Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting

Working Group on Chagas Disease in Bolivia and Peru

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)268-275
Number of pages8
JournalClinical Infectious Diseases
Volume65
Issue number2
DOIs
StatePublished - Jul 15 2017

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Chagas Disease
Early Diagnosis
Trypanosoma cruzi
Public Health
Parturition
Parasite Load
Bolivia
Antigens
Polymerase Chain Reaction
Latin America
Urban Hospitals
Serology
Infection
Fetal Blood
Immunoglobulin M
Microscopy
Immunoglobulin G
Mothers
Newborn Infant
Sensitivity and Specificity

Keywords

  • Bolivia
  • Chagas disease
  • congenital
  • diagnostics.
  • Trypanosoma cruzi

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting. / Working Group on Chagas Disease in Bolivia and Peru.

In: Clinical Infectious Diseases, Vol. 65, No. 2, 15.07.2017, p. 268-275.

Research output: Contribution to journalArticle

Working Group on Chagas Disease in Bolivia and Peru. / Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting. In: Clinical Infectious Diseases. 2017 ; Vol. 65, No. 2. pp. 268-275.
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abstract = "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.",
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author = "{Working Group on Chagas Disease in Bolivia and Peru} and Messenger, {Louisa A.} and Gilman, {Robert H} and Manuela Verastegui and Gerson Galdos-Cardenas and Gerardo Sanchez and Edward Valencia and Leny Sanchez and Edith Malaga and Rendell, {Victoria R.} and Malasa Jois and Vishal Shah and Nicole Santos and Abastoflor, {Maria Del Carmen} and Carlos Lafuente and Rony Colanzi and Ricardo Bozo and Caryn Bern",
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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

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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.

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