Chagas disease: using a non-invasive biomarker to identify diagnosis
Maria MALLART RAVENTOS, Victoria TALLON WALTON, Cristina GARCIA NAVAS, Mariam AL HAMOD and Janina SCHLOSSER LLORENS
We present our experience when diagnosing Chagas disease in a male migrant patient native of Bolivia who attends the GP due to a 3 day-long lower back pain that does not ease when taking analgesics. No record of previous injuries. Expresses mechanical back pain when flexing/extending the torso. The patient migrated to Catalunya (Spain) 23 years ago due to socioeconomic reasons. We observe the phenotypic traits of the patient: brown skin, almond-shaped eyes, Roman nose, black, straight hair. We ask his place of origin. He is Quechua, from the Cochabamba valley in the Bolivian Andes mountains. Following the guidelines on migrant patients, we proceed to screen for Chagas disease due to it’s high morbidity and mortality and taking into account that Bolivia is the country with the highest prevalence in the world, where Chagas it’s an endemic disease.We request a Trypanosoma Cruzi serology test, it comes out positive. Confirms Chagas disease, the silent neglected disease. From the Primary Health Centre we investigate about cardiovascular and digestive affectation and a screening of any electrocardiographic alterations. The patient is transfered to the Imported Disease Tropical Medicine Hospital Unit for the echocardiographic study given that 25-30% of Chagas patients have cardiac complications. Monitored and treated by both the Hospital and the Primary Health Centre.The fenotype is a non-invasive biomarker that can provide important information.This case calls for the importance to look beyond the reasons for a GP appointment and consider the patient’s personal story. Understanding the patient’s personal context can save lives.The information that the phenotype (non-invasive biomarker) of the migrant population provides is relevant, although not conclusive.It’s necessary to approach the patient with a holistic vision: to listen, understand and observe to provide the appropriate support.
