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Yves Carlier - One of the best experts on this subject based on the ideXlab platform.
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Placenta, Trypanosoma cruzi, and Congenital Chagas Disease
Current Tropical Medicine Reports, 2020Co-Authors: Yves Carlier, Alejandro G. Schijman, Ulrike KemmerlingAbstract:Purpose of Review Why around 5% of Trypanosoma cruzi –infected pregnant women transmit the parasite to their offspring whereas 95% do not? Answers to this main question are needed in order to improve the programs aiming to control or eliminate Congenital Chagas Disease (CCD), which has become an important global public health problem. Recent Findings Turnover of syncitiotrophoblast as a new innate defense mechanism of placenta and analyses of transcriptomic responses of placental genes and of new parasite DNA sequences have allowed a re-evaluation of the relationship between parasite diversity, placental tropism, and CCD transmission. Summary A synthetic view of the gradual interactions between the human placenta facing up the parasites present in the maternal blood and the occurrence and severity of CCD is proposed. Further researches on the role of parasite molecular diversity, maternal microbiomes, transfers of parasite and placenta exovesicles, and genetic features of infected mothers should improve our understanding of such maternal-fetal complex relationship.
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Congenital Chagas Disease: Updated recommendations for prevention, diagnosis, treatment, and follow-up of newborns and siblings, girls, women of childbearing age, and pregnant women.
PLoS neglected tropical diseases, 2019Co-Authors: Yves Carlier, Alejandro G. Schijman, Alejandro O. Luquetti, Hector Freilij, Andrea Angheben, Jaime Altcheh, Manuel Segovia, Noemie Wagner, Pedro Albajar ViñasAbstract:In 2005, the World Health Organization (WHO) recognized Chagas Disease (CD; Trypanosoma cruzi infection) as a neglected tropical Disease (NTD) [1] and included it into the global plan to combat NTDs [2]. The Target 3.3 of the United Nations Sustainable Development Goals (UN/SDG) aims at ending the epidemics of NTDs by 2030 [3]. Mother-to-child (Congenital/connatal) transmission is currently the main mode of transmission of T. cruzi over blood transfusions and organ transplantations in vector-free areas within and outside Latin America (LA). Based on recent demonstrations that Congenital transmission can be prevented [4–7], WHO has shifted its objective, in 2018, from control to elimination of Congenital CD (cCD) (road map reference documents in preparation). This article summarizes the recommendations of the WHO Technical Group on “Prevention and Control of Congenital Transmission and Case Management of Congenital Infections with Trypanosoma cruzi” (WHO, Department of Control of Neglected Tropical Diseases). It updates and completes the recommendations previously published in 2011 by the Technical Group [8]. These consensual recommendations derive from discussions at technical meetings convened by WHO in Murcia (Spain) on 9–10 October 2018 (II WHO Technical Consultation on Control of Congenital Chagas Disease in nonendemic countries, and specific meetings of the Technical Group).
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Comparison of methodologies for detecting Trypanosoma cruzi parasites by microscopic observation of microhematocrit capillary tubes.
Revista da Sociedade Brasileira de Medicina Tropical, 2019Co-Authors: Marina Vera-ku, Carine Truyens, Yves Carlier, Guillermo Meza-gonzález, Rubi Gamboa-leonAbstract:INTRODUCTION The microscopic examination of microhematocrit tubes (mHCT) has been proposed as the gold standard for acute and Congenital Chagas Disease diagnosis. We compared different mHCT methodologies detecting T. cruzi parasites in the blood. METHODS The rotating method, water mount, and immersion oil methods were compared for their suitability, sensitivity, and specificity. RESULTS The rotating method was easier, faster, and more sensitive than the others with 100% specificity. CONCLUSIONS The rotating method is feasible for laboratory technicians with standard training in microscopic techniques and is recommended for the diagnosis of acute Chagas Disease in primary health care facilities.
