title: Chagas disease as a cause of heart failure and ventricular arrhythmias in patients long removed from endemic areas: an emerging problem in Europe.
abstract: Chagas disease is a parasitic disease caused by the protozoan Trypanosoma cruzi. In endemic areas (South and Central America), Chagas disease represents a relevant public health issue, and is the most frequent cause of cardiomyopathy. In nonendemic areas, such as Europe, Chagas disease represents an emerging problem following the establishment of sizeable communities from Brazil and Bolivia. Chagas cardiomyopathy represents the most frequent and serious complication of chronic Chagas disease, affecting about 20-30% of patients, potentially leading to heart failure, arrhythmias, thromboembolism, stroke and sudden death. Because late complications of Chagas disease may develop several years or even decades after the acute infection, it may be extremely challenging to reach the correct diagnosis in patients long removed from the countries of origin. We report two examples of Chagas cardiomyopathy in South American women permanently residing in Italy for more than 20 years, presenting with cardiac manifestations ranging from left ventricular dysfunction and heart failure to isolated ventricular arrhythmias. The present review emphasizes that Chagas disease should be considered as a potential diagnosis in patients from endemic areas presenting with 'idiopathic' cardiac manifestations, even when long removed from their country of origin, with potential implications for treatment and control of Chagas disease transmission.
authors.affiliation: aReferral Center for Myocardial Diseases, Internal Medicine and Infectious Disease Unit, Careggi University Hospital, Florence bDipartimento di Medicina Sperimentale e Clinica, Sezione Medicina Critica e Medicine Specialistiche, Clinica Malattie Infettive, Università degli Studi di Firenze, Firenze cInternal and Emergency Medicine Unit, Careggi Uninersity Hospital, Florence dMedicina Interna all'Orientamento all'alta complessità aziendale 2, Università degli Studi di Firenze, Firenze, Italia eDepartment of Medicine, Imperial College, Hammersmith Campus, London, UK.
authors.forename: Vieri
authors.initials: V
authors.lastname: Vannucchi
authors.forename: Benedetta
authors.initials: B
authors.lastname: Tomberli
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Zammarchi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fornaro
authors.forename: Gabriele
authors.initials: G
authors.lastname: Castelli
authors.forename: Filippo
authors.initials: F
authors.lastname: Pieralli
authors.forename: Andrea
authors.initials: A
authors.lastname: Berni
authors.forename: Sophie
authors.initials: S
authors.lastname: Yacoub
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bartoloni
authors.forename: Iacopo
authors.initials: I
authors.lastname: Olivotto
mesh_terms: D001145:Arrhythmias, Cardiac / Q000469:parasitology*; D002598:Chagas Cardiomyopathy / Q000150:complications / Q000175:diagnosis* / Q000635:transmission; D021821:Communicable Diseases, Emerging / Q000150:complications / Q000175:diagnosis / Q000635:transmission; D019468:Disease Management; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000469:parasitology*; D006801:Humans; D008875:Middle Aged