Marta González Sanz1, Valentina De Sario1, Ana García-Mingo1, Debbie Nolder2, Naghum Dawood1, Míriam J Álvarez-Martínez3, Rosemarie Daly1, Patricia Lowe1, Sophie Yacoub4, David Aj Moore5, Peter L Chiodini6. 1. Hospital for Tropical Diseases; Mortimer Market Centre, Mortimer Market, London, WC1E 6JB, UK. 2. London School of Hygiene & Tropical Medicine; Keppel St, London, WC1E 7HT, UK. 3. Hospital Clínic; Centro de Diagnóstico Biomédico, Villarroel 170, 08036, Barcelona, Spain; ISGlobal; Rosselló 132, 5th 2nd, 08036, Barcelona, Spain. 4. Hospital for Tropical Diseases; Mortimer Market Centre, Mortimer Market, London, WC1E 6JB, UK; Center for Tropical Medicine and Global Health, University of Oxford, UK. 5. Hospital for Tropical Diseases; Mortimer Market Centre, Mortimer Market, London, WC1E 6JB, UK; London School of Hygiene & Tropical Medicine; Keppel St, London, WC1E 7HT, UK. 6. Hospital for Tropical Diseases; Mortimer Market Centre, Mortimer Market, London, WC1E 6JB, UK; London School of Hygiene & Tropical Medicine; Keppel St, London, WC1E 7HT, UK. Electronic address: p.chiodini@nhs.net.
Abstract
BACKGROUND: Chagas disease (CD), is a parasitic disease endemic in Latin America. Presentation in non-endemic areas is either in the asymptomatic indeterminate phase or the chronic phase with cardiac and/or gastrointestinal complications. METHODS: The Hospital for Tropical Diseases (HTD) based in central London, provides tertiary care for the management of CD. We reviewed all cases managed at this centre between 1995 and 2018. RESULTS: Sixty patients with serologically proven CD were identified. Most were female (70%), with a median age at diagnosis of 41 years. Three quarters of the patients were originally from Bolivia. 62% of all patients were referred to the HTD by their GP. Nearly half of the patients were asymptomatic (47%). Twelve patients had signs of cardiac involvement secondary to CD. Evidence of gastrointestinal damage was established in three patients. Treatment was provided at HTD for 31 patients (47%). Most patients (29) received benznidazole, five of them did not tolerate the course and were switched to nifurtimox. Of the seven patients receiving this second line drug, five completed treatment, whilst two interrupted it due to side effects. CONCLUSIONS: Despite the UK health system having all the resources required to diagnose, treat and follow up cases, there is lack of awareness of CD, such that the vast majority of cases remain undiagnosed and therefore do not receive treatment. We propose key interventions to improve the detection and management of this condition in the UK, especially in pregnant women and neonates.
BACKGROUND: Chagas disease (CD), is a parasitic disease endemic in Latin America. Presentation in non-endemic areas is either in the asymptomatic indeterminate phase or the chronic phase with cardiac and/or gastrointestinal complications. METHODS: The Hospital for Tropical Diseases (HTD) based in central London, provides tertiary care for the management of CD. We reviewed all cases managed at this centre between 1995 and 2018. RESULTS: Sixty patients with serologically proven CD were identified. Most were female (70%), with a median age at diagnosis of 41 years. Three quarters of the patients were originally from Bolivia. 62% of all patients were referred to the HTD by their GP. Nearly half of the patients were asymptomatic (47%). Twelve patients had signs of cardiac involvement secondary to CD. Evidence of gastrointestinal damage was established in three patients. Treatment was provided at HTD for 31 patients (47%). Most patients (29) received benznidazole, five of them did not tolerate the course and were switched to nifurtimox. Of the seven patients receiving this second line drug, five completed treatment, whilst two interrupted it due to side effects. CONCLUSIONS: Despite the UK health system having all the resources required to diagnose, treat and follow up cases, there is lack of awareness of CD, such that the vast majority of cases remain undiagnosed and therefore do not receive treatment. We propose key interventions to improve the detection and management of this condition in the UK, especially in pregnant women and neonates.