1. Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo.
- Author
-
Shikanai Yasuda MA, Sátolo CG, Carvalho NB, Atala MM, Ferrufino RQ, Leite RM, Furucho CR, Luna E, Silva RA, Hage M, de Oliveira CMR, Busser FD, de Freitas VLT, Wanderley DM, Martinelli L, Almeida SR, Viñas PA, and Carneiro N Jr
- Subjects
- Adolescent, Adult, Bolivia ethnology, Brazil epidemiology, Chagas Disease drug therapy, Child, Cross-Sectional Studies, Emigrants and Immigrants, Enzyme-Linked Immunosorbent Assay, Female, Humans, Male, Middle Aged, Nitroimidazoles therapeutic use, Serologic Tests, Trypanocidal Agents therapeutic use, Trypanosoma cruzi, Young Adult, Chagas Disease diagnosis, Chagas Disease ethnology, Mass Screening methods, Patient Care Team, Primary Health Care organization & administration
- Abstract
Background/methods: 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., Results: 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., Conclusion: 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.
- Published
- 2017
- Full Text
- View/download PDF