Cribado ampliado de Trypanosoma cruzi en la descendencia de mujeres infectadas en la zona metropolitana norte de Barcelona, Cataluña (España), 2005-2016 / Extended screening of Trypanosoma cruzi among the offspring of infected women. Barcelona North metropolitan area, Catalonia (Spain), 2005-2016

INTRODUCCIÓN: Existen escasos datos sobre el cribado serológico extenso, familiar, de Trypanosoma cruzi a partir de un infectado-índice. Por tratarse de una parasitosis con posibilidad de transmisión materno-fetal, el estudio de la descendencia de mujeres crónicamente infectadas posee una especial relevancia. MÉTODOS: Estudio observacional por método de captura-recaptura que valora el estado serológico en la descendencia de las mujeres diagnosticadas de infección por T. cruzi en el área metropolitana norte de Barcelona durante el periodo 2005-2016. RESULTADOS: Se identificaron 238 mujeres son serología positiva para T. cruzi. De ellas, se pudieron localizar 117 (49,2%) y sus 300 descendientes. Entre los descendientes, 192 (64%) tenían registro de serología, con 23 positivas para T. cruzi (11,98%; IC 95%: 8,1-17,3). Hubo 53 niños nacidos en el área de estudio, con 5 casos de transmisión vertical (9,8%; IC 95%: 4,2-20,9). Todos los nacidos a partir de la implementación del programa de cribado materno (en 2010) tenían registro serológico. CONCLUSIONES: La población de descendientes de mujeres con serología positiva para T. cruzi muestra una tasa elevada de seropositividad. La prevalencia de transmisión vertical es notablemente alta, pero comparable a la obtenida en otros estudios europeos. La principal fuente de pérdidas lo constituyen las mujeres ilocalizables. Es razonable incluir la determinación serológica familiar extensa en los protocolos de cribado de enfermedad de Chagas. A fin de evitar pérdidas, se debería implementar un eventual cribado en el momento del diagnóstico materno

INTRODUCTION: To date, very little data is available on the extensive, familiar, serological screening of Trypanosoma cruzi from infected-index cases. As it is a parasite with possibility of mother-to-child fetal transmission, the study of the offspring of chronically infected women has a special relevance. METHODS: An observational study using a capture-recapture method that evaluates the offspring serological status of women diagnosed with T. cruzi infection (positive serology) in the northern metropolitan area of Barcelona during 2005-2016. RESULTS: A total of 238 women with positive serology for T. cruzi were identified. Of these, 117 (49.2%) could be localized. Their offspring summarized 300 individuals, of which 192 (64%) had serology records, with 23 positive for T. cruzi (11.98%; CI95%: 8.1-17.3). Among the 53 children born within the study area, 5 (9.8%, CI95%: 4.2-20.9) cases of vertical transmission were recorded. All children born as of 2010 (the starting year of mother screening) had serological outputs. CONCLUSIONS: Offspring of T. cruzi-seropositive women showed a high rate of seropositivity. The prevalence of vertical transmission is also remarkably high but comparable to that obtained in other European studies. The main source of loss was non-accessible women. It is reasonable to formaly include extensive, familiar, serological assessment in Chagas screening guidelines. In order to avoid losses, any eventual screening should be implemented at the time of the maternal diagnosis

Extended screening of Trypanosoma cruzi among the offspring of infected women. Barcelona North metropolitan area, Catalonia (Spain), 2005-2016. / Cribado ampliado de Trypanosoma cruzi en la descendencia de mujeres infectadas en la zona metropolitana norte de Barcelona, Cataluña (España), 2005-2016.

INTRODUCTION: To date, very little data is available on the extensive, familiar, serological screening of Trypanosoma cruzi from infected-index cases. As it is a parasite with possibility of mother-to-child fetal transmission, the study of the offspring of chronically infected women has a special relevance. METHODS: An observational study using a capture-recapture method that evaluates the offspring serological status of women diagnosed with T. cruzi infection (positive serology) in the northern metropolitan area of Barcelona during 2005-2016. RESULTS: A total of 238 women with positive serology for T. cruzi were identified. Of these, 117 (49.2%) could be localized. Their offspring summarized 300 individuals, of which 192 (64%) had serology records, with 23 positive for T. cruzi (11.98%; CI95%: 8.1-17.3). Among the 53 children born within the study area, 5 (9.8%, CI95%: 4.2-20.9) cases of vertical transmission were recorded. All children born as of 2010 (the starting year of mother screening) had serological outputs. CONCLUSIONS: Offspring of T. cruzi-seropositive women showed a high rate of seropositivity. The prevalence of vertical transmission is also remarkably high but comparable to that obtained in other European studies. The main source of loss was non-accessible women. It is reasonable to formaly include extensive, familiar, serological assessment in Chagas screening guidelines. In order to avoid losses, any eventual screening should be implemented at the time of the maternal diagnosis.

Epidemiological, clinical, diagnostic and economic features of an immigrant population of chronic schistosomiasis sufferers with long-term residence in a non-endemic country (North Metropolitan area of Barcelona, 2002-2016).

BACKGROUND: Schistosomiasis, one of the neglected tropical diseases (NTD) listed by the WHO, is an acute and chronic parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma. Complications of long-term infestation include liver cirrhosis, bladder tumors and kidney failure. The objective of this study was to carry out a clinical and epidemiological characterization of a schistosomiasis-diagnosed immigrant population with long-term residencein the EU as well as to evaluate the diagnostic methods available to date. METHODS AND RESULTS: A total of 61 individuals with Schistosoma infection who received medical attention between June 2002 and June 2016 at the North Metropolitan International Health Unit in Barcelona (Catalonia, Spain), were included in the study. All patients were sub-Saharan African immigrants. The majority were male (91.8%) with a median age of 34 years. Symptoms attributable to infection such as haematuria, abdominal pain and dysuria were recorded in up to 90% of patients. The percentage of eosinophils decreased amongst older patients (p = 0.002) and those with symptoms associated with urinary tract infections (p = 0.017). Serology was used for diagnosis in 80.3% of the cases, with microscopic examination showing the remaining 9.8% positive for parasite eggs. Direct microbiological diagnosis was more useful in patients with less than 5 years of residence in the EU (p = 0.05). Chronic complications were present in 22 (36%) of the patients, with renal failure affecting 20 (33%). Of these 20, 6(10%) developed terminal renal failure and required hemodialysis, while 3 (5%) received a renal transplantation. CONCLUSION: Morbidity associated with chronic long-term schistosomiasis is frequent among African immigrants in non-endemic countries. Better diagnostic tools and appropriate early treatment would prevent the development of visceral damage. Thorough screening in selected patients would also be useful to avoid chronic complications.