title: 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 (n5101; 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.
authors.affiliation: Department of Internal Medicine, Hospital General Universitario de Alicante, C/Pintor Baeza 10, Alicante, Spain. jramosrincon@yahoo.es
authors.forename: José M
authors.initials: JM
authors.lastname: Ramos
authors.forename: Diego
authors.initials: D
authors.lastname: Torrús
authors.forename: Concepción
authors.initials: C
authors.lastname: Amador
authors.forename: Francisco
authors.initials: F
authors.lastname: Jover
authors.forename: Fabiola
authors.initials: F
authors.lastname: Pérez-Chacón
authors.forename: Yamileth
authors.initials: Y
authors.lastname: Ponce
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Arjona
authors.forename: Elena
authors.initials: E
authors.lastname: Caro
authors.forename: Concepción
authors.initials: C
authors.lastname: Martínez-Peinado
authors.forename: Ingrid
authors.initials: I
authors.lastname: Gallegos
authors.forename: José M
authors.initials: JM
authors.lastname: Cuadrado
authors.forename: Antonio
authors.initials: A
authors.lastname: Tello
authors.forename: Felix
authors.initials: F
authors.lastname: Gutiérrez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001838:Bolivia; D014355:Chagas Disease / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004641:Emigration and Immigration; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009593:Nitroimidazoles / Q000627:therapeutic use; D011247:Pregnancy; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D014349:Trypanosoma cruzi / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D009593:Nitroimidazoles; C009999:benzonidazole