Design, setting, and recruitment

Barcelona has been one of the urban areas in Spain where a large Bolivian migrant population settled in the early 2000s [12], and the IHS of Hospital Clinic de Barcelona and Barcelona Institute of Global Health (ISGlobal) has a 17-year of experience in the clinical management and follow-up of this population. We conducted a descriptive retrospective study of 2,820 individuals originating from endemic Latin American countries considered T. cruzi endemic areas. Study subjects attended the medical consultation outpatient clinic of the IHS from March 2002 to March 2019. Subjects came to IHS (i) voluntarily, (ii) for screening after a positive result of a relative, (iii) upon advice by family or friends, (iv) referred by another doctor and (v) following information, education, and communication (IEC) community outreach.

The following countries were considered T. cruzi endemic areas: Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, French Guyana, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay and Venezuela. Exclusion criteria for individuals to be included in the cohort were: a) individuals born in a non-endemic country; b) individuals under 16-years-old; c) inconclusive serology test; d) individuals who had not signed the informed consent.

Epidemiological and clinical data were collected from electronic medical records and questionnaires over the study period and registered in a database [22], and published in a data repository [23]. Collected variables included age, sex, country and department of origin, date of arrival to Spain, risk factors for T. cruzi infection and T. cruzi serology result. Also, the results of complementary tests performed by protocol were collected: ECG and echocardiogram, and barium enema and esophagogram when performed. Patients were then classified as follows: T. cruzi infection with no evidence of organ damage, CC and DCD. Only the first evaluation was included in this study to ascertain the phase of the infection at diagnosis.