Combination of ultra-rapid DNA purification (PURE) and loop-mediated isothermal amplification (LAMP) for rapid detection of Trypanosoma cruzi DNA in dried blood spots.

BACKGROUND: Chagas disease or American trypanosomiasis, a neglected tropical disease, is a persistent Public Health problem in Latin America and other, non-endemic, countries. Point-of-care (POC) sensitive methods are still needed to improve and extend early diagnosis in acute infections such as congenital Chagas disease. The objective of this study was to analytically evaluate in the lab the performance of a qualitative POC molecular test (Loop-mediated isothermal amplification (LAMP), Eiken, Japan) for rapid diagnosis of congenital Chagas disease employing FTA cards or Whatman 903 filter paper as solid supports for small-scale volumes of human blood. METHODOLOGY/PRINCIPAL FINDINGS: We used human blood samples artificially infected with cultured T. cruzi strains to assess the analytical performance of the test in comparison with liquid blood anticoagulated with heparin. The DNA extraction process was evaluated using the ultrarapid purification system PURE manufactured by Eiken Chemical Company (Tokio, Japan) over artificially infected liquid blood or different amounts of dried blood spot (DBS) 3- and 6-mm pieces of FTA and Whatman 903 paper. LAMP was performed on a AccuBlock (LabNet, USA) heater or in the Loopamp LF-160 incubator (Eiken, Japan), and visualization of results was either done at naked eye, using the LF-160 device or P51 Molecular Fluorescence Viewer (minipcr bio, USA). Best conditions tested showed a limit of detection (LoD) with 95% accuracy (19/20 replicates) of 5 and 20 parasites/mL, respectively for heparinized fluid blood or DBS samples. FTA cards showed better specificity than Whatman 903 filter paper. CONCLUSIONS/SIGNIFICANCE: Procedures to operate LAMP reactions from small volumes of fluid blood or DBS in FTA were standardized for LAMP detection of T. cruzi DNA. Our results encourage prospective studies in neonates born to seropositive women or oral Chagas disease outbreaks to operationally evaluate the method in the field.

Amplicon Sequencing Reveals Complex Infection in Infants Congenitally Infected With Trypanosoma Cruzi and Informs the Dynamics of Parasite Transmission.

Congenital transmission of Trypanosoma cruzi is an important source of new Chagas infections worldwide. The mechanisms of congenital transmission remain poorly understood, but there is evidence that parasite factors are involved. Investigating changes in parasite strain diversity during transmission could provide insight into the parasite factors that influence the process. Here we use amplicon sequencing of a single copy T. cruzi gene to evaluate the diversity of infection in clinical samples from Chagas positive mothers and their infected infants. Several infants and mothers were infected with multiple parasite strains, mostly of the same TcV lineage, and parasite strain diversity was higher in infants than mothers. Two parasite haplotypes were detected exclusively in infant samples, while one haplotype was never found in infants. Together, these data suggest multiple parasites initiate a congenital infection and that parasite factors influence the probability of vertical transmission.

Estimation of the morbidity and mortality of congenital Chagas disease: A systematic review and meta-analysis.

Chagas disease is caused by the parasite Trypanosoma cruzi which can be transmitted from mother to baby during pregnancy. There is no consensus on the proportion of infected infants with clinical signs of congenital Chagas disease (cCD). The objective of this systematic review is to determine the burden of cCD. Articles from journal inception to 2020 reporting morbidity and mortality associated with cCD were retrieved from academic search databases. Observational studies, randomized-control trials, and studies of babies diagnosed with cCD were included. Studies were excluded if they were case reports or series, without original data, case-control without cCD incidence estimates, and/or did not report number of participants. Two reviewers screened articles for inclusion. To determine pooled proportion of infants with cCD with clinical signs, individual clinical signs, and case-fatality, random effects meta-analysis was performed. We identified 4,531 records and reviewed 4,301, including 47 articles in the narrative summary and analysis. Twenty-eight percent of cCD infants showed clinical signs (95% confidence interval (CI) = 19.0%, 38.5%) and 2.2% of infants died (95% CI = 1.3%, 3.5%). The proportion of infected infants with hepatosplenomegaly was 12.5%, preterm birth 6.0%, low birth weight 5.8%, anemia 4.9%, and jaundice 4.7%. Although most studies did not include a comparison group of non-infected infants, the proportion of infants with cCD with clinical signs at birth are comparable to those with congenital toxoplasmosis (10.0%-30.0%) and congenital cytomegalovirus (10.0%-15.0%). We conclude that cCD burden appears significant, but more studies comparing infected mother-infant dyads to non-infected ones are needed to determine an association of this burden to cCD.

Emergence of Congenital Chagas Disease in Ireland.

Chagas disease (CD) is an under-diagnosed tropical disease that is increasingly being observed outside of Latin America. We describe the first 2 infants with congenital Chagas Disease (cCD) in Ireland. Clinicians in nonendemic countries need to be aware of the potential for cCD due to the migration of women from countries of high prevalence.

