TY - JOUR
T1 - Sustained Domestic Vector Exposure Is Associated with Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk among Young Women in Bolivia
AU - Kaplinski, Michelle
AU - Jois, Malasa
AU - Galdos-Cardenas, Gerson
AU - Rendell, Victoria R.
AU - Shah, Vishal
AU - Do, Rose Q.
AU - Marcus, Rachel
AU - Burroughs Pena, Melissa S.
AU - Del Carmen Abastoflor, Maria
AU - Lafuente, Carlos
AU - Bozo, Ricardo
AU - Valencia, Edward
AU - Verastegui, Manuela
AU - Colanzi, Rony
AU - Gilman, Robert H.
AU - Bern, Caryn
N1 - Publisher Copyright:
© 2015 The Author.
PY - 2015/6/8
Y1 - 2015/6/8
N2 - 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.
AB - 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.
KW - Chagas disease
KW - Trypanosoma cruzi
KW - cardiomyopathy
KW - infectious disease transmission
KW - vertical
UR - http://www.scopus.com/inward/record.url?scp=84940661174&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84940661174&partnerID=8YFLogxK
U2 - 10.1093/cid/civ446
DO - 10.1093/cid/civ446
M3 - Article
C2 - 26063720
AN - SCOPUS:84940661174
SN - 1058-4838
VL - 61
SP - 918
EP - 926
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -