Risk factors and consequences of congenital Chagas disease in Yacuiba, south Bolivia

Abstract

Summaryobjective 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.keywords congenital Chagas disease, vertical transmission, pregnant women, newborns, Bolivia

Congenital Trypanosoma cruzi Infection. Efficacy of Its Monitoring in an Urban Reference Health Center in a Non-Endemic Area of Argentina

“…[20][21][22][23] In connection with the diagnosis protocol, in our experience parasitemia was a determining factor in the diagnosis of congenital T. cruzi infection within the first 5 months, by micromethod and xenodiagnosis, which is similar to reported findings in other studies. 17,19,20,22,23 Between 6 and 12 months of age, serology confirmed congenital T. cruzi infection in 74.7% of the babies when the serological titers were clearly over the cut-off level. However, serology was not always conclusive in the diagnosis in this period, especially when it was non-reactive or discordant.…”

“…17,[20][21][22] Increasing the effectiveness of the first line of health services in direct contact with the community in our endemic countries and establishing congenital T. cruzi infection as a priority in Public Health Programs could contribute to achieve better surveillance coverage and to reduce potential undiagnosed and untreated children, facts that have failed to be clearly reported in different studies. [20][21][22][23] In connection with the diagnosis protocol, in our experience parasitemia was a determining factor in the diagnosis of congenital T. cruzi infection within the first 5 months, by micromethod and xenodiagnosis, which is similar to reported findings in other studies. 17,19,20,22,23 Between 6 and 12 months of age, serology confirmed congenital T. cruzi infection in 74.7% of the babies when the serological titers were clearly over the cut-off level.…”

“…The 6.5% of children without congenital transmission had reactive or discordant serology up to the 6th month of age. 19 and in Bolivia, 42.2% in Yacuiba, a highly endemic area, 20 and 33.8% in Bermejo with control of vectorial transmission. 21 Variations in the support of vectorial control activities in the different regions, countries, or areas of Latin America seem to determine the levels of serological prevalence of CHD in pregnant women.…”

2 nd Brazilian Consensus on Chagas Disease, 2015

“…As discussed in the specific section on vertical transmission of T. cruzi in this Consensus, there is evidence indicating the benefit of the antiparasitic treatment, with better evolution of Chagas disease (116) (119) (120) (121) (122) , reduced risk of vertical transmission in future pregnancies (109) (116) , and lower risk of vertical transmission and evolution to spontaneous abortion by reducing the parasitemia (103) (115) .…”

“…Studies point to the possible benefit of antiparasitic treatment, with better evolution of Chagas disease (116) (119) (120) (121) (122) and reduction of the risk of vertical transmission in future gestations (109) (116) . High maternal parasitemia is associated with an increased risk of vertical transmission and abortion (103) (115) . Pregnant women who are in the acute phase of Chagas disease should be evaluated case by case, preferably with the participation of experts, to define the risk-benefit of indicating the antiparasitic treatment.…”