Severe Chagas disease in Ecuador: a countrywide geodemographic epidemiological analysis from 2011 to 2021

Abstract

BackgroundChagas disease is a neglected and often forgotten tropical disease caused by the Trypanosoma cruzi. This parasite can be transmitted through the direct contact of human skin with feces and urine of the triatomine insect. According to the World Health Organization (WHO), an estimated 6–7 million people are infected worldwide, killing at least 14,000 every year. The disease has been reported in 20 of the 24 provinces of Ecuador, with El Oro, Guayas, and Loja being the most affected.MethodologyWe analyzed the morbidity and mortality rates of severe Chagas disease in Ecuador on a nationwide, population-based level. Hospitalization cases and deaths were also examined based on altitude, including low (< 2,500 m) and high (> 2,500 m) altitudes, according to the International Society. Data was retrieved from the National Institute of Statistics and Census hospital admissions and in-hospital mortality databases from 2011 to 2021.ResultsA total of 118 patients have been hospitalized in Ecuador since 2011 due to Chagas disease. The overall in-hospital mortality rate was 69.4% (N = 82). Men have a higher incidence rate (4.8/1,000,000) than women, although women have a significantly higher mortality rate than men (6.9/1,000,000).ConclusionChagas disease is a severe parasitic condition that primarily affects rural and poorer areas of Ecuador. Men are more likely to be infected due to differences in work and sociocultural activities. Using average elevation data, we conducted a geodemographic analysis to assess incidence rates by altitude. Our findings indicate that the disease is more common at low and moderate altitudes, but recent increases in cases at higher altitudes suggest that environmental changes, such as global warming, could be driving the proliferation of disease-carrying vectors in previously unaffected areas.

Spatio-temporal distribution of hospitalizations for chronic Chagas disease and risk factors associated with in-hospital mortality and surgical intervention in Chile

“…Based on the figures mentioned above, it is crucial to highlight the financial burden of CD on the healthcare system. Ecuador has estimated US$ 300 per day hospitalized whereas Brazil reported a median cost of US$ 550 per hospitalization event, increasing to US$ 800 when surgical procedures are involved [ 16 , 17 ]. In Chile, the median cost per day of hospital stay is approximately US$ 400 [ 33 , 34 ].…”

“…In the multivariate models, in-hospital mortality risk increases with age and in patients with cardiac involvement. The increase in mortality due to age is consistent, since the disease requires a prolonged period to develop, commonly between the third and fifth decades of life [ 16 , 17 , 40 , 54 ], This risk is further compounded by comorbidities such as hypertension, dyslipidemia, and ischemic conditions, which are also associated with CD in older patients [ 15 , 53 ]. Probably, these individuals were infected during the period of significant triatomine infestation in Chile until 1999, similar to the situation described in Brazil [ 16 , 40 ].…”

“…Limited studies have reported in-hospital mortality. Bierrenbach et al (2022) [ 16 ] reported an in-hospital mortality of 5.8% for the digestive form in Brazil, and Vasconez-Gonzalez et al (2023) reported a mortality of 69.4% for severe cases[ 17 ]. However, general mortality (in and out-of-hospital) has been consistently reported to be higher in cardiac diagnosis, for instance, in Chile, Salas (2020) described the cardiac form as the most significant specific cause of CD Núñez-González et al (2018) [ 41 ].…”

Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases

“…In relation to parasites, the most common of these organisms capable of affecting the heart is T. cruzi ( Vásconez-González et al., 2023b ). This parasite is associated with chronic chagasic cardiomyopathy that generates hypertrophy of the heart (cardiomegaly), incomplete or complete right bundle branch block, left anterior fascicular block, cardiomegaly, fibrosing myocarditis, apical aneurysms, and progressive heart failure ( Marin-Neto et al., 2007 ; Rassi et al., 2007 ; Pinto et al., 2008 ; Meymandi et al., 2018 ; Martín-Escolano et al., 2022 ).…”