Chagas cardiomyopathy in Boston, Massachusetts: Identifying disease and improving management after community and hospital-based screening.

Autor: Reifler KA; Section of Infectious Disease, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America., Wheelock A; Section of Preventative Medicine and Epidemiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America., Hall SM; Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, United States of America., Salazar A; Section of Infectious Disease, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America., Hassan S; Department of Internal Medicine, Boston University Medical Center, Boston, Massachusetts, United States of America., Bostrom JA; Cardiovascular Division, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America., Barnett ED; Section of Pediatric Infectious Disease, Department of Pediatrics, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America., Carrion M; Boston University College of Health and Rehabilitation Sciences: Sargent College, Massachusetts, United States of America., Hochberg NS; Section of Infectious Disease, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America., Hamer DH; Section of Infectious Disease, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America.; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Center for Emerging Infectious Disease Policy & Research, Boston University, Boston, Massachusetts, United States of America., Gopal DM; Cardiovascular Division, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America., Bourque D; Section of Infectious Disease, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2024 Jan 19; Vol. 18 (1), pp. e0011913. Date of Electronic Publication: 2024 Jan 19 (Print Publication: 2024).
DOI: 10.1371/journal.pntd.0011913
Abstrakt: Background: Limited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions.
Methods: A retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected.
Results: Mean age of the 109 patients was 43 years (range 19-76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus.
Conclusions: These data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: After completing this study, NSH was employed by Novartis Institutes for BioMedical Research for which she receives a salary and stocks. NSH, DB, and DHH have collaborated with Kephera Diagnostics on the National Institutes of Health (NIH) Small Business Innovation Research (SBIR) grant funding research for Chagas disease diagnostics and biomarkers
(Copyright: © 2024 Reifler et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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