Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo

Autor: Rubens Antonio da Silva, Pedro Albajar Viñas, Felipe Delatorre Busser, Sonia Regina Almeida, Expedito José de Albuquerque Luna, Ruth Moreira Leite, Nivaldo Carneiro Jr., Luzia Martinelli, Camila Gonçalves Sátolo, Célia Regina Furucho, Maria Aparecida Shikanai Yasuda, Noemia Barbosa Carvalho, Dalva Marli Valério Wanderley, Vera Lúcia Teixeira de Freitas, Marcia Hage, Rosario Quiroga Ferrufino, Caroline Medeji Ramos de Oliveira, Magda Maya Atala
Jazyk: angličtina
Rok vydání: 2017
Předmět:
0301 basic medicine
Male
Medical Doctors
Health Care Providers
Maternal Health
Disease
Pathology and Laboratory Medicine
Serology
0302 clinical medicine
Antiparasitic Therapy
Pregnancy
Health care
Epidemiology
Medicine and Health Sciences
Mass Screening
Public and Occupational Health
Enzyme-Linked Immunoassays
Child
Protozoans
Trypanosoma Cruzi
Allied Health Care Professionals
education.field_of_study
Traditional medicine
lcsh:Public aspects of medicine
Obstetrics and Gynecology
Middle Aged
Trypanocidal Agents
Vaccination and Immunization
Professions
Infectious Diseases
Benznidazole
Nitroimidazoles
Female
BOLIVIANOS
Psychosocial
Brazil
medicine.drug
Research Article
Neglected Tropical Diseases
Chagas disease
Adult
medicine.medical_specialty
Bolivia
Trypanosoma
lcsh:Arctic medicine. Tropical medicine
Adolescent
lcsh:RC955-962
030231 tropical medicine
030106 microbiology
Population
Immunology
Emigrants and Immigrants
Enzyme-Linked Immunosorbent Assay
Research and Analysis Methods
03 medical and health sciences
Young Adult
Physicians
medicine
Parasitic Diseases
Humans
Chagas Disease
Serologic Tests
education
Immunoassays
Patient Care Team
Protozoan Infections
Primary Health Care
business.industry
Public Health
Environmental and Occupational Health
Organisms
Biology and Life Sciences
lcsh:RA1-1270
medicine.disease
Tropical Diseases
Parasitic Protozoans
Health Care
Cross-Sectional Studies
Family medicine
People and Places
Immunologic Techniques
Women's Health
Population Groupings
Preventive Medicine
business
Zdroj: PLoS Neglected Tropical Diseases, Vol 11, Iss 3, p e0005466 (2017)
Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual)
Universidade de São Paulo (USP)
instacron:USP
PLoS Neglected Tropical Diseases
ISSN: 1935-2735
1935-2727
Popis: Background/Methods In a pioneering cross-sectional study among Bolivian immigrants in the city of São Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients. Results The majority of the 28 seropositive patients were women, of whom 88.89% were of child-bearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed. Conclusion An interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system.
Author summary Chagas disease affects approximately 6 million Latin American people. It is considered a neglected tropical disease since it mainly affects vulnerable, poverty-stricken people. Public health policies and investments in research on new treatment and control instruments have not been prioritized. In fact, disease urbanization occurred in Latin America in the 80s, and an estimated 15 million people moved from disease-endemic areas to nonendemic areas. Estimations have indicated that 2.9% of immigrants were infected by T. cruzi in 15 European countries, and more than 300,000 infected immigrants resided in the USA. In São Paulo, the estimated number of Bolivian immigrants exceeds 300,000. This study revealed the presence of mild clinical manifestations in predominantly young infected individuals, including reproductive-age women. For the first time, the feasibility of managing chronic Chagas disease at primary healthcare level centers with a biomedical and psychosocial interdisciplinary approach has been reported in the National Public Health System of Brazil. Additionally, the utilized commercial tests did not confirm the previously expected performance for diagnosis of infection. Finally, the itinerant characteristics of the Bolivian immigrant population was reported as a main factor underlying the lack of adherence to antiparasitic treatment and a main challenge for complete clinical management.
Databáze: OpenAIRE
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