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Congenital Chagas Disease as an ecological model of interactions between Trypanosoma cruzi parasites, pregnant women, placenta and fetuses.
Acta tropica, 2015Co-Authors: Yves Carlier, Carine TruyensAbstract:The aim of this paper is to discuss the main ecological interactions between the parasite Trypanosoma cruzi and its hosts, the mother and the fetus, leading to the transmission and development of Congenital Chagas Disease. One or several infecting strains of T. cruzi (with specific features) interact with: (i) the immune system of a pregnant woman whom responses depend on genetic and environmental factors, (ii) the placenta harboring its own defenses, and, finally, (iii) the fetal immune system displaying responses also susceptible to be modulated by maternal and environmental factors, as well as his own genetic background which is different from her mother. The severity of Congenital Chagas Disease depends on the magnitude of such final responses. The paper is mainly based on human data, but integrates also complementary observations obtained in experimental infections. It also focuses on important gaps in our knowledge of this Congenital infection, such as the role of parasite diversity vs host genetic factors, as well as that of the maternal and placental microbiomes and the microbiome acquisition by infant in the control of infection. Investigations on these topics are needed in order to improve the programs aiming to diagnose, manage and control Congenital Chagas Disease.
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Congenital Chagas Disease: an update
Memorias do Instituto Oswaldo Cruz, 2015Co-Authors: Yves Carlier, Sergio Sosa-estani, Alejandro O. Luquetti, Pierre BuekensAbstract:Congenital infection with Trypanosoma cruzi is a global problem, occurring on average in 5% of children born from chronically infected mothers in endemic areas, with variations depending on the region. This presentation aims to focus on and update epidemiological data, research methods, involved factors, control strategy and possible prevention of Congenital infection with T. cruzi. Considering that etiological treatment of the child is always effective if performed before one year of age, the diagnosis of infection in pregnant women and their newborns has to become the standard of care and integrated into the surveillance programs of syphilis and human immunodeficiency virus. In addition to the standard tests, polymerase chain reaction performed on blood of neonates of infected mothers one month after birth might improve the diagnosis of Congenital infection. Recent data bring out that its transmission can be prevented through treatment of infected women before they become pregnant. The role of parasite genotypes and host genetic factors in parasite transmission and development of infection in foetuses/neonates has to be more investigated in order to better estimate the risk factors and impact on health of Congenital infection with T. cruzi.
Susan P. Montgomery - One of the best experts on this subject based on the ideXlab platform.
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Evaluation and Management of Congenital Chagas Disease in the United States.
Journal of the Pediatric Infectious Diseases Society, 2019Co-Authors: Morven S. Edwards, Kelly K. Stimpert, Stephanie R. Bialek, Susan P. MontgomeryAbstract:Chagas Disease is underappreciated as a health concern in the United States. Approximately 40 000 women of childbearing age living in the United States have chronic Chagas Disease. Most of them are unaware that they have an infection that is transmissible to their offspring. The estimated US maternal-to-infant transmission rate of Trypanosoma cruzi is 1% to 5%. Ten percent to 40% of neonates with Congenital T cruzi infection have clinical signs consistent with a Congenital infection but no findings are unique to Chagas Disease. If left untreated, 20% to 40% of infants with Chagas Disease will later develop potentially fatal cardiac manifestations. Molecular testing can confirm the diagnosis in neonates. Treatment is well tolerated in infancy and usually results in cure. Screening of at-risk women during pregnancy can identify maternal infection and allow early assessment and treatment for Congenital T cruzi infection.
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Congenital Chagas Disease in the United States: Cost Savings through Maternal Screening.
