Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo.
In a pioneering cross-sectional study among Bolivian immigrants in the city of São Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients.



The majority of the 28 seropositive patients were women, of whom 88.89% were of child-bearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed.



An interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system.
Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil.|Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil.
Maria Aparecida
0000-0003-3864-041X
MA
Shikanai Yasuda
Centro de Saúde Escola Barra Funda "Alexandre Vranjac", Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
Camila Gonçalves
CG
Sátolo
Division of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil.
Noemia Barbosa
NB
Carvalho
Hospital das Clínicas, Faculdade de Medicina Ribeirão Preto of the University of São Paulo, São Paulo, Brazil.
Magda Maya
MM
Atala
Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil.
Rosario Quiroga
RQ
Ferrufino
Centro de Vigilância Epidemiológica, Coordenadoria de Controle de Doenças da Secretaria da Saúde do Estado de São Paulo, São Paulo, Brazil.
Ruth Moreira
RM
Leite
Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil.
Célia Regina
CR
Furucho
Tropical Medicine Institute of São Paulo, University of São Paulo, São Paulo, Brazil.
Expedito
E
Luna
Superintendência de Controle de Endemias, Secretaria da Saúde do Estado de São Paulo, São Paulo, Brazil.
Rubens Antonio
RA
Silva
Laboratory of Parasitology (LIM 46), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil.
Marcia
M
Hage
Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil.
Caroline Medeji Ramos
CMR
de Oliveira
Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil.
Felipe Delatorre
FD
Busser
Department of Infectious and Parasitic Diseases, Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil.|Laboratory of Immunology (LIM 48), Hospital das Clínicas da Faculdade de Medicina of the University of São Paulo, São Paulo, Brazil.
Vera Lucia Teixeira
VLT
de Freitas
Superintendência de Controle de Endemias, Secretaria da Saúde do Estado de São Paulo, São Paulo, Brazil.
Dalva Marli Valerio
DM
Wanderley
Centro de Saúde Escola Barra Funda "Alexandre Vranjac", Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
Luzia
L
Martinelli
Centro de Saúde Escola Barra Funda "Alexandre Vranjac", Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
Sonia Regina
SR
Almeida
Control of Neglected Tropical Diseases, World Health Organization, Geneve, Switzerland.
Pedro Albajar
PA
Viñas
Centro de Saúde Escola Barra Funda "Alexandre Vranjac", Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.|Department of Social Medicine, School of Medical Sciences of Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
Nivaldo
N
Carneiro
D000293:Adolescent; D000328:Adult; D001838:Bolivia / Q000208:ethnology; D001938:Brazil / Q000453:epidemiology; D014355:Chagas Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology*; D002648:Child; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009593:Nitroimidazoles / Q000627:therapeutic use; D010348:Patient Care Team; D011320:Primary Health Care / Q000458:organization & administration*; D012698:Serologic Tests; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014349:Trypanosoma cruzi; D055815:Young Adult
D009593:Nitroimidazoles; D014344:Trypanocidal Agents; C009999:benzonidazole