Frequency of the congenital transmission of Trypanosoma cruzi: a systematic review and meta‐analysis

Abstract

Background Chagas disease is caused by the parasite Trypanosoma cruzi and endemic in much of Latin America. With increased globalization and immigration, it is a risk in any country due in part to congenital transmission. The frequency of congenital transmission is unclear. Objective To assess the frequency of congenital transmission of T. cruzi. Search Strategy PubMed, Journals@Ovid Full Text, EMBASE, CINAHL, Fuente Academica and BIREME databases were searched using seven search terms related to Chagas disease or Trypanosoma cruzi and congenital transmission. Selection Criteria The inclusion criteria were the following: Dutch, English, French, Portuguese or Spanish language; case report, case series or observational study; original data on congenital T. cruzi infection in humans; congenital infection rate reported or it could be derived. This systematic review included 13 case reports/series and 51 observational studies. Data Collection and Analysis Two investigators independently collected data on study characteristics, diagnosis and congenital infection rate. The principal summary measure – the congenital transmission rate – is defined as the number of congenitally infected infants divided by the number of infants born to infected mothers. A random effects model was utilized. Main Results The pooled congenital transmission rate was 4.7% (95% confidence interval: 3.9–5.6%). Endemic countries had a higher rate of congenital transmission compared to non-endemic (5.0% vs. 2.7%). Conclusions Congenital transmission of Chagas disease is a global problem. Overall risk of congenital infection in infants born to infected mothers is about 5%. The congenital mode of transmission requires targeted screening to prevent future cases of Chagas disease.

Mother-to-Child Transmission of Trypanosoma cruzi

“…Sosa-Estani et al [26] observed 16 women treated for Chagas disease during their childhood and found that none of their 32 infants were congenitally infected; however, transmission rates are relatively low [19], and this result would need to be confirmed by large prospective studies.…”

“…Data also suggest vector control programs may potentially decrease the risk of MTCT and the severity of congenital Chagas disease by decreasing maternal parasitic load [18]. Congenital transmission rates are lower in nonendemic countries compared with endemic countries [19], and congenital Chagas disease in Bolivia has been less symptomatic in recent periods [20].…”

“…A recent systematic review concluded that congenital transmission of T cruzi occurs in 5.0% of infected women in endemic countries [19]. In nonendemic countries, congenital T cruzi infection occurs in approximately 2.7% of infected pregnant women [19].…”

“…In nonendemic countries, congenital T cruzi infection occurs in approximately 2.7% of infected pregnant women [19]. With growing migration from Latin America, congenital T cruzi has been reported with increasing frequency in areas nonendemic to T cruzi, including Spain [29,30] and the United States [31].…”

Chagas disease prevalence in pregnant women: migration and risk of congenital transmission

“…In addition, it should be noted that at this stage, treatment could lead to complete cure. Diagnosis during pregnancy and risk characterization of a given population should be seen as a window of opportunity for inquest cases of congenital Chagas 4, 7,8]. The healing of congenital Chagas disease in this critical age depends on detection during pregnancy, early diagnosis in the neonate, and quick treatment [5,9].…”