PREVALENCE OF CHAGAS DISEASE IN THE BOLIVIAN COMMUNITY IN PALMA DE MALLORCA , SPAIN P.F Escobio, J Ribas, M G.Morillo, G Rodriguez, J Vicens,M Esteva C.S. Escuela Graduada; CS Camp Redó, CS Son Pisà. Unidad Docente Medicina Familiar y Comunitaria Mallorca
With the support of Medicos del Mundo Baleares
OBJETIVES Main objetive: To estimate the seroprevalence of Chagas disease in Bolivian residents in Mallorca, Spain, Secondary objetives : To compare sociodemographic and risk factors , know about the underdiagnosis of Chagas disease in the bolivian population and identify the knowledge about Chagas disease in this population
MATERIAL AND METHODS A descriptive cross-sectional study in Mallorca Health Area. Included bolivian patients> 18 years old, assigned to 2 basic health areas Selected by systematic random sampling health card database and were recruited by telephone. Exclusion criteria: People with great physical or mental disability that precludes the study,those not having a phone and people who refuse to participate in the study or to sign the informed consent. Sample size and selection: From an estimated prevalence of 7%, a 3% accuracy and a confidence level of 95% and 30% of losses, 344 subjects were required.
43.2% 56.8%
MEASUREMENTS: In consultation with interview of sociodemographic variables, risk factors and symptoms for Chagas. Case were confirmed after 2 positive ELISA test. If results were positive or inconclusive, the sample was sent to the National Microbiology Centre for confirmation.
p= 0.037
EPIDEMIOLOGIC VARIABLES Measurements
RURAL AREA 65.9% URBAN AREA 34.1% p= 0.017
2.3%
BRICK HOUSE 27.3% ADOBE HOUSE 72.7% p= 0.032
0% 6.8%
50%
25%
Chagas in relatives Yes No Insect Yes No Transfusion Yes No Previous Chagas Results Positive Negative Previous Chagas Treatment Yes No
Serology – N(%)
P
7 (22.6) 24 (77.4)
6 (3.8) 150 (96.2)
19 (54.3) 16 (45.7)
47 (25.4) 138 (74.6)
0.001
38 (88.4) 5 (11.6)
127 (62.9) 75 (37.1)
0.001
6 (13.6) 38 (86.4)
24 (11.8) 180 (88.2)
0.730
3(13.0) 20 (87.0)
2 (2.2) 87 (97.8)
0.025
2 (4.5) 42 (95.5)
1 (0.5) 192(99.5)
0.031
<0.00 1
SYMPTOMS No significant difference between serology results and symptoms (dyspnea, palpitations ,syncope, oedema,dysphagia, constipation,,chagoma, lymphadenopathy)
0% 13.6% 0%
Mother Serology Positive Negative
Serology + N (%)
p=0.008 KNOWLEDGE No significant difference between serology results and knowledge about Chagas disease 75.8% of patients with positive serologies consider possible vertical transmision against 90% with negative serologies (p=0.025)
RESULTS:251 subjects were included, 57.8% were men, originally from rural areas.Mean age 34.6 years (SD = 9.3). 48 cases were positive (19.1%). All positive cases were confirmed by two different techniques (no false positives). There were no statistically significant differences for any of the heart or digestive symptoms, in subjects with positive results in relation with the negative. We observed a higher prevalence in those who had lived in rural areas, in houses of adobe, and those who had a family history of Chagas. No significant differences were found by age or in those who had recived blood transfusion . CONCLUSION We observed a high prevalence in the bolivian population in Palma de Mallorca, and specially in those with the more usual risk factors for this disease. It should be considered to screen for Chagas disease on this inmigrant population to prevent progresion and to include it on the protocols of our health system. 1.Y.Jackson et col Chagas disease in Latin American inmigrants living in Geneve. Switzerland; prevalence, clinical description and risk for blood-borne transmission , European Journal of tropical medicine and international health Vol 14 suppl2pp98-247 september 2009, MC 14-216) 2.Gascon J, et Al. Diagnostico y tratamiento de la enfermedad de Chagas importada. Med Clin (Barc). 2005;125(6):230-5 3.Gascón J et al. Clinical Guide of Diagnosis, Management, and Treatment of Chronic Chagas’ Heart DiseaseRev Esp Cardiol. 2007;60(3):285-93 4.M.J. Pinazo et al Diagnosis, management and treatment of chronic Chagas’ gastrointestinal disease GastroenterolHepatol.2010;33(3):191–200 5. j. Muñoz et al. / Acta Tropica 111 (2009) 51–55. Clinical profile of Trypanosoma cruzi infection in a non-endemic setting:Immigration and Chagas disease in Barcelona (Spain) 6. Gabriel A Schmunis+Epidemiology of Chagas disease in non endemic countries: the role of international migration.Mem. Inst. Oswaldo Cruz vol.102 suppl.1 Rio de Janeiro Oct. 2007 Epub Aug 31, 2007 6.