The congenital transmission of Chagas’ disease was evaluated in 57 pregnant women with Chagas’ disease and their 58 offspring. The patients were selected from three Health Institutions in São Paulo City. The maternal clinical forms of Chagas’ disease were: indeterminate (47.4%), cardiac (43.8%) and digestive (8.8%); 55 were born in endemic areas and two in São Paulo City. The transmission of Chagas’ disease at fetal level was confirmed in three (5.17%) of the 58 cases studied and one probably case of congenital Chagas’ disease. Two infected infants were born to chagasic women with HIV infection and were diagnosed by parasitolological assays (microhematocrit, quantitative buffy coat-QBC or artificial xenodiagnosis). In both cases the placenta revealed T. cruzi and HIV p24 antigens detected by immunohistochemistry. In one case, a 14-week old abortus, the diagnosis of congenital T. cruzi infection was confirmed by immunohistochemistry. The other probable infection, a 30-week old stillborn, the parasites were found in the placenta and umbilical cord. The Western blot method using trypomastigote excreted/secreted antigens of T. cruzi (TESA) was positive for IgG antibodies in 54/55 newborns and for IgM in 1/55 newborns. One of the two newborns with circulating parasites had no detectable IgG or IgM antibodies. The assessment of IgG antibodies in the sera of pregnant women and their newborns was performed by ELISA using two different T. cruzi antigens: an alkaline extract of epimastigotes (EAE) and trypomastigote excreted/secreted antigens (TESA). The analysis showed a linear correlation between maternal and newborn IgG antibody titers at birth.

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Adherence to non-occupational post-exposure prophylaxis (nPEP) among sexual violence (SV) victims and their retention in care after SV represent significant challenges. This study aimed at identifying predictors of adherence to nPEP and retention in clinical-laboratory follow-up among SV victims in São Paulo, Brazil.We conducted a retrospective cohort study of SV victims admitted to care and follow-up at the SV unit of the main reference hospital in São Paulo within 72 hours following the SV episode. Eligible patients were submitted to a standardised protocol that included nPEP, screening and management for other STI as well as emergency contraception. Predictors of adherence to nPEP for 28 days and retention in care until discharge at 180 days after admission were analysed. A total of 199 SV episodes in 197 victims were recorded from January/2001 to December/2013 (156 months). Of those episodes, 167 were eligible to receive nPEP and 160 (96%) actually received a prescription. Overall 104/160 (65%, 95%CI 57-72%) SV victims, who received nPEP, were fully adherent to nPEP up to 28 days, whereas 89/199 (45%, 95%CI 38-52%) were retained in care for 180 days following admission. In multivariate analysis, patients undergoing at least one psychological consultation (n=126) were more likely to adhere to nPEP (adjusted OR 8.32; 95%CI 3.0-23.3) and to be retained in care for 6 months (adjOR 40.33;) compared to patients not receiving psychological support. In contrast, study outcomes were not associated with victims' age and sex and with type of perpetrator. In our cohort provision of psychological care was shown to be associated with enhanced adherence to nPEP and retention in care.

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Noventa anos depois da descoberta da doença de Chagas, por Carlos Chagas em conjunto de exemplares investigações científicas que concretizaram os aspectos fundamentais da enfermidade, essa endemia continua, lamentavelmente, ainda proeminente em países latino-americanos, sobretudo em virtude da falta de maiores e melhores providências preventivas por parte de vários setores governamentais. No Brasil tiveram lugar em fase relativamente recente medidas adequadas que tornaram bem menos expressiva a transmissão do Trypanosoma cruri. Almejamos que prossigam e sejam imitadas por outras nações. Convém lembrar, a propósito, que o êxito foi devido à vontade política, à programação elaborada por profissionais competentes e à persistência, não influenciada pelas mudanças de governantes. No Estado de São Paulo, em particular, a transmissão vetorial a seres humanos foi controlada desde o início da década de 80, ocorrendo praticamente o desaparecimento da infestação domiciliar por Triatoma infestans (Souza, AG; Wanderley, D.M.V.; Buralli, G.M.M & Andrade, J.c.R. - Consolidation of the control of Chagas' disease in the State of São Paulo. (Mem. Inst, Oswaldo Cruz, 79 (supl.): 125-132, 1984). Nesse contexto merecem destacada atenção as modalidades alternativas de transmissão do T. cruri, porquanto diante do arrefecimento da veiculação através de triatomíneos elas contribuem efetivamente para o surgimentode novos acometimentos, devendo por isso haver, com rapidez e objetividade, proposição de propostas profiláticas pertinentes. Por isso, o Instituto de Medicina Tropical de São Paulo decidiu promover "Reunião sobre prevenção referente às modalidades alternativas de transmissão do Trypanosoma cruri", com a finalidade de apontar condutas atualmente tidas como recomendáveis, conforme explanações a cargo de alguns convidados capacitados a cooperar efetivamente. Fomos os organizadores do evento, realizado no dia 16 de outubro de 1998 e apoiado pelo Departamento de Higiene e Medicina Tropical da Associação Paulista de Medicina, pela Sociedade Brasileira de Medicina Tropical, pela Sociedade Médica Ítalo-Brasileira e pela Sociedade Paulista de Infectologia. As opiniões emitidas estão nesta coletânea, sempre respaldadas em pontos-de-vista pessoais, justificativas e bibliografia. Representam, se pelo menos suceder valorização do conjunto, contribuição realística para adoção de ações coibitórias a respeito de componentes alternativos, antes erroneamente sob determinados itens rotulados como excepcionais, atuantes na disseminação da doença de Chagas.

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