Seroprevalence and risk factors of Chagas disease in a rural population of the Quixeré municipality, Ceará, Brazil

Abstract INTRODUCTION: This study estimated the seroprevalence and risk factors of Chagas disease (CD) in a population of the Quixeré municipality, Ceará. METHODS: We conducted serological methods to detect the Trypanosoma cruzi infection. The other variables were evaluated by a standardized questionnaire. RESULTS: The estimated prevalence of CD was 3.7%. Male sex, age >40 years, being farmers, low education level, origin from rural areas, and being born in Quixeré were significantly associated with infection. CONCLUSION: CD persists in this rural population of Northeast Brazil. Poverty, low education, and limited information regarding CD are critical issues that need to be addressed.

Prevalência da Infecção pelo Trypanosoma cruzi em Doadores de Sangue / Prevalence of Trypanosoma Cruzi Infection in Blood Donors

Resumo Fundamento A doença de Chagas (DC) é considerada um problema de saúde pública na América Latina. A região nordeste, principalmente o estado do Ceará, ainda representa grande preocupação em termos de risco de transmissão da doença. Objetivo Estimar a prevalência de T. cruzi em doadores de sangue do estado do Ceará. Métodos Trata-se um de estudo retrospectivo descritivo realizado no período de 2010 a 2015, a partir de dados registrados no sistema informatizado do Centro de Hematologia e Hemoterapia do Ceará (HEMOCE). Resultados Dos 763.731 potenciais doadores de sangue, 14.159 foram considerados impedidos de fazer a doação devido à sorologia, sendo que 1.982 (0,33%) o foram devido à positividade/inconclusão para doença de Chagas. Compareceram à Hemorrede para a repetição 425 indivíduos, sendo confirmados 28,2% (120/425) como impedidos de doar devido a DC. Conclusão Não houve redução significativa das sorologias positivas/inconclusivas no período entre 2010-2015, porém foi observada redução em relação a 1996/1997 no estado. A determinação da prevalência da doença de Chagas em bancos de sangue pode ser relevante como indicador do risco de transmissão transfusional em determinada região. Novos testes sorológicos para triagem com melhor acurácia são necessários, reduzindo o descarte desnecessário de bolsas de sangue, os custos para o Sistema Único de Saúde e a insegurança para os pacientes e familiares. (Arq Bras Cardiol. 2020; 115(6):1082-1091)

Abstract Background Chagas disease (CD) is considered a public health problem in Latin America. The northeastern region, especially the state of Ceará, still represents a major concern in terms of the risk of transmission of CD. Objective To estimate the prevalence of T. cruzi in blood donors from the state of Ceará. Methods This is a retrospective descriptive study that was performed in the period from 2010 to 2015 from data recorded in the computerized system of the Hematology and Hemotherapy Center of Ceará (HEMOCE in Portuguese). Results Of the 763,731 potential blood donors, 14,159 were serologically ineligible; 1,982 (0.33%) were serologically ineligible due to positive / inconclusive diagnosis for CD. A total of 425 individuals came to the HEMOCE to repeat the test, with 28.2% (120/425) declared ineligible for donations due to CD. Conclusion No significant reduction of positive / inconclusive serology was observed in the period between 2010 and 2015, but a reduction was observed when compared to 1996/1997 in the state. The determination of the prevalence of CD in blood banks may be relevant as an indicator of the risk of CD transmission through blood transfusions in a given region. New serological tests for triage with better accuracy in screening are needed, in an attempt to reduce the unnecessary disposal of blood bags, reduce costs for the Brazilian Unified Health System, and diminish insecurity for the patient and family members. (Arq Bras Cardiol. 2020; 115(6):1082-1091)

Pharmaceutical care in the state of Ceará, Brazil: socioeconomic and demographic profile of patients with chagas disease attended in a referral center

The Pharmaceutical Care Service of the Chagas Disease Research Laboratory (LPDC), in the State of Ceará, Brazil, treats patients with Chagas disease (CD), characterized as a chronic, neglected disease that requires full patient follow-up. Objective: determine the socioeconomic and demographic profile of patients with CD treated at the LPDC. A descriptive cross-sectional study was carried out, in which 507 patients were treated from January 2007 to May 2016. The variables collected were gender, age, place of birth, schooling, family income, type of health care, occupation, living conditions and habits. The profile of Trypanosoma cruzi infected individuals consisted of 51.1% males; mean age of 50.4 years; 26.6% were small farmers; 48.7% had not finished elementary school; 36.9% had a family income of one minimum wage; 77.7% did not have private health insurance and most of them came from rural areas. Regarding habits, 66.5% were nonsmokers and 70.0% were sedentary. Additionally, an improvement was noted in housing conditions, with most patients moving from wattle and daub huts, which were their first homes, to brick houses. We conclude that the analysis of the socioeconomic and demographic profile of patients treated at the LPDC showed that most of them come from a low socioeconomic population, where the demand for treatment has been occurring at a later age, further reinforcing the importance of the follow-up provided by the LPDC.

