Congenital transmission of Trypanosoma cruzi: an operational outline for detecting and treating infected infants in north‐western Argentina

Abstract

SummaryWe designed a set of procedures for first-line local health services to detect and treat the congenital transmission of Trypanosoma cruzi at a province-wide scale, and field-tested the programme in the province of Tucumán, northwestern Argentina, from 1992 to 1994. The programme consists of routine screening of pregnant women for seroreactivity to T. cruzi, serological and parasitological follow-up of the newborn at least twice during the first year of age, treatment of the infected infants, and evaluation of the outcome. 927 (5.5%) of 16 842 pregnant women were seroreactive to T. cruzi by indirect haemagglutination assay and ELISA. Twenty-one (6.7%) of 315 newborns to seroreactive mothers were diagnosed as infected with T. cruzi parasites microhaematocrit concentration before 30 days of age. Five newborns who initially tested negative had a T. cruzi infection detected by microhaematocrit and/or serological techniques at 3 or 6 months of age. Thus, congenital infection was diagnosed in 26 (7.1%) infants born to seroreactive women and residing in houses free of triatomine bugs. Four of 6 infants born to seroreactive mothers died during the first year of age and had some evidence of T. cruzi infection; one of the deaths was attributed to T. cruzi based on clinical evidence. After specific treatment with nifurtimox or benznidazole, 30 of 32 infants remained parasitologically and serologically negative. This study shows the feasibility of controlling the incidence of congenitally acquired T. cruzi infections at a province-wide scale by means of a specific screening programme at first-line health services level.

Usefulness of PCR-based assays to assess drug efficacy in Chagas disease chemotherapy: value and limitations

“…Cure was demonstrated by both negativation of PCR and serology in 100% of infants from GI, in 66.7% of children from GII and in only 12.5% of GIII cases. In those infants who started therapy in their first months of life (< 3 months), cure was achieved early after treatment, in accordance with previous studies (Blanco et al 1999(Blanco et al , 2000. In these cases, PCR became negative earlier or at the same stage as serology did.…”

“…Moreover, a small proportion of infected newborns is seronegative. The detection of IgM antibodies against T. cruzi is not satisfactory (Freilij & Altcheh 1995, Blanco et al 2000. Therefore, the diagnosis of congenital infections usually relies on microscopic observation of bloodstream trypomastigotes, which is more effective by microhaematocrit concentration technique in infants less than six months of age (Freilij et al 1983, Freilij & Altcheh 1995.…”

Mother-to-Child Transmission of Trypanosoma cruzi

“…Neonatal mortality was high in early publications but low in recent ones. The possible association with miscarriages and stillbirths is controversial [8]. Uninfected babies of seropositive mothers are healthy.…”

“…Control of blood supply sources for T cruzi infection has been rigorously addressed in many countries [3]. The success with vector control has led to a relative increase in the burden attributed to congenital transmission of T cruzi [5][6][7][8]. This review will highlight gaps in the literature and focus on diagnosis, clinical features, prevention, treatment, epidemiology, and pathophysiology of mother-to-child transmission (MTCT) of T cruzi.…”

Antiprotozoal compounds: state of the art and new developments

“…Another antimalarial, orally M a n u s c r i p t [67,68] since approximately 40% of all untreated cases are fatal [69].…”