With the control of the vectorial and transfusional routes of infection with Trypanosoma cruzi, congenital transmission has become an important source of new cases. This study evaluated the efficacy of trypanocidal therapy to prevent congenital Chagas disease and compared the clinical and serological evolution between treated and untreated infected mothers. We conducted a multicenter, observational study on a cohort of mothers infected with T. cruzi, with and without trypanocidal treatment before pregnancy. Their children were studied to detect congenital infection. Among 354 “chronically infected mother-biological child” pairs, 132 were treated women and 222 were untreated women. Among the children born to untreated women, we detected 34 infected with T. cruzi (15.3%), whose only antecedent was maternal infection. Among the 132 children of previously treated women, no infection with T. cruzi was found (0.0%) (p<0.05). Among 117 mothers with clinical and serological follow up, 71 had been treated and 46 were untreated. The women were grouped into three groups. Group A: 25 treated before 15 years of age; Group B: 46 treated at 15 or more years of age; Group C: untreated, average age of 29.2±6.2 years at study entry. Follow-up for Groups A, B and C was 16.3±5.8, 17.5±9.2 and 18.6±8.6 years respectively. Negative seroconversion: Group A, 64.0% (16/25); Group B, 32.6% (15/46); Group C, no seronegativity was observed. Clinical electrocardiographic alterations compatible with chagasic cardiomyopathy: Group A 0.0% (0/25); B 2.2% (1/46) and C 15.2% (7/46). The trypanocidal treatment of women with chronic Chagas infection was effective in preventing the congenital transmission of Trypanosoma cruzi to their children; it had also a protective effect on the women's clinical evolution and deparasitation could be demonstrated in many treated women after over 10 years of follow up.

SUMMARYThis work compared the time at which negative seroconversion was detected by conventional serology (CS) and by the ELISA-F29 test on a cohort of chronic chagasic patients treated with nifurtimox or benznidazole. A retrospective study was performed using preserved serum from 66 asymptomatic chagasic adults under clinical supervision, and bi-annual serological examinations over a mean follow-up of 23 years. Twenty nine patients received trypanocide treatment and 37 remained untreated. The ELISA-F29 test used a recombinant antigen which was obtained by expressing the Trypanosoma cruzi flagellar calcium-binding protein gene in Escherichia coli. Among the untreated patients, 36 maintained CS titers. One patient showed a doubtful serology in some check-ups. ELISA-F29 showed constant reactivity in 35 out of 37 patients and was negative for the patient with fluctuating CS. The treated patients were divided into three groups according to the CS titers: in 13 they became negative; in 12 they decreased and in four they remained unchanged. ELISA-F29 was negative for the first two groups. The time at which negativization was detected was significantly lower for the ELISA-F29 test than for CS, 14.5 ± 5.7 and 22 ± 4.9 years respectively. Negative seroconversion was observed in treated patients only. The results obtained confirm that the ELISA-F29 test is useful as an early indicator of negative seroconversion in treated chronic patients.

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Los anticuerpos anti-muscarínicos (anti-M2) podrían estar relacionados con alteraciones disautonómicas en la enfermedad de Chagas. Objetivo: evaluar efecto del tratamiento tripanocida sobre los anticuerpos anti-M2 en adultos chagásicos crónicos seguidos durante 24 años promedio. Estudio de cohorte retrospectivo. Infectados crónicos por T. cruzi agrupados en: A) 31 tratados con drogas tripanocidas (102 muestras post-tratamiento); B) 36 no tratados (95 muestras). Controles no chagásicos: 17 cardiópatas y 22 sanos. Pacientes tratados: 11/31(35,5%) inicialmente presentaron reactividad anti-M2; 2/31(6,4%) permanecieron reactivos durante el estudio. No tratados: 14/36(38,9%) fueron positivos al inicio y final del seguimiento. Todos los pacientes permanecieron sin cambio clínicos durante el estudio. Los controles no presentaron reactividad anti-M2. El origen de los anticuerpos anti-M2 no sería de naturaleza autoinmune ya que desaparecen por efecto del tratamiento tripanocida y por otro lado la presencia de los mismos no tendría utilidad como marcador pronóstico de evolución clínica. Palabras claves: Enfermedad de Chagas-Tratamiento tripanocida-Anticuerpos antimuscarínicos SUMMARY Chronic Chagas Disease: effect of trypanocidal treatment on antimuscarinic antibodies Anti-muscarinic antibodies (anti-M2) could be related to dysautonomic alterations in Chagas disease. Objective: evaluate effect of trypanocidal treatment on the anti-M2 antibodies in chronic chagasic adults followed for 24 years on average. Retrospective cohort study. Chronic patients infected by T. cruzi were grouped into: A)31 treated with trypanocidal drugs (102 samples post-treatment); B)36 untreated (95 samples). Controls no chagasic: 17 with cardiopathies and 22 healthy. Patients treated: 11/31(35.5%) initially presented anti-M2 reactivity; 2/31 during the study remained reactive. Untreated: 14/36(38.9%) were positive at the beginning and to the end of follow up. All patients remained without clinical change during the study. The controls no showed anti-M2 reactivity. The origin of anti-M2 antibodies would not be autoimmune as they disappear by effect of trypanocidal treatment and on the other hand the presence of them would not be useful as a prognostic marker of clinical evolution.