Abstract
With the control of the vectorial and transfusional routes of infection with Trypanosoma cruzi, congenital transmission has become an important source of new cases. This study evaluated the efficacy of trypanocidal therapy to prevent congenital Chagas disease and compared the clinical and serological evolution between treated and untreated infected mothers. We conducted a multicenter, observational study on a cohort of mothers infected with T. cruzi, with and without trypanocidal treatment before pregnancy. Their children were studied to detect congenital infection. Among 354 “chronically infected mother-biological child” pairs, 132 were treated women and 222 were untreated women. Among the children born to untreated women, we detected 34 infected with T. cruzi (15.3%), whose only antecedent was maternal infection. Among the 132 children of previously treated women, no infection with T. cruzi was found (0.0%) (p<0.05). Among 117 mothers with clinical and serological follow up, 71 had been treated and 46 were untreated. The women were grouped into three groups. Group A: 25 treated before 15 years of age; Group B: 46 treated at 15 or more years of age; Group C: untreated, average age of 29.2±6.2 years at study entry. Follow-up for Groups A, B and C was 16.3±5.8, 17.5±9.2 and 18.6±8.6 years respectively. Negative seroconversion: Group A, 64.0% (16/25); Group B, 32.6% (15/46); Group C, no seronegativity was observed. Clinical electrocardiographic alterations compatible with chagasic cardiomyopathy: Group A 0.0% (0/25); B 2.2% (1/46) and C 15.2% (7/46). The trypanocidal treatment of women with chronic Chagas infection was effective in preventing the congenital transmission of Trypanosoma cruzi to their children; it had also a protective effect on the women's clinical evolution and deparasitation could be demonstrated in many treated women after over 10 years of follow up.
Highlights
Significant progress has been made in the fight against triatomines, which, added to the controls implemented by blood banks, drastically reduced infections by Trypanosoma cruzi through the vectorial and transfusional routes [1]
We evaluated the efficacy of trypanocidal therapy in preventing congenital Chagas disease and compared the clinical and serological changes between treated and untreated mothers
From medical records of infected women with and without trypanocidal treatment, we studied their children to detect congenital infection
Summary
Given the current migrations from rural areas to urban centers, this way of infection may be encountered may occur in regions considered of low or very low endemicity and even in countries where the vector is not found [2,3,4,5]. Vertical transmission is considered as the source that generates the highest number of new acute infection cases [6]. Less than 20% of children born with congenital infection are diagnosed early, due to difficulties in the health system, which fails to perform an adequate follow-up of the newborn [7,8]. As most infected children have no symptoms, the mothers feel no need for medical intervention, to which one must add the economic difficulties of traveling to the health center. The importance of early detection lies in the possibility of receiving trypanocidal therapy, which is highly effective at this stage of the infection [9,10,11]
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