Chagas Diesease or American Tripanosomiasis is a disease transmitted by Tripanosoma Cruzii, endemic in some regions of the Central and South America, discovered in 1909 by Carlos Chagas. It has only recently become a real problem in Italy when the blood donors who could have contracted the infection in some way were preventively excluded from the donation to allow a subsequent serological evaluation to ensure the absence of infection in the donor.
The epidemiology of Chagas Disease has in fact changed over the years due to the high migratory flow from areas where it has long been known, to Europe and North America, or because of increased travels for work and holidays to the regions of South of the world. The changed situation has therefore led the clinicians of our latitudes to deal with a problem so far unknown.
This review will therefore highlight the different aspects of Chagas Disease in Europe, the screening programs being put in place and the treatments employed. The review is based on published literature data on this pathology from 1985 to 2016.Until the last century, the presence of cases of Chagas Disease in Europe was almost only anecdotal, mostly related to travels in endemic regions or blood transfusion or marrow transplants from these regions, but in recent years, the increase of migratory flows from these areas has greatly increased the incidence of the disease.
A recent Spanish study has shown that in the diagnosis of hospitalization, Chagas Disease was 13 times higher in the period 2005-2011 than in the period 1997-2004, confirming that the basis of this pandemia is the transfer of infected subjects from one continent to the other.In Europe, few cases of transmission of the virus have been reported by blood transfusion, because donor selection programs have been implemented since the early 1990s (Great Britain 1999). Clearly infected donors are excluded from donation, while not yet clear is the attitude to be kept in front of who has only been exposed to the infectious agent. In Italy, the positive serology for Tripanosoma Cruzii is between 0 and 3.9%, higher than in other countries (Spain 0.62-1.91%, France 0.31%, Switzerland 0.04-0.08%, Great Britain 0.007%, The Netherlands 0% ).
Chagas Disease consists of a first acute phase and a subsequent chronic phase followed by a latency period of over 20 years. The main manifestations are myocarditis, pericarditis and meningoencephalitis, with a mortality rate of between 0.2 and 0.5%. Diagnosis is by direct search of the parasite causing the infection, so it is a microbiological investigation, but it depends on the clinical stage of the infection itself. In the acute phase of the disease, the analysis of a peripheral blood stream is sufficient to detect the presence of the pathogen. In other cases, when the disease is chronic or latent, more sophisticated techniques of molecular biology (PCR) are needed.
Techniques currently used also to carry out preventive screening on potentially infected blood donors. Chagas Disease is therefore a real problem in Europe in the 2000s, careful screening and surveillance programs are therefore needed to reduce the risk of transmission by transfusion and infusion of blood derived products.
Eur J Med Int, 2017 May 11; epub ahead of print
Chagas disease in Europe: a review for the internist in the globalized world
Antinori S, Galimberti L, Bianco R, Grande R, Galli M, Corbellino M