Association of Trypanosoma cruzi infection with risk factors and electrocardiographic abnormalities in northeast Mexico

Abstract

BackgroundAmerican trypanosomiasis is a major disease and public health issue, caused by the protozoan parasite Trypanosoma cruzi. The prevalence of T. cruzi has not been fully documented, and there are few reports of this issue in Nuevo Leon. The aim of this study was to update the seroprevalence rate of T. cruzi infection, including an epidemiological analysis of the risk factors associated with this infection and an electrocardiographic (ECG) evaluation of those infected.MethodsSera from 2,688 individuals from 10 municipalities in the state of Nuevo Leon, Mexico, were evaluated using an enzyme-linked immunosorbent assay and an indirect hemagglutination assay. An ECG case–control study was performed in subjects seropositive for T. cruzi and the results were matched by sex and age to seronegative residents of the same localities. A univariate analysis with χ2 and Fisher’s exact tests was used to determine the association between seropositivity and age (years), sex, and ECG changes. A multivariate analysis was then performed to calculate the odd ratios between T. cruzi seropositivity and the risk factors.ResultsThe seropositive rate was 1.93% (52/2,688). In the ECG study, 22.85% (8/35) of the infected individuals exhibited ECG abnormalities. Triatoma gerstaeckeri was the only vector reported. The main risk factors were ceiling construction material (P ≤ 0.0024), domestic animals (P ≤ 0.0001), and living in rural municipalities (P ≤ 0.0025).ConclusionsThese findings demonstrate a 10-fold higher prevalence of Chagas disease than previously reported (0.2%), which implies a serious public health threat in northeastern Mexico. The epidemiological profile established in this study differs from that found in the rest of Mexico, where human populations live in close proximity to domiciliary triatomines.

Chagas Disease Infection among Migrants at the Mexico/Guatemala Border

“…The median age of individuals tested positive for T. cruzi was 33 (IQR: [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. The potential progression from asymptomatic (indeterminate) to the symptomatic determinate form usually occurs 10-30 years after the initial infection.…”

“…Because Chagas disease is also transmitted in animals, they also suggested that the introduction of the rural practices of domestic animal husbandry into peri-urban areas with poor housing conditions may have facilitated the spread of the vector. 6,21,23,24 Finally, because of stigma or discrimination against migrants and variable legal status, diminished access to health services may preclude diagnosis and treatment of Chagas disease. 6 In particular, undocumented migrants may be unwilling or unable to access health services.…”

Electrocardiographic abnormalities in Chagas disease in the general population: A systematic review and meta-analysis

“…The association between CD and cardiac abnormalities (stages B or more) is widely reported, however, the information is challenged by the diverse design, sample size and quality of the studies[ 19 – 24 ]. This information is largely based on outdated individual studies, and reports vary substantially among the population based studies making the scientific interpretation challenging[ 8 , 20 , 25 – 28 ]. Furthermore, it is known that the prevalence of different types of ECG abnormalities such as intraventricular conduction abnormalities, atrioventricular block, and arrhythmias, is higher in subjects with CD as compared to non-CD subjects, calling for its update and synthesis, which would be very useful and relevant for physicians in non-endemic countries where health care implications of CD are real and neglected[ 29 ].…”

A global systematic review of Chagas disease prevalence among migrants

“…Traditionally considered a disease of poverty, risk of Chagas disease has been associated with housing in rural areas, of poor construction quality (e.g., palm roof, cracks in the walls), and with domestic pets and livestock in or near the house (Enger et al, 2004; Molina-Garza et al, 2014; Ramsey et al, 2005; World Health Organization, 2002). Coordinated efforts by endemic countries in the 1990’s were instrumental in shrinking the domestic vector infestation and thus the population at risk for Chagas disease (Coura and Dias; Dias and Schofield, 1999; Dias et al, 2002).…”