The American journal of tropical medicine and hygiene, 2018Co-Authors: Eileen Stillwaggon, Stephanie R. Bialek, Victoria Perez-zetune, Susan P. MontgomeryAbstract:Chagas Disease, also called American trypanosomiasis, is caused by Trypanosoma cruzi, which is spread by triatomine insect vectors.1,2 Infected insects are found from southern South America to the southern states of the United States, although vector transmission to humans is very rare in the United States.3–5 Vector control has been very successful in many endemic regions.1,2,6 Transmission can also occur through blood transfusions, organ transplantation, consumption of insect feces in food, and from mother to child during gestation.3 Almost all endemic countries have instituted screening of blood products.1,2 Despite the existence of domestic and wild animal reservoirs, significant progress in reducing incidence is possible through rigorous domestic vector control and screening of blood and organ donors.1 Congenital transmission, on the other hand, could perpetuate the existence of Chagas Disease indefinitely, even in countries or regions with no or almost no autochthonous vector transmission.7–10 This article uses a decision-analytic model to evaluate the societal economic cost of maternal screening to identify and treat infected newborns and their mothers compared with the societal cost of undiagnosed or late-diagnosed Chagas Disease in the United States. Prevalence. The World Health Organization estimates that there are 5.7 million people infected with T. cruzi in Latin America1 and about 400,000 Latin Americans with Chagas Disease residing in Europe, Japan, and the United States.4,6,11 Successful programs in domestic and peridomestic vector control reduced the estimated number of new cases from 700,000 per year in the 1970s to 40,000 per year in 2010.1,6 Vector transmission has been the predominant mode, but with control programs and blood bank screening, incidence is decreasing. Congenital transmission, however, accounts for 9,000 new cases per year in Central and South America1 and several hundred more in the United States and Europe.4,12 The Pan American Health Organization estimates that a quarter of new cases are caused by Congenital transmission.7,13
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Survey of Pediatric Infectious Diseases Society Members About Congenital Chagas Disease.
The Pediatric infectious disease journal, 2018Co-Authors: Morven S. Edwards, Francisca Abanyie, Susan P. MontgomeryAbstract:Participants in a survey about Congenital Chagas Disease, distributed electronically to Pediatric Infectious Diseases Society members, perceived having limited knowledge about Congenital Trypanosoma cruzi infection. Most rarely or never consider the diagnosis in infants born to parents from Latin America. Improved awareness of Congenital Chagas Disease and assessment of at-risk infants is needed.
Laurent Brutus - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of compliance to Congenital Chagas Disease treatment: results of a randomised trial in Bolivia.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2012Co-Authors: Jean-philippe Chippaux, Jorge Postigo, Dominique Schneider, Jose A. Santalla, Alejandra Nadin Salas-clavijo, Laurent BrutusAbstract:Background: A randomised, unblinded, clinical trial comparing two benznidazole regimens for Congenital Chagas Disease was carried out to determine whether simplification and reduction in the length of treatment could lead to better treatment compliance. Methods: This study was conducted in Santa Cruz, Bolivia. Serological screening was carried out in pregnant women, and parasites were sought in the blood of newborns from seropositive mothers. Infected infants were randomly assigned to two treatment groups. Recovery was assessed by parasite seeking at 1 month and 2 months as well as serological tests at 9 months. Assessment of treatment adherence was based on weekly home visits and use of electronic monitors. Results: Benznidazole was given to 63 newborns in group A (5 mg/kg in two daily doses for 60 days) and 61 newborns in group B (7.5 mg/kg in a single daily dose for 30 days). There was no difference in compliance between the two groups. The study confirmed the efficacy and good tolerance of both benznidazole regimens in the treatment of Congenital Chagas Disease. Conclusions: The short treatment should be preferred as it allows reducing the dose of benznidazole as well as the cost of treatment.
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Door-to-door screening as a strategy for the detection of Congenital Chagas Disease in rural Bolivia.
