Recommendations for antiparasitic treatment.

Chagas disease (CD), caused by Trypanosoma cruzi, is a neglected tropical disease with significant public health implications. While its primary transmission occurs in endemic regions via triatomine vectors, migratory processes have led to an increased prevalence in non-endemic areas as in Spain where an estimated 50,000 people live with CD. Chronic Chagas cardiomyopathy (CCC) and digestive complications are the primary manifestations, yet diagnostic criteria, especially regarding organic involvement, and treatment indications are still a matter of debate. There is an urgent need for standardized approaches to improve care and identify biomarkers for progression and treatment response. The Chagas non-endemic cohort (ChaNoE) aims to recruit individuals with chronic CD across multiple centers in Spain. Inclusion criteria involve a confirmed diagnosis based on two serological tests. Participants will receive comprehensive diagnostic evaluations, including electrocardiography, echocardiography, and periodic serological and PCR assessments. Follow-up will focus on disease progression, particularly CCC and digestive involvement, using standardized protocols. The study also establishes a biobank for serum samples to facilitate biomarker research. The ChaNoE cohort addresses critical gaps in the understanding of CD in non-endemic regions. By standardizing diagnostic and treatment protocols, it seeks to harmonize care and enable comparisons with cohorts in endemic areas. The creation of a biobank supports the identification of biomarkers for disease progression and treatment efficacy, a current unmet need in CD management. This initiative also strengthens research networks and informs public health strategies to mitigate the burden of CD in non-endemic settings. Findings will be disseminated to key stakeholders to improve the clinical and epidemiological understanding of this neglected disease.

恰加斯病（Chagas disease, CD）由克氏锥虫（Trypanosoma cruzi）引起，是一类具有重大公共卫生影响的被忽视热带病。其主要传播途径为流行地区通过锥蝽媒介（triatomine vectors）实现，但移民流动导致该病在非流行地区的患病率上升，例如西班牙，该国估计有5万名恰加斯病患者。慢性恰加斯心肌病（Chronic Chagas cardiomyopathy, CCC）与消化系统并发症是该病的主要临床表现，但目前针对包括器官受累在内的诊断标准以及治疗适应证仍存在争议。当前亟需建立标准化方案以优化诊疗，并识别用于评估疾病进展与治疗反应的生物标志物（biomarkers）。非流行地区恰加斯病队列（ChaNoE）计划在西班牙多家中心招募慢性恰加斯病患者。纳入标准为经两项血清学检测（serological tests）确诊的病例。受试者将接受全面诊断评估，包括心电图检查（electrocardiography）、超声心动图（echocardiography），以及定期血清学与聚合酶链式反应（PCR）检测。随访将采用标准化方案，重点关注疾病进展情况，尤其是慢性恰加斯心肌病与消化系统受累情况。本研究同时建立了血清样本生物样本库（biobank），以推动生物标志物相关研究。ChaNoE队列填补了非流行地区恰加斯病研究的关键空白。通过标准化诊断与治疗方案，该研究旨在统一诊疗规范，并实现与流行地区队列的对比分析。生物样本库的建立则助力识别疾病进展与治疗疗效相关的生物标志物，这恰是当前恰加斯病诊疗中尚未满足的需求。本项目还强化了研究网络建设，并为制定公共卫生策略以减轻非流行地区恰加斯病负担提供依据。研究结果将向关键利益相关方传播，以提升临床与流行病学界对这一被忽视疾病的认知。