Trypanosoma cruzi seroprevalence among solid organ donors in Ceará State, Brazil

Abstract INTRODUCTION: The transmission of Chagas disease (CD) through blood transfusion, organ transplantation, and oral transmission has gained greater visibility as a result of intensified vector control activities in endemic regions and to control CD in non-endemic regions. In Brazil, Ceará is one of the states that perform the most organ transplants. Therefore, the objective of this study was to assess the prevalence of Trypanosoma cruzi infection in organ donor candidates. METHODS: A retrospective analysis was performed on data from potential organ donors at the Center of Transplantation of the State of Ceará from 2010 - 2015. RESULTS: Data from a total of 2,822 potential donors were obtained, of which 1,038 were effective donors and 1,784 were excluded, likely due to lack of family authorization or medical contraindication. The prevalence of T. cruzi infection among these potential donors was 1.3% (n = 29). The majority of infected donors were males aged 41 - 60 years, residing in the interior of the state. Interestingly, 72.4% (n = 21) had positive or inconclusive serology for additional infections, such as cytomegalovirus, hepatitis B and C, and toxoplasmosis. Probability analysis revealed that stroke was the most common cause of death among potential donors with CD. CONCLUSIONS: There was a high prevalence of CD and other coinfections among potential solid organ donors in Ceará, and statistical tests have shown that these individuals are at increased risk of stroke when compared to potential non-reactive donors. This work highlights the importance of screening DC infection in potential donors.

Satisfação dos pacientes com doença de Chagas atendidos por um serviço de atenção farmacêutica no estado do Ceará, Brasil / Satisfaction of Chagas disease patients attended at a pharmaceutical care service in the State of Ceará, Brazil

Resumo O Serviço de Atenção Farmacêutica ao paciente com doença de Chagas do estado do Ceará foi criando em 2005, com a finalidade de proporcionar seguimento farmacoterapêutico àqueles com esta morbidade. Decorridos 10 anos de atuação, objetivou-se avaliar a satisfação dos pacientes atendidos no serviço. Tratou-se de um estudo prospectivo, empregando um questionário subdividido nas seções: dados socioeconômicos; infraestrutura, localização e funcionamento; cuidado farmacêutico e importância do serviço. Foram entrevistados 70 pacientes de ambos os sexos e acima de 18 anos, entre agosto de 2014 e maio de 2015. Quanto à infraestrutura, localização e funcionamento, as notas obtidas mostraram que os pacientes estão satisfeitos com os parâmetros analisados. Com relação ao cuidado farmacêutico, a maioria dos pacientes mostrou-se satisfeita, tendo o "ser bem atendido" como aspecto mais importante durante o atendimento. Em relação à importância do serviço, 100% o considerou muito importante e o indicaria para outras pessoas. De modo geral, o estudo demonstrou um alto nível de satisfação com o serviço. Há muito a ser trabalhado neste serviço, como promover maior acesso e qualificação do atendimento, contribuindo para a concretização de um modelo humanizado, centrado nas necessidades do paciente.

Abstract In 2005, a pharmaceutical care service was created in the State of Ceará to provide pharmacotherapeutic follow-up for individuals infected with Trypanosoma cruzi (Chagas Disease). After 10 years of operation, an evaluation was conducted to assess the degree of satisfaction of patients treated under the service. This prospective study used a questionnaire comprising the following sections: socioeconomic data; infrastructure, facilities and operations; pharmaceutical care; and importance of the service. Seventy patients of both sexes and over 18 years of age were interviewed between August 2014 and May 2015. As for infrastructure, location and operation, the average grades show a high level of patient satisfaction. Regarding pharmaceutical care, most patients reported being satisfied and considered "being well treated" to be the most important aspect during treatment. In addition, all patients (100%) rated the service as very important and would recommend it to other individuals. Overall, the study showed a high level of patient satisfaction with the service. There is, however, still much to work to be done on this service in order to promote greater access and qualified care to fully achieve a humanized model focused on patient needs.

Insect vectors of Chagas disease (Trypanosoma cruzi) in Northeastern Brazil

Abstract INTRODUCTION: Chagas disease remains a public health problem in the rural and urban areas of 19 countries in the Americas. METHODS: The aim of the present study was to investigate the Trypanosoma cruzi infection rate of triatomines collected from both intra- and peridomiciliary areas in eleven municipalities of Southeastern Ceará, Brazil, from 2009 to 2015. RESULTS: A total of 32,364 triatomine specimens, including nymphs and adults, were collected, and 31,736 (98.06%) of these were examined. More nymphs were collected than adults, and the greatest number of triatomines (n = 8,548) was collected in 2010, for which the infection rate was 1.3%, with the highest rate of infections observed for specimens from Quixere. The species collected during the study were identified as Triatoma pseudomaculata, Triatoma brasiliensis, Panstrongylus megistus, Panstrongylus lutzi, and Rhodnius nasutus, with T. pseudomaculata being the most abundant (n = 19,962). CONCLUSIONS: These results verify the presence of triatomines in both intra- and peridomiciliary areas, thereby ensuring persistence of the pathogen and consequently, the disease, as the presence of infected vectors in households is an important risk factor. According to these findings, the Chagas Disease Control Program should intensify its efforts in order to prevent the spread of the disease.

