued benznidazole due to adverse events. In total, 50% of patients experienced documented adverse reactions. Among patients with positive PCR results before treatment, all demonstrated negative PCR results following treatment. In conclusion, majority of our patients were female Bolivians immigrants, one of four of our patients demonstrated cardiac involvement, and treatment tolerance was poor. It is important to improve the clinical and epidemiological knowledge of Chagas disease in nonendemic with additional multicenter studies in order to determine the magnitude of this problem and provide improved public health and health resource planning