Abstract and Introduction
Abstract
Background. Chagas disease, a potentially fatal parasitic infection, is emerging in Europe in the context of international migration but there is little public health attention and frequent lack of clinicians' awareness. To date, there is no published information about clinical characteristics in children.
Methods. We reviewed the medical files of all children (<18 years) with Chagas disease managed in 2 hospitals in Barcelona, Spain and Geneva, Switzerland between January 2004 and July 2012.
Results. Forty-five cases were identified. Two children (4.4%) were diagnosed during the acute phase and the remaining 43 (95.6%) were in the chronic phase of the infection. All but 1 were asymptomatic. Of the 41 treated children, 40 (97.6%) completed 60 days of treatment. Thirty-five (85.4%) received benznidazole, 5 (12.2%) nifurtimox and 1 (2.4%) both drugs consecutively. There were 2 (4.9%) treatment interruptions due to adverse events. The most frequent adverse events were rash (24.4%), anorexia or insufficient weight gain (14.6%) and anemia (2.4%). Twenty-nine (64.4%) children were followed up by serology after 2 years. Five (17.2%) were cured.
Conclusions. Pediatric Chagas disease is an emerging health issue in Europe that requires enhanced attention. Greater emphasis should be put on screening pregnant women at risk and their newborns in case of infection along with older children and relatives. Pediatricians have a central role to play in providing families with information and offering testing in situations of risk.
Introduction
Chagas disease, a parasitic zoonosis caused by Trypanosoma cruzi predominates in Latin America. It puts 8–10 million infected persons at risk of potentially life-threatening cardiomyopathy and disabling chronic digestive tract complications occurring decades after the initial infection. Despite past successes of regional control initiatives, there is currently an epidemiological shift entailing new challenges following enhanced local and transnational population movements in Latin America and alongside the progressive urbanization of the infection. As a result, vertical infection is becoming a prominent route of transmission. Recently, a growing number of T. cruzi infections have been recorded outside Latin America, after >18 million people at risk moved to nonendemic countries, mostly to North America, Europe and Australia. In 2009, >3.2 million immigrants from endemic regions lived in Europe, of whom around 1 million were without valid residence permits (undocumented) thus facing difficulties in accessing to medical care. It is estimated that 60,000–120,000 infected persons currently live in Europe. Sixteen European countries have reported cases, mostly in adult immigrants from Latin America, and T. cruzi transmission via blood transfusion, organ transplant and from mother-to-child has been identified in several countries. A large proportion of cases in Europe affect immigrants originating from Bolivia, where high prevalence rate and operational difficulties represent consequent challenges in controlling Chagas disease. While most endemic countries have put emphasis on detecting infection in children because of more favorable treatment outcomes when compared with adults, nonendemic countries have so far paid only very limited attention to Chagas disease in children. Yet, it has been shown that screening for Chagas disease in pregnant women or newborns provide the opportunity of detecting further cases among siblings and relatives as infections often occur in clusters. Only few cities or regions in Western Europe have implemented screening programs in mothers and newborns to detect congenital transmission. Detection in older children is even less practiced as no recommendations on systematic or regular opportunistic screening exists in this age group. Considering the frequent vulnerable socioeconomic conditions, in which affected immigrant family live, and the long-lasting course of the infection, a holistic whole-of-family approach within a longitudinal perspective is required to effectively tackle this issue. Several health institutions in Europe have initiated programs along this line in recent years. This article reports a series of cases of pediatric T. cruzi infections diagnosed and managed in 2 hospitals in Barcelona, Spain and Geneva, Switzerland. It discusses the clinical and epidemiological significance of this emerging health issue and presents a set of recommendations regarding the management of pediatric Chagas disease in this region.