Search

Background Chagas disease (CD) is a chronic parasitic disease caused by Trypanosoma cruzi and is endemic to continental Latin America. In Spain, the main transmission route is congenital. We aimed to assess adherence to regional recommendations of universal screening for CD during pregnancy in Latin American women in the province of Alicante from 2014 to 2018. Methodology/Principal findings Retrospective quality study using two data sources: 1) delivery records of Latin American women that gave birth in the 10 public hospitals of Alicante between January 2014 and December 2018; and 2) records of Chagas serologies carried out in those centers between May 2013 and December 2018. There were 3026 deliveries in Latin American women during the study period; 1178 (38.9%) underwent CD serology. Screening adherence ranged from 17.2% to 59.3% in the different health departments and was higher in Bolivian women (48.3%). Twenty-six deliveries (2.2%) had a positive screening; CD was confirmed in 23 (2%) deliveries of 21 women. Bolivians had the highest seroprevalence (21/112; 18.7%), followed by Colombians (1/333; 0.3%) and Ecuadorians (1/348; 0.3%). Of 21 CD-positive women (19 Bolivians, 1 Colombian, 1 Ecuadorian), infection was already known in 12 (57.1%), and 9 (42.9%) had already been treated. Only 1 of the 12 untreated women (8.3%) was treated postpartum. Follow-up started in 20 of the 23 (87.0%) neonates but was completed only in 11 (47.8%); no cases of congenital transmission were detected. Among the 1848 unscreened deliveries, we estimate 43 undiagnosed cases of CD and 1 to 2 undetected cases of congenital transmission. Conclusions/Significance Adherence to recommendations of systematic screening for CD in Latin American pregnant women in Alicante can be improved. Strategies to strengthen treatment of postpartum women and monitoring of exposed newborns are needed. Currently, there may be undetected cases of congenital transmission in our province., Author summary Chagas disease (CD) is a neglected tropical disease endemic to Latin America. In absence of the triatomine vector in Spain, congenital (mother-to-infant) transmission is the main infection route. The Valencian Community has recommended universal screening for CD in pregnant Latin American women since 2007. In our study we analyzed adherence to that recommendation in Alicante province from 2014 to 2018, finding that it is quite low (38.9% overall, 48.3% in Bolivians) and heterogeneous between health departments. Among unscreened pregnant women during the study period, we estimate that there could be 43 undiagnosed cases of CD and 1 to 2 undetected infections in infants. We also observed very low adherence to treatment after delivery in CD-diagnosed, untreated women (8.3%), and a low rate of completed follow-up in newborns at risk of vertical infection (47.8%). We need to improve the program in order to achieve universal CD screening in Latin American (and especially Bolivian) pregnant women, to enhance CD treatment in postpartum women, and to improve monitoring in exposed newborns through a well-established notification and follow-up circuit.

Background: Strongyloidiasis is a parasitic disease with global prevalence. In Spain, autochthonous cases are concentrated in the Mediterranean basin. We aimed to analyze clinical and epidemiological characteristics of Strongyloides stercoralis infection in Vega Baja del Segura (Spain), comparing autochthonous versus imported cases. Methods: Observational retrospective study of all strongyloidiasis cases from January 2009 to January 2019. Cases were diagnosed by stool larvae visualization, positive culture, PCR, Strongyloides serology, and/or compatible histology. Results: We included 36 patients (21 men) with a mean age of 60.8 years &plusmn, 17.6, 15 cases were autochthonous and 21 imported 80.9% from Latin America. Autochthonous cases were associated with older age (mean 71.3 vs 53.3 years, p = 0.002), male sex (odds ratio (OR) 5.33, 95% confidence interval (CI) 1.15&ndash, 24.68, p = 0.041), and agricultural activity (OR 13.5, 95% CI 2.4&ndash, 73.7, p = 0.002). Fourteen were asymptomatic, three autochthonous cases presented with hyperinfection syndrome, and two patients died. There was no difference between autochthonous versus imported origin in eosinophilia at diagnosis (93.3% vs 75%, p = 0.207), treatment received, or clinical response (85.7% vs 88.9% cured, p = 1). Conclusion: In our region, imported strongyloidiasis coexists with autochthonous cases, which are mainly in older male farmers who are diagnosed at more advanced stages. Systematic screening programs are needed.

Resumen Introduccion La infestacion por Strongyloides stercoralis es mas prevalente en regiones tropicales, pero existen casos autoctonos en Espana, principalmente en La Safor (Valencia). Nuestro objetivo era estudiar los casos de un hospital de la provincia de Alicante y conocer si existian casos autoctonos. Procedimiento Estudio retrospectivo de los casos diagnosticados de estrongiloidiasis en el Hospital Vega Baja (Orihuela, Alicante) entre enero de 1999 y marzo de 2016. Resultados Se registraron 10 casos, 4 de ellos autoctonos, presentando 2 de ellos un cuadro de hiperinfestacion con desenlace fatal. Todos los casos autoctonos fueron en personas ≥ 69 anos con sintomas digestivos, cutaneos y/o respiratorios. La serologia fue positiva en los 8 casos en los que se realizo. En 3 casos se visualizaron larvas en el estudio histopatologico. Conclusiones Comunicamos los primeros casos autoctonos de estrongiloidiasis en la region Vega Baja. Se deben implantar programas de cribado principalmente en pacientes inmunosuprimidos o en tratamiento corticoideo.

Introduction Strongyloides stercoralis infection is more prevalent in tropical regions but autochthonous cases have been reported in Spain, mainly in La Safor (Valencia). The objective is to describe the strongyloidiasis cases registered in a regional hospital of Alicante province (Spain) and to determine if they were autochthonous cases. Methods Retrospective study of all diagnosed cases of strongyloidiasis in Vega Baja Hospital (Orihuela, Alicante) between January 1999 and March 2016. Results A total of 10 cases were found, four of which were autochthonous cases. Two of them presented with a hyper-infection syndrome, with a fatal outcome. All autochthonous cases were in patients ≥69 years old with gastrointestinal, cutaneous, and/or respiratory symptoms. Serology was positive in the 8 cases studied. Larvae were found in histopathological samples of the gastrointestinal tract of three patients. Conclusions We communicate the first autochthonous cases of strongyloidiasis in the region of Vega Baja. Screening programs should be implemented, especially in immunosuppressed patients or patients under chronic corticosteroid treatment.