Sustained Domestic Vector Exposure Is Associated with Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk among Young Women in Bolivia

Michelle Kaplinski, Malasa Jois, Gerson Galdos-Cardenas, Victoria R. Rendell, Vishal Shah, Rose Q. Do, Rachel Marcus, Melissa S. Burroughs Pena, Maria Del Carmen Abastoflor, Carlos Lafuente, Ricardo Bozo, Edward Valencia, Manuela Verastegui, Rony Colanzi, Robert H. Gilman, Caryn Bern

Research output: Contribution to journalArticlepeer-review

Abstract

Background.We studied women and their infants to evaluate risk factors for congenital transmission and cardiomyopathy in Trypanosoma cruzi-infected women. Methods.Women provided data and blood for serology and quantitative polymerase chain reaction (PCR). Infants of infected women had blood tested at 0 and 1 month by microscopy, PCR and immunoblot, and serology at 6 and 9 months. Women underwent electrocardiography (ECG). Results.Of 1696 women, 456 (26.9%) were infected; 31 (6.8%) transmitted T. cruzi to their infants. Women who transmitted had higher parasite loads than those who did not (median, 62.0 [interquartile range {IQR}, 25.8-204.8] vs 0.05 [IQR, 0-29.6]; P <. 0001). Transmission was higher in twin than in singleton births (27.3% vs 6.4%; P =. 04). Women who had not lived in infested houses transmitted more frequently (9.7% vs 4.6%; P =. 04), were more likely to have positive results by PCR (65.5% vs 33.9%; P <. 001), and had higher parasite loads than those who had lived in infested houses (median, 25.8 [IQR, 0-64.1] vs 0 [IQR, 0-12.3]; P <. 001). Of 302 infected women, 28 (9.3%) had ECG abnormalities consistent with Chagas cardiomyopathy; risk was higher for older women (odds ratio [OR], 1.06 [95% confidence interval {CI}, 1.01-1.12] per year) and those with vector exposure (OR, 3.7 [95% CI, 1.4-10.2]). We observed a strong dose-response relationship between ECG abnormalities and reported years of living in an infested house. Conclusions.We hypothesize that repeated vector-borne infection sustains antigen exposure and the consequent inflammatory response at a higher chronic level, increasing cardiac morbidity, but possibly enabling exposed women to control parasitemia in the face of pregnancy-induced Th2 polarization.

Original languageEnglish (US)
Pages (from-to)918-926
Number of pages9
JournalClinical Infectious Diseases
Volume61
Issue number6
DOIs
StatePublished - Jun 8 2015

Keywords

  • Chagas disease
  • Trypanosoma cruzi
  • cardiomyopathy
  • infectious disease transmission
  • vertical

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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