Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting
| Autor: | Robert H. Gilman, Maria del Carmen Abastoflor, Leny Sanchez, Louisa A. Messenger, Gerson Galdos-Cardenas, Edith Málaga, Carlos LaFuente, Ricardo Bozo, Victoria R. Rendell, Edward Valencia, Rony Colanzi, Peru, Caryn Bern, Nicole Santos, Malasa Jois, Manuela Verastegui, Vishal Shah, Gerardo Sanchez |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Pediatrics Chagas disease Endemic Diseases Antibodies Protozoan Parasite load Parasite Load Serology 0302 clinical medicine diagnostics 030212 general & internal medicine biology Respiratory distress Transmission (medicine) 3. Good health Antigens Protozoan/blood/immunology Infectious Diseases Female medicine.symptom Microbiology (medical) Adult medicine.medical_specialty Bolivia Trypanosoma cruzi 030231 tropical medicine Mothers Antigens Protozoan Enzyme-Linked Immunosorbent Assay macromolecular substances purl.org/pe-repo/ocde/ford#3.03.08 [https] Real-Time Polymerase Chain Reaction Trypanosoma cruzi/genetics/immunology 03 medical and health sciences parasitic diseases medicine Major Article Humans Chagas Disease Antibodies Protozoan/blood business.industry Enzyme-Linked Immunosorbent Assay/methods Public health congenital Infant Newborn Infant Infant Low Birth Weight biology.organism_classification medicine.disease Immunoglobulin M/blood Infectious Disease Transmission Vertical Low birth weight Early Diagnosis Immunoglobulin M Immunoglobulin G/blood Immunoglobulin G Immunology Chagas Disease/congenital/diagnosis/immunology/transmission business |
| ISSN: | 1058-4838 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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