title: Pediatric Chagas disease in Europe: 45 cases from Spain and Switzerland.
abstract: BACKGROUND
  Chagas disease, a potentially fatal parasitic infection, is emerging in Europe in the context of international migration but there is little public health attention and frequent lack of clinicians' awareness. To date, there is no published information about clinical characteristics in children.
  
  
  METHODS
  We reviewed the medical files of all children (<18 years) with Chagas disease managed in 2 hospitals in Barcelona, Spain and Geneva, Switzerland between January 2004 and July 2012.
  
  
  RESULTS
  Forty-five cases were identified. Two children (4.4%) were diagnosed during the acute phase and the remaining 43 (95.6%) were in the chronic phase of the infection. All but 1 were asymptomatic. Of the 41 treated children, 40 (97.6%) completed 60 days of treatment. Thirty-five (85.4%) received benznidazole, 5 (12.2%) nifurtimox and 1 (2.4%) both drugs consecutively. There were 2 (4.9%) treatment interruptions due to adverse events. The most frequent adverse events were rash (24.4%), anorexia or insufficient weight gain (14.6%) and anemia (2.4%). Twenty-nine (64.4%) children were followed up by serology after 2 years. Five (17.2%) were cured.
  
  
  CONCLUSIONS
  Pediatric Chagas disease is an emerging health issue in Europe that requires enhanced attention. Greater emphasis should be put on screening pregnant women at risk and their newborns in case of infection along with older children and relatives. Pediatricians have a central role to play in providing families with information and offering testing in situations of risk.
authors.affiliation: From the *Department of Pediatrics, University Hospitals of Geneva and University of Geneva, Switzerland; †Department of Pediatrics; ‡Laboratory of Microbiology, Sant Joan de Déu Hospital, University of Barcelona, Spain; §Department of Gynecology & Obstetrics; ¶Division of International and Humanitarian Medicine, Department of Community Medicine, Primary Care and Emergency Medicine; and ‖Division of Primary Care, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
authors.forename: Luciana
authors.initials: L
authors.lastname: Rodriguez-Guerineau
authors.forename: Klara M
authors.initials: KM
authors.lastname: Posfay-Barbe
authors.forename: Manuel
authors.initials: M
authors.lastname: Monsonis-Cabedo
authors.forename: Teresa
authors.initials: T
authors.lastname: Juncosa-Morros
authors.forename: Alessandro
authors.initials: A
authors.lastname: Diana
authors.forename: Claire-Anne
authors.initials: CA
authors.lastname: Wyler-Lazarevic
authors.forename: Begoña Martinez
authors.initials: BM
authors.lastname: de Tejada
authors.forename: François
authors.initials: F
authors.lastname: Chappuis
authors.forename: Victoria
authors.initials: V
authors.lastname: Fumadó-Pérez
authors.forename: Yves
authors.initials: Y
authors.lastname: Jackson
mesh_terms: D000293:Adolescent; D000981:Antiprotozoal Agents / Q000009:adverse effects / Q000627:therapeutic use; D014355:Chagas Disease / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging / Q000188:drug therapy / Q000453:epidemiology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000473:pathology; D005060:Europe; D006801:Humans; D007223:Infant; D008297:Male; D013030:Spain / Q000453:epidemiology; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000981:Antiprotozoal Agents