Tropical medicine & international health : TM & IH, 2011Co-Authors: Mario Romero, Jorge Postigo, Dominique Schneider, Jean-philippe Chippaux, Jose A. Santalla, Laurent BrutusAbstract:OBJECTIVE: To demonstrate the feasibility of a house-to-house screening system used for Congenital Chagas Disease in rural areas based on an active search for pregnant women and newborns in their homes in addition to passive case detection in health facilities. METHODS: Exploratory phase conducted by the research team followed by an operational period coordinated by municipal health service. A blood sample was taken for serological and parasitological tests of Trypanosoma cruzi from pregnant women who were searching antenatal care or visited at home by field investigators. Infants born to T. cruzi-infected women were examined for infection at birth and again at 1 and 7 months of age. RESULTS: 64.5% of the pregnant women were infected. Congenital infection was diagnosed at birth in 4.0% (12/299) of the children born to seroreactive mothers. Twelve additional cases of infection (4%) were diagnosed in children between 1 and 7 months of age. Finally 37% of the children were lost to follow-up in the exploratory phase and 53% during the operational phase (P=0.002) significantly fewer than in most passive case detection studies. CONCLUSION: Despite poorer outcomes after door-to-door screening activities have been transferred to the health system a combined strategy based on active and passive case detection appeared to be efficient for identifying rural cases of Congenital Chagas Disease. (c) 2011 Blackwell Publishing Ltd.
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Detectable Trypanosoma cruzi Parasitemia during Pregnancy and Delivery as a Risk Factor for Congenital Chagas Disease
The American journal of tropical medicine and hygiene, 2010Co-Authors: Laurent Brutus, Dominique Schneider, Jose A. Santalla, Nadin Alejandra Salas, Helen Castillo, Claudia Bernal, Jean-philippe ChippauxAbstract:Vector control has led to a drastic decrease in the prevalence of acquired Chagas Disease in Latin America, thus redirecting attention to Congenital Chagas Disease. We report results of a longitudinal study of 359 pregnant women in Yacuiba in southern Bolivia, of whom 147 (40.9%) were infected with Trypanosoma cruzi, to evaluate the relationship between the patency period of the parasitemia and the risk of Congenital infection. Maternal infection was assessed by using T. cruzi-specific serologic tests, and parasitemia in mothers and newborns was diagnosed by using microscopic examination of blood in heparinized microhematocrit tubes. Parasitemia was present in 28.6% of the infected women. Its prevalence increased during the third trimester, then decreased at delivery. The likelihood of Congenital infection was significantly correlated with the parasite density in the mother's blood. The risk of transmission increased during the third trimester of pregnancy and could explain premature births or low-weight newborns for infected mothers.
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Congenital Chagas Disease: diagnostic and clinical aspects in an area without vectorial transmission, Bermejo, Bolivia.
Acta tropica, 2008Co-Authors: Laurent Brutus, Mario Romero, Jorge Postigo, Dominique Schneider, Jose A. Santalla, Jean-philippe ChippauxAbstract:The authors carried out a 1-year study of a population of pregnant women delivering at Bermejo hospital, South Bolivia. In this area, vectorial transmission of Trypanosoma cruzi is negligible and women infect themselves during displacements in close endemic areas. The prevalence of T. cruzi in 508 pregnant women, diagnosed by several serological tests, was 33.9%. In eight infants, we observed T. cruzi in the umbilical cord (Congenital transmission rate of 5.2%). The means of birth weights, lengths and hemoglobin rates were similar in the children from both seronegative and seropositive women, and in children infected or not by T. cruzi. This study could confirm a less severity of the Congenital Disease of Chagas in the absence of re-infestation of the mother during pregnancy. Serological screening of pregnant women by rapid diagnostic tests and examination of babies born from seropositive mothers by microhematocrit method at birth is a suitable strategy to detect and prevent Congenital Chagas Disease in non-endemic areas.
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Risk factors and consequences of Congenital Chagas Disease in Yacuiba, south Bolivia.
