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The NHEPACHA Iberoamerican Network, founded on the initiative of a group of researchers from Latin American countries and Spain, aims to establish a research framework for Chagas disease that encompasses diagnosis and treatment. For this purpose, the network has created a questionnaire to gather relevant data on epidemiological, clinical, diagnostic, and therapeutic aspects of the disease. This questionnaire was developed based on a consensus of expert members of the network, with the intention of collecting high-quality standardized data, which can be used interchangeably by the different research centers that make up the NHEPACHA network. Furthermore, the network intends to offer a clinical protocol that can be embraced by other researchers, facilitating comparability among published studies, as well as the development of therapeutic response and progression markers. Author summary: In this work, we present a new clinical questionnaire for the standardized evaluation and collection of clinical data from patients with acute or chronic Trypanosoma cruzi infection, as well as a uniformed database to collect it. The questionnaire has been produced after consensus from clinical experts belonging to the NHEPACHA network, a coalition of clinical research institutions in Latin America and Spain. This tool will facilitate the collection and sharing of high-quality clinical and paraclinical data useful to annotate sample collections, and allow clinically meaningful comparisons between different cohorts. [ABSTRACT FROM AUTHOR]

Chagas disease, caused by the parasite Trypanosoma cruzi, affects over 6 million people, mainly in Latin America. Two different clinical phases, acute and chronic, are recognised. Currently, 2 anti-parasitic drugs are available to treat the disease (nifurtimox and benznidazole), but diagnostic methods require of a relatively complex infrastructure and trained personnel, limiting its widespread use in endemic areas, and the access of patients to treatment. New diagnostic methods, such as rapid tests (RDTs) to diagnose chronic Chagas disease, or loop-mediated isothermal amplification (LAMP), to detect acute infections, represent valuable alternatives, but the parasite's remarkable genetic diversity might make its implementation difficult. Furthermore, determining the efficacy of Chagas disease treatment is complicated, given the slow reversion of serological anti-T. cruzi antibody reactivity, which may even take decades to occur. New biomarkers to evaluate early therapeutic efficacy, as well as diagnostic tests able to detect the wide variety of circulating genotypes, are therefore, urgently required. To carry out studies that address these needs, high-quality and traceable samples from T. cruzi-infected individuals with different geographical backgrounds, along with associated clinical and epidemiological data, are necessary. This work describes the framework for the creation of such repositories, following standardised and uniform protocols, and considering the ethical, technical, and logistic aspects of the process. The manual can be adapted according to the resources of each laboratory, to guarantee that samples are obtained in a reproducible way, favouring the exchange of data among different work groups, and their generalizable evaluation and analysis. The main objective of this is to accelerate the development of new diagnostic methods and the identification of biomarkers for Chagas disease. Author summary: The diagnosis of Chagas disease requires costly equipment and trained personnel, which unavailability hinders access to diagnosis, and treatment, in vast areas of endemic regions. Additionally, timely assessment of treatment efficacy is complicated due to the slow reversion of serological anti-T. cruzi reactivity. Hence, there is an urgent need for biomarkers of early therapeutic efficacy and disease prognosis, as well as more practical diagnostic tools. To conduct studies that can address these needs, it is essential to have collections of clinical samples with good quality, traceability, and appropriately associated clinical-epidemiological information. In this work, we provide a standard protocol to collect, process, store, and transport clinical samples from Chagas disease patients. The manual was produced upon reaching a consensus among the experts within the NHEPACHA network, a coalition of clinical and academic researchers from the Americas and Spain that pursues the identification and validation of new biomarkers and diagnostics for Chagas disease. [ABSTRACT FROM AUTHOR]

Chagas disease (CD) is recognized as one of the 20 neglected tropical diseases by the World Health Organization (WHO), posing a significant global health challenge. The objective of this work was to conduct a systematic methodology review to explore the different classifications used to describe the presence and degree of organ involvement in patients with CD since the disease's description in 1909. We searched relevant electronic medical databases from their inception dates to July 2023. We also delved into historical variations and revisions of each classification, the necessary diagnostic methods, their prognostic value, and their uptake. Our study underscores the conspicuous absence of a universally accepted CD classification system for cardiac and digestive involvement, both in the context of clinical trials and within current clinical guidelines. This endeavour will facilitate cross-population comparisons if clinical manifestations and complementary test results are available for each patient, constituting a pivotal stride toward identifying precise prognoses and establishing a minimum data set requisite for a fitting CD classification, tailored to the test availability in both endemic and non-endemic regions. Author summary: Chagas disease (CD) is a serious global health issue, and in our research, we aimed to investigate how doctors classify the impact of this disease on different organs. CD is one of the neglected tropical diseases recognized by the World Health Organization. It is important for us to understand how this disease affects people because it can lead to severe health problems. To conduct our study, we reviewed the various ways doctors have classified CD since it was first described in 1909. We looked at how these classifications have changed over time, the tests used to diagnose CD, and how these classifications are applied in clinical practice and research. One crucial discovery we made during our research is that there isn't a universally accepted classification system for CD, especially when it comes to assessing its impact on the heart and digestive system. This absence of a standard classification system makes it difficult to compare CD cases across different regions and to predict the disease's progression in individual patients. We believe that establishing a standardized classification system for CD is of utmost importance. Such a system would greatly assist doctors and researchers in gaining a better understanding of the disease, making more accurate predictions about how it will affect patients, and improving CD diagnosis and treatment, both in regions where the disease is prevalent and in areas where it's not. In summary, our study highlights the urgent need for a standardized method to classify Chagas disease, which is a significant global health concern. Establishing a common classification system would simplify the study and treatment of the disease, benefiting people worldwide. [ABSTRACT FROM AUTHOR]

