Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting
Open Access
- 25 March 2017
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 65 (2), 268-275
- https://doi.org/10.1093/cid/cix277
Abstract
Congenital Trypanosoma cruzi transmission is now estimated to account for 22% of new infections, representing a significant public health problem across Latin America and internationally. Treatment during infancy is highly efficacious and well tolerated, but current assays for early detection fail to detect >50% of infected neonates, and 9-month follow-up is low. Women who presented for delivery at 2 urban hospitals in Santa Cruz Department, Bolivia, were screened by rapid test. Specimens from infants of infected women were tested by microscopy (micromethod), quantitative PCR (qPCR), and immunoglobulin (Ig)M trypomastigote excreted-secreted antigen (TESA)-blots at birth and 1 month and by IgG serology at 6 and 9 months. Among 487 infants of 476 seropositive women, congenital T. cruzi infection was detected in 38 infants of 35 mothers (7.8%). In cord blood, qPCR, TESA-blot, and micromethod sensitivities/specificities were 68.6%/99.1%, 58.3%/99.1%, and 16.7%/100%, respectively. When birth and 1-month results were combined, cumulative sensitivities reached 84.2%, 73.7%, and 34.2%, respectively. Low birthweight and/or respiratory distress were reported in 11 (29%) infected infants. Infants with clinical signs had higher parasite loads and were significantly more likely to be detected by micromethod. The proportion of T. cruzi–infected infants with clinical signs has fallen since the 1990s, but symptomatic congenital Chagas disease still represents a significant, albeit challenging to detect, public health problem. Molecular methods could facilitate earlier diagnosis and circumvent loss to follow-up but remain logistically and economically prohibitive for routine screening in resource-limited settings.Funding Information
- National Institutes of Health (R01-AI087776)
This publication has 27 references indexed in Scilit:
- How to Improve the Early Diagnosis of Trypanosoma cruzi Infection: Relationship between Validated Conventional Diagnosis and Quantitative DNA Amplification in Congenitally Infected ChildrenPLoS Neglected Tropical Diseases, 2013
- Achievements and Challenges upon the Implementation of a Program for National Control of Congenital Chagas in Bolivia: Results 2004–2009PLoS Neglected Tropical Diseases, 2013
- Vertical transmission of Trypanosoma cruzi infection: quantification of parasite burden in mothers and their children by parasite DNA amplificationTransactions of the Royal Society of Tropical Medicine and Hygiene, 2012
- Urbanization of congenital transmission of Trypanosoma cruzi: prospective polymerase chain reaction study in pregnancyTransactions of the Royal Society of Tropical Medicine and Hygiene, 2011
- CongenitalTrypanosoma cruziTransmission in Santa Cruz, BoliviaClinical Infectious Diseases, 2009
- Eliminating Chagas disease: challenges and a roadmapBMJ, 2009
- Development of a real-time PCR assay for Trypanosoma cruzi detection in blood samplesActa Tropica, 2007
- EARLY DIAGNOSIS OF CONGENITAL TRYPANOSOMA CRUZI INFECTION USING PCR, HEMOCULTURE, AND CAPILLARY CONCENTRATION, AS COMPARED WITH DELAYED SEROLOGYJournal of Parasitology, 2005
- Aetiological treatment of congenital Chagas' disease diagnosed and monitored by the polymerase chain reactionJournal of Antimicrobial Chemotherapy, 2003
- Congenital Chagas DiseaseArchives of Pediatrics & Adolescent Medicine, 1976