Tropical medicine & international health : TM & IH, 2007Co-Authors: Nadin Alejandra Salas, Jorge Postigo, Dominique Schneider, Jean-philippe Chippaux, Jose A. Santalla, Michel Cot, Bertha Mendoza, Laurent BrutusAbstract:OBJECTIVE To determine the risk factors of Congenital Chagas Disease and the consequences of the Disease in newborns. METHODS Study of 2712 pregnant women and 2742 newborns in Yacuiba, south Bolivia. Chagas infection was determined serologically in mothers and parasitologically in newborns. Consequences of Congenital Chagas Disease were assessed clinically. RESULTS The prevalence of Chagas Disease in pregnant women was 42.2%. Congenital transmission was estimated at 6% of infected mothers leading to an incidence rate of 2.6% among newborns. Main risk factors of Congenital transmission were mothers' seropositivity and maternal Trypanosoma cruzi parasitaemia. Parity was higher in infected than in non-infected mothers, but it was not associated with the risk of Congenital transmission. The rate of Congenital infection was significantly higher in newborns from multiple pregnancies than in singletons. However, we did not observe statistically significant consequences of Chagas Disease in newborns from single pregnancies or among twins. CONCLUSIONS The main risk factors for Congenital transmission were infection and parasitaemia of mothers. Consequences of the Disease seemed mild in newborns from single pregnancies and perhaps more important in multiple births.
Pedro R. Aranda - One of the best experts on this subject based on the ideXlab platform.
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An electrochemical immunosensor for anti-T. cruzi IgM antibodies, a biomarker for Congenital Chagas Disease, using a screen-printed electrode modified with gold nanoparticles and functionalized with shed acute phase antigen
Microchimica Acta, 2016Co-Authors: Matías Regiart, Sirley V. Pereira, Franco A. Bertolino, Carlos D. Garcia, Julio Raba, Pedro R. ArandaAbstract:The authors describe a sandwich immunosensor for anti-IgM T. cruzi -specific antibodies which are a biomarker for Congenital Chagas Disease (CCD). A screen-printed carbon electrode (SPCE) was modified with gold nanoparticles (AuNPs) and then functionalized with recombinant shed acute phase antigen (SAPA). The AuNPs/SPCE was characterized by scanning electron microscopy, cyclic voltammetry, and X-ray diffraction. The AuNPs provide an increased active surface area, high conductivity, and improved electrocatalytic characteristics, this resulting in a significant improvement of the detection limit. Following interaction between immobilized SAPA and the target antibodies in the serum sample, secondary antibody (an anti-human IgM-HRP conjugate) and solutions of H_2O_2 and 4-tert-butylcatechol were added and the enzymatic product was detected at −100 mV (vs. Ag/SPCE). The resulting current was proportional to the anti- T. cruzi IgM antibodies present in the sample and showed a linear trend from 10 to 200 ng mL^−1 ( R = 0.998). The detection limit was 3.03 ng mL^−1. These values demonstrate that this electrochemical immunosensor can be used as an alternative serological method for diagnosis of Congenital Chagas Disease. Graphical abstract A screen printed carbon electrode was modified with gold nanoparticles functionalized with recombinant shed acute phase antigen (SAPA). The resulting biosensor was applied to the quantification of antibodies against anti-IgM T. cruzi that are biomarkers for Congenital Chagas Disease.
