Serological evaluation for Chagas disease in migrants from Latin American countries resident in Rome, Italy

Abstract

BackgroundChagas disease (CD) is a systemic parasitic infection caused by the protozoan Trypanosoma cruzi, whose chronic phase may lead to cardiac and intestinal disorders. Endemic in Latin America where it is transmitted mainly by vectors, large-scale migrations to other countries have turned CD into a global health problem because of its alternative transmission routes through blood transfusion, tissue transplantation, or congenital. Aim of this study was to compare the performance of two commercially available tests for serological diagnosis of CD in a group of Latin American migrants living in a non-endemic setting (Rome, Italy). The study was based on a cross-sectional analysis of seroprevalence in this group. Epidemiological risk factors associated to CD were also evaluated in this study population.MethodsThe present study was conducted on 368 subjects from the Latin American community resident in Rome. Following WHO guidelines, we employed a diagnostic strategy based on two tests to detect IgG antibodies against T. cruzi in the blood (a lysate antigen-based ELISA and a chemiluminescent microparticle CMIA composed of multiple recombinant antigens), followed by a third test (an immunochromatographic assay) on discordant samples.ResultsOur diagnostic approach produced 319/368 (86.7%) concordant negative and 30/368 (8.1%) concordant positive results after the first screening. Discrepancies were obtained for 19/368 (5.2%) samples that were tested using the third assay, obtaining 2 more positive and 17 negative results. The final count of positive samples was 32/368 (8.7% of the tested population). Increasing age, birth in Bolivia, and previous residence in a mud house were independent factors associated with T. cruzi positive serology.ConclusionsSerological diagnosis of CD is still challenging, because of the lack of a reference standard serological assay for diagnosis. Our results reaffirm the importance of performing CD screening in non-endemic countries; employing a fully automated and highly sensitive CMIA assay first could be a cost- and resource-effective strategy for mass screening of low-risk patients. However, our results also suggest that the WHO strategy of using two different serological assays, combined with epidemiological information, remains the best approach for patients coming from endemic countries.

Community-based screening of Chagas disease among Latin American migrants in a non-endemic country: an observational study

“…In fact, the factor most strongly associated with Chagas disease was being born in Bolivia. These results are consistent with other community-based seroprevalence studies [ 18 , 27 , 28 ]. People who had stopped studies after primary school were also at higher risk of having Chagas disease, in keeping with other studies of T. cruzi antibodies in blood donors in endemic countries [ 29 ].…”

“…Our study showed that one of 10 participants in our screening program have Chagas disease, slightly higher than the pooled prevalence reported in a recent systematic review of Chagas disease in migrants in Europe [ 18 , 27 ]. All except one came from Bolivia, so one of five Bolivians had Chagas disease.…”

Immune reactivity to Trypanosoma cruzi chimeric proteins for Chagas disease diagnosis in immigrants living in a non-endemic setting

“…The epidemiological pattern of CD has undergone substantial changes in last decades as a consequence of control campaigns in endemic countries, which have reduced vectorial and transfusional transmission [ 4 ]. Increasing international migration flows and more affordable traveling conditions from Latin America to non-endemic areas have contributed to epidemiology changes [ 5 , 6 ]. CD is no longer limited exclusively to the impoverished rural regions of Latin America; it is transformed into a global health concern affecting people worldwide in both endemic and non-endemic countries and placing 100 million people at risk for acquiring the infection [ 7 ].…”

Describing nearly two decades of Chagas disease in Germany and the lessons learned: a retrospective study on screening, detection, diagnosis, and treatment of Trypanosoma cruzi infection from 2000 – 2018

“…Nevertheless, it has to be stated that 20 years later there is still a precarious lack of standardized policies in this regard. Previous studies named the absence of clear recommendations as well as standardisation in respect of screening, detection, diagnosis, and treatment as an important risk factor for inadequate care of individuals at risk [ 21 , 22 ].…”

“…Despite the aforementioned limitations, this study highlights that even though Germany performed a pioneering implementation of screening, detection, diagnosis, and treatment of T. cruzi infections in regard to the knowledge that was available during the first period of the nearly two decades included in this study, currently there seems to be only a small percentage of individuals at risk of T. cruzi infection receiving adequate care. Previous studies show that a lack of guidelines is an important risk factor for inadequate care [ 21 , 22 ] and regard the implementation of a screening programme for T. cruzi infection among Latin American adults living in Europe a cost-effective strategy [ 10 ]. A prospective survey will be needed in the future to have a better estimation of the prevalence of CD in Germany.…”