TY - JOUR
T1 - Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting
AU - Working Group on Chagas Disease in Bolivia and Peru
AU - Messenger, Louisa A.
AU - Gilman, Robert H.
AU - Verastegui, Manuela
AU - Galdos-Cardenas, Gerson
AU - Sanchez, Gerardo
AU - Valencia, Edward
AU - Sanchez, Leny
AU - Malaga, Edith
AU - Rendell, Victoria R.
AU - Jois, Malasa
AU - Shah, Vishal
AU - Santos, Nicole
AU - Abastoflor, Maria Del Carmen
AU - Lafuente, Carlos
AU - Colanzi, Rony
AU - Bozo, Ricardo
AU - Bern, Caryn
N1 - Funding Information:
This work was supported by the National Institutes of Health (NIH; R01-AI087776) and NIH Global research training grant (D43 TW006581). L. A. M. was supported by a Biotechnology and Biological Sciences Research Council doctoral training grant, the Dr Gordon Smith Travelling Fellowship, and a grant from the Royal Society of Tropical Medicine and Hygiene.
Publisher Copyright:
© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2017/7/15
Y1 - 2017/7/15
N2 - Background. 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. Methods. 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. Results. 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. Conclusions. 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.
AB - Background. 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. Methods. 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. Results. 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. Conclusions. 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.
KW - Bolivia
KW - Chagas disease
KW - Trypanosoma cruzi
KW - congenital
KW - diagnostics.
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U2 - 10.1093/cid/cix277
DO - 10.1093/cid/cix277
M3 - Article
C2 - 28369287
AN - SCOPUS:85020235917
SN - 1058-4838
VL - 65
SP - 268
EP - 275
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 2
ER -