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An electrochemical immunosensor for anti-T. cruzi IgM antibodies, a biomarker for Congenital Chagas Disease, using a screen-printed electrode modified with gold nanoparticles and functionalized with shed acute phase antigen
Microchimica Acta, 2016Co-Authors: Matías Regiart, Sirley V. Pereira, Franco A. Bertolino, Carlos D. Garcia, Julio Raba, Pedro R. ArandaAbstract:The authors describe a sandwich immunosensor for anti-IgM T. cruzi-specific antibodies which are a biomarker for Congenital Chagas Disease (CCD). A screen-printed carbon electrode (SPCE) was modified with gold nanoparticles (AuNPs) and then functionalized with recombinant shed acute phase antigen (SAPA). The AuNPs/SPCE was characterized by scanning electron microscopy, cyclic voltammetry, and X-ray diffraction. The AuNPs provide an increased active surface area, high conductivity, and improved electrocatalytic characteristics, this resulting in a significant improvement of the detection limit. Following interaction between immobilized SAPA and the target antibodies in the serum sample, secondary antibody (an anti-human IgM-HRP conjugate) and solutions of H2O2 and 4-tert-butylcatechol were added and the enzymatic product was detected at −100 mV (vs. Ag/SPCE). The resulting current was proportional to the anti-T. cruzi IgM antibodies present in the sample and showed a linear trend from 10 to 200 ng mL−1 (R = 0.998). The detection limit was 3.03 ng mL−1. These values demonstrate that this electrochemical immunosensor can be used as an alternative serological method for diagnosis of Congenital Chagas Disease.
Jean-philippe Chippaux - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of compliance to Congenital Chagas Disease treatment: results of a randomised trial in Bolivia.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2012Co-Authors: Jean-philippe Chippaux, Jorge Postigo, Dominique Schneider, Jose A. Santalla, Alejandra Nadin Salas-clavijo, Laurent BrutusAbstract:Background: A randomised, unblinded, clinical trial comparing two benznidazole regimens for Congenital Chagas Disease was carried out to determine whether simplification and reduction in the length of treatment could lead to better treatment compliance. Methods: This study was conducted in Santa Cruz, Bolivia. Serological screening was carried out in pregnant women, and parasites were sought in the blood of newborns from seropositive mothers. Infected infants were randomly assigned to two treatment groups. Recovery was assessed by parasite seeking at 1 month and 2 months as well as serological tests at 9 months. Assessment of treatment adherence was based on weekly home visits and use of electronic monitors. Results: Benznidazole was given to 63 newborns in group A (5 mg/kg in two daily doses for 60 days) and 61 newborns in group B (7.5 mg/kg in a single daily dose for 30 days). There was no difference in compliance between the two groups. The study confirmed the efficacy and good tolerance of both benznidazole regimens in the treatment of Congenital Chagas Disease. Conclusions: The short treatment should be preferred as it allows reducing the dose of benznidazole as well as the cost of treatment.
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Door-to-door screening as a strategy for the detection of Congenital Chagas Disease in rural Bolivia.
Tropical medicine & international health : TM & IH, 2011Co-Authors: Mario Romero, Jorge Postigo, Dominique Schneider, Jean-philippe Chippaux, Jose A. Santalla, Laurent BrutusAbstract:OBJECTIVE: To demonstrate the feasibility of a house-to-house screening system used for Congenital Chagas Disease in rural areas based on an active search for pregnant women and newborns in their homes in addition to passive case detection in health facilities. METHODS: Exploratory phase conducted by the research team followed by an operational period coordinated by municipal health service. A blood sample was taken for serological and parasitological tests of Trypanosoma cruzi from pregnant women who were searching antenatal care or visited at home by field investigators. Infants born to T. cruzi-infected women were examined for infection at birth and again at 1 and 7 months of age. RESULTS: 64.5% of the pregnant women were infected. Congenital infection was diagnosed at birth in 4.0% (12/299) of the children born to seroreactive mothers. Twelve additional cases of infection (4%) were diagnosed in children between 1 and 7 months of age. Finally 37% of the children were lost to follow-up in the exploratory phase and 53% during the operational phase (P=0.002) significantly fewer than in most passive case detection studies. CONCLUSION: Despite poorer outcomes after door-to-door screening activities have been transferred to the health system a combined strategy based on active and passive case detection appeared to be efficient for identifying rural cases of Congenital Chagas Disease. (c) 2011 Blackwell Publishing Ltd.