Pharmacotherapeutic follow-up of patients with Chagas disease using benznidazole: drug-related problems and pharmaceutical interventions

Abstract INTRODUCTION Benznidazole (BNZ) is a drug available for the etiological treatment of Chagas disease. However, this drug is toxic and has a limited effectiveness on the chronic phase of this disease, often leading to poor treatment adherence. METHODS: This is a descriptive and exploratory study conducted at the Pharmaceutical Care Service for Chagas disease patients of the Federal University of Ceará. Drug-related problems (DRPs) and pharmaceutical interventions (PIs) were classified according to the Second Consensus of Granada. RESULTS: The average age of patients with Chagas disease was 62 years, with the majority residing in the Ceará countryside (86.7%), and having low education levels (63.3% with elementary school education). Regarding family income, most patients belonged to a household that earned ≤1-2 times the minimum wage per month. Approximately 73% of these patients complied with the BNZ treatment, and nearly 7% underwent therapy interruption after medical evaluation. A total of 189 DRPs were identified, of which 51.9% (n=98) were classified as potential, and 48.1% (n=91) as actual. The most frequent DRPs were related to safety (qualitative safety; n=70; 37%), necessity (non-adherence; n=52; 27.5%), and effectiveness (qualitative effectiveness/non-optimal drug selection; n=45; 23.8%). Among the 216 PIs conducted, the majority were related to patient education (n=168; 77.8%) and pharmacological strategy (n=42; 19.4%). CONCLUSIONS: This study indicates the need for pharmacotherapeutic monitoring in patients with Chagas because of the high number of therapeutic interventions, DRPs (approximately 3 DRPs/patient), BNZ adherence, and polypharmacy.

Evolução eletrocardiográfica e sorológica de pacientes com doença de Chagas crônica acompanhados por seis anos após o tratamento com benzonidazol / Electrocardiographic and serological evolution of patients with chronic Chagas disease followed-up for six years after treatment with benzonidazole

Introdução: O tratamento com benzonidazol na fase crônica da doença de Chagas ainda permanece controverso. O presente estudo objetiva avaliar a efetividade da quimioterapia com benzonidazol em pacientes chagásicos crônicos por meio de análises sorológica e eletrocardiográfica. Método: Estudo prospectivo histórico, com acompanhamento eletrocardiográfico e sorológico pelos métodos imunoenzimático (ELISA) e de imunofluorescência indireta uma vez por ano, antes e após o tratamento, entre 2005 e 2011. No perfil sociodemográfico dos 30 pacientes acompanhados o predomínio era do sexo masculino, faixa etária entre 25-64 anos, com primeiro grau incompleto e em sua maioria agricultores. Resultados: A análise sorológica por ELISA demonstrou queda significativa da densidade óptica das amostras coletadas antes (2005) e após o tratamento com benzonidazol (2011). Em relação à imunofluorescência indireta, os pacientes se mantiveram inalterados durante o acompanhamento (variação de no máximo uma diluição entre as amostras basal e final). Na avaliação eletrocardiográfica, 76,2% (16/21) dos pacientes apresentaram manutenção dos laudos eletrocardiográficos ao longo do estudo. Conclusão: Foram observadas regressões nas análises sorológicas dos pacientes tratados com benzonidazol, acompanhados por 6 anos, além da manutenção dos padrões eletrocardiográficos iniciais na maioria dos casos, o que pode sugerir um efeito benéfico do fármaco no tratamento desses pacientes na fase crônica da doença de Chagas.

Background: Treatment with benzonidazole in the chronic phase of Chagas disease remains controversial. This study is aimed at evaluating the effectiveness of chemotherapy with benzonidazole in chronic Chagas disease using serological and electrocardiographic analysis. Method: Historical prospective study with electrocardiographic and serological monitoring by enzyme immunoassay (ELISA) and indirect immunofluorescence once a year, before and after the treatment, from 2005 to 2011. In the socio-demographic profile of the 30 patients followed-up, there was a prevalence of males, ages ranged between 25-64 years, incomplete school education and most of them farmers. Results: ELISA serology showed a significant decrease in the optical density of the samples collected before (2005) and after treatment with benzonidazole (2011). Indirect immunofluorescence demonstrated patients remained unchanged during follow-up (maximum variation of one dilution between the baseline sample and 2011). In the electrocardiographic assessment, 76.2% (16/21) of the patients maintained their electrocardiographic reports throughout the study. Conclusion: Patients treated with benzonidazole and followed-up for 6 years presented a regression in serological analysis and maintenance of their baseline ECG patterns in most cases, which may suggest a beneficial effect of the drug in the chronic treatment of Chagas disease.