03486nas a2200433   4500000000100000008004100001653003900042653001900081653001200100653001500112653001100127653001400138653003600152653001600188100002300204700001500227700001600242700001300258700001700271700001300288700001500301700001100316700001300327700001100340700001700351700001400368700001600382700001800398700001700416700001500433700001400448700001500462245013400477856009800611300001300709490000700722520230900729022001403038       2017                            d10aNeglected tropical diseases (NTDs)10aChagas disease10aBolivia10aImmigrants10aBrazil10aTreatment10aInterdisciplinary Communication10aHealth care1 aShikanai Yasuda MA1 aSátolo CG1 aCarvalho NB1 aAtala MM1 aFerrufino RQ1 aLeite RM1 aFurucho CR1 aLuna E1 aSilva RA1 aHage M1 aOliveira CMR1 aBusser FD1 aFreitas VLT1 aWanderley DMV1 aMartinelli L1 aAlmeida SR1 aViñas PA1 aCarneiro N00aInterdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo.  uhttp://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0005466&type=printable  ae00054660 v113 a<p><strong>BACKGROUND/METHODS: </strong>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.</p>

<p><strong>RESULTS: </strong>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.</p>

<p><strong>CONCLUSION: </strong>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.</p>
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