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Detectable Trypanosoma cruzi Parasitemia during Pregnancy and Delivery as a Risk Factor for Congenital Chagas Disease
The American journal of tropical medicine and hygiene, 2010Co-Authors: Laurent Brutus, Dominique Schneider, Jose A. Santalla, Nadin Alejandra Salas, Helen Castillo, Claudia Bernal, Jean-philippe ChippauxAbstract:Vector control has led to a drastic decrease in the prevalence of acquired Chagas Disease in Latin America, thus redirecting attention to Congenital Chagas Disease. We report results of a longitudinal study of 359 pregnant women in Yacuiba in southern Bolivia, of whom 147 (40.9%) were infected with Trypanosoma cruzi, to evaluate the relationship between the patency period of the parasitemia and the risk of Congenital infection. Maternal infection was assessed by using T. cruzi-specific serologic tests, and parasitemia in mothers and newborns was diagnosed by using microscopic examination of blood in heparinized microhematocrit tubes. Parasitemia was present in 28.6% of the infected women. Its prevalence increased during the third trimester, then decreased at delivery. The likelihood of Congenital infection was significantly correlated with the parasite density in the mother's blood. The risk of transmission increased during the third trimester of pregnancy and could explain premature births or low-weight newborns for infected mothers.
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Congenital Chagas Disease: diagnostic and clinical aspects in an area without vectorial transmission, Bermejo, Bolivia.
Acta tropica, 2008Co-Authors: Laurent Brutus, Mario Romero, Jorge Postigo, Dominique Schneider, Jose A. Santalla, Jean-philippe ChippauxAbstract:The authors carried out a 1-year study of a population of pregnant women delivering at Bermejo hospital, South Bolivia. In this area, vectorial transmission of Trypanosoma cruzi is negligible and women infect themselves during displacements in close endemic areas. The prevalence of T. cruzi in 508 pregnant women, diagnosed by several serological tests, was 33.9%. In eight infants, we observed T. cruzi in the umbilical cord (Congenital transmission rate of 5.2%). The means of birth weights, lengths and hemoglobin rates were similar in the children from both seronegative and seropositive women, and in children infected or not by T. cruzi. This study could confirm a less severity of the Congenital Disease of Chagas in the absence of re-infestation of the mother during pregnancy. Serological screening of pregnant women by rapid diagnostic tests and examination of babies born from seropositive mothers by microhematocrit method at birth is a suitable strategy to detect and prevent Congenital Chagas Disease in non-endemic areas.
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Risk factors and consequences of Congenital Chagas Disease in Yacuiba, south Bolivia.
Tropical medicine & international health : TM & IH, 2007Co-Authors: Nadin Alejandra Salas, Jorge Postigo, Dominique Schneider, Jean-philippe Chippaux, Jose A. Santalla, Michel Cot, Bertha Mendoza, Laurent BrutusAbstract:OBJECTIVE To determine the risk factors of Congenital Chagas Disease and the consequences of the Disease in newborns. METHODS Study of 2712 pregnant women and 2742 newborns in Yacuiba, south Bolivia. Chagas infection was determined serologically in mothers and parasitologically in newborns. Consequences of Congenital Chagas Disease were assessed clinically. RESULTS The prevalence of Chagas Disease in pregnant women was 42.2%. Congenital transmission was estimated at 6% of infected mothers leading to an incidence rate of 2.6% among newborns. Main risk factors of Congenital transmission were mothers' seropositivity and maternal Trypanosoma cruzi parasitaemia. Parity was higher in infected than in non-infected mothers, but it was not associated with the risk of Congenital transmission. The rate of Congenital infection was significantly higher in newborns from multiple pregnancies than in singletons. However, we did not observe statistically significant consequences of Chagas Disease in newborns from single pregnancies or among twins. CONCLUSIONS The main risk factors for Congenital transmission were infection and parasitaemia of mothers. Consequences of the Disease seemed mild in newborns from single pregnancies and perhaps more important in multiple births.