Background: Trypanosoma cruzi causes Chagas disease (CD), a potentially fatal disease characterized by cardiac disorders and digestive, neurological or mixed alterations. T. cruzi is transmitted to humans by the bite of triatomine vectors; both the parasite and disease are endemic in Latin America and the United States. In the last decades, population migration has changed the classic epidemiology of T. cruzi, contributing to its global spread to traditionally non-endemic countries. Screening is recommended for Latin American populations residing in non-endemic countries. Methods: The present study analyzes the epidemiological characteristics of 2,820 Latin American individuals who attended the International Health Service (IHS) of the Hospital Clinic de Barcelona between 2002 and 2019. The initial assessment of organ damage among positive cases of T. cruzi infection was analyzed, including the results of electrocardiogram (ECG), echocardiogram, barium enema and esophagogram. Results: Among all the screened individuals attending the clinic, 2,441 (86.6%) were born in Bolivia and 1,993 (70.7%) were female. Of individuals, 1,517 (81.5%) reported previous exposure to the vector, which is a strong risk factor associated with T. cruzi infection; 1,382 individuals were positive for T. cruzi infection. The first evaluation of individuals with confirmed T. cruzi infection, showed 148 (17.1%) individuals with Chagasic cardiomyopathy, the main diagnostic method being an ECG and the right bundle branch block (RBBB) for the most frequent disorder; 16 (10.8%) individuals had a normal ECG and were diagnosed of Chagasic cardiomyopathy by echocardiogram. Conclusions: We still observe many Latin American individuals who were at risk of T. cruzi infection in highly endemic areas in their countries of origin, and who have not been previously tested for T. cruzi infection. In fact, even in Spain, a country with one of the highest proportion of diagnosis of Latin American populations, T. cruzi infection remains underdiagnosed. The screening of Latin American populations presenting with a similar profile as reported here should be promoted. ECG is considered necessary to assess Chagasic cardiomyopathy in positive individuals, but echocardiograms should also be considered as a diagnostic approach given that it can detect cardiac abnormalities when the ECG is normal. Author summary: Trypanosoma cruzi is a protozoan infection that can be transmitted to humans by triatomine insects, endemic from 21 Latin American countries. It can also be transmitted vertically (mother to child) and by blood transfusions, among other less frequent methods. T. cruzi infection is called Chagas Disease (CD) when causing organ damage, such as Chagasic cardiomyopathy (CC) and digestive involvement in 30–40% of cases. The large migration flows from Latin America to Europe have globalized the distribution of T. cruzi infection. Thus, screening is recommended for Latin Americans living in non-endemic countries. We have retrospectively analyzed the epidemiologic characteristics of individuals from endemic countries screened for T. cruzi infection in Barcelona over 17 years, revealing a great number of working-age women coming from highly endemic areas for T. cruzi infection, which reflect the migration movements of the last decades and help us to focus the screening and health promotion programs. We have also analyzed the initial organ damage assessment, which revealed a great proportion of right bundle branch block and left anterior fascicular block, considered typical CD lesions (although unspecific). We also found an important proportion of patients with an altered echocardiogram but having a normal ECG, which reinforces the echocardiogram as an essential test for the assessment of CC. [ABSTRACT FROM AUTHOR]

Introduction: Chagas disease affects 6-7 million people, mainly in the Americas, and benznidazole is one of the two therapeutic options available. Trypanocide treatment aims to eliminate the parasite from the body to prevent the establishment or progression of visceral damage, mainly cardiac and/or digestive. Remarkably, it helps interrupt vertical transmission when administered to women of childbearing age., Areas Covered: We discuss the basic and scarce data regarding chemical, pharmacokinetic, and pharmacodynamic structure. We also collect the most important data from previous phase II and III studies, as well as studies currently underway and upcoming. We reflect on the main indications for treatment and its challenges, such as the profile of adverse effects in adults, the pharmaceutical formulations, the search for reliable biomarkers, as well as regulatory aspects and access barriers. Alternative strategies such as shorter regimens, lower doses, and fixed doses are currently being evaluated to improve access and the safety profile of this treatment., Expert Opinion: Benznidazole is likely to continue to be the drug of choice for Chagas disease in the coming years. However, it would probably be with a different treatment scheme.