Chemiluminescent Microparticle Immunoassay for the Diagnosis of Congenital Chagas Disease: A Prospective Study in Spain.

Congenital Chagas disease (CCD) has become a global health problem. Historically, the diagnosis of CCD has been carried out using parasitological methods and traditional serological techniques, however, new serological techniques such as chemiluminescent microparticle immunoassays (CMIA) have been developed in the last few years with many advantages compared with traditional serological tests. A total of 75 children born to 72 Latin American Chagas-infected mothers were consecutively enrolled and studied by CMIA and indirect immunofluorescence (IIF) at 0-2, 6, 9, and 12 months of age. At the end of the follow-up, 74 out of 75 children were considered uninfected and one child was diagnosed with CCD. Our study emphasizes the need to carry out serological follow-up on every newborn from a mother with Chagas disease and shows that CMIA assay is a great diagnostic tool as a single serological test at 9 months of age to rule out CCD or to identify possible transmission.

Is Antibody-Dependent Enhancement of Trypanosoma cruzi Infection Contributing to Congenital/Neonatal Chagas Disease?

The newborns of women infected with the parasite Trypanosoma cruzi (the agent of Chagas disease) can be infected either before birth (congenitally), or after birth (as e.g., by vector route). Congenital Chagas disease can induce high levels of neonatal morbidity and mortality. Parasite-infected pregnant women transmit antibodies to their fetus. Antibodies, by opsonizing parasites, can promote phagocytosis and killing of T. cruzi by cells expressing FcγR, on the mandatory condition that such cells are sufficiently activated in an inflammatory context. Antibody-dependent enhancement (ADE) is a mechanism well described in viral infections, by which antibodies enhance entry of infectious agents into host cells by exploiting the phagocytic FcγR pathway. Previously reported Chagas disease studies highlighted a severe reduction of the maternal-fetal/neonatal inflammatory context in parasite-transmitting pregnant women and their congenitally infected newborns. Otherwise, experimental observations brought to light ADE of T. cruzi infection (involving FcγR) in mouse pups displaying maternally transferred antibodies, out of an inflammatory context. Herein, based on such data, we discuss the previously unconsidered possibility of a role of ADE in the trans-placental parasite transmission, and/or the development of severe and mortal clinical forms of congenital/neonatal Chagas disease in newborns of T. cruzi-infected mothers.

Diagnostic Accuracy of Two Molecular Tools for Diagnosis of Congenital Chagas Disease.

BACKGROUND AND OBJECTIVE: The real prevalence of congenital Chagas disease is undefined because of difficulties in the detection of Trypanosoma cruzi by microscopic examination. The aim of this study was to determine the diagnostic accuracy of two molecular diagnostic tools, qPCR and LAMP, in the diagnosis of congenital Chagas disease in a clinical setting. METHODS: To this end, we conducted a prospective cohort study in a tertiary care center, of infants under 9 months of age, born in Buenos Aires to women with Chagas disease. Blood samples were collected for microscopic examination and molecular diagnosis at baseline. If negative, infants were followed up until 9 months of age to determine a final diagnosis by serology. In-house qPCR and LAMP previously validated were challenged as index tests. RESULTS: A total of 154 participants were potentially eligible, 120 of whom were enrolled. Finally, 102 (66.2%) of them fulfilled the follow-up. The diagnosis of congenital Chagas disease was confirmed in 13 infants and excluded in 89. Both the sensitivity and specificity of the qPCR were 100.0% (95% confidence interval 75.3-100.0 and 95% confidence interval 95.9-100.0, respectively), whereas the sensitivity and specificity of LAMP were 69.2% (95% confidence interval 38.6-90.9) and 100% (95% confidence interval 95.9-100.0), respectively. CONCLUSIONS: The qPCR agreed with the current diagnostic algorithm, and was a reliable and sensitive tool to detect congenital Chagas disease earlier, providing an appropriate and timely identification of infected infants requiring treatment. LAMP was able to detect congenital Chagas disease in infected infants by naked-eye visualization in accordance with a microscopic examination. The advantages of molecular diagnostic tools should be taken into account by the health system to improve congenital Chagas disease diagnosis.

Prospective multicenter evaluation of real time PCR Kit prototype for early diagnosis of congenital Chagas disease.

BACKGROUND: Current algorithm for Congenital Chagas Disease (cCD) diagnosis is unsatisfactory due to low sensitivity of the parasitological methods. Moreover, loss to follow-up precludes final serodiagnosis after nine months of life in many cases. A duplex TaqMan qPCR kit for Trypanosoma cruzi DNA amplification was prospectively evaluated in umbilical cord (UCB) and peripheral venous blood (PVB) of infants born to CD mothers at endemic and non-endemic sites of Argentina. METHODS: We enrolled and followed-up 370 infants; qPCR was compared to gold-standard cCD diagnosis following studies of diagnostic accuracy guidelines. FINDINGS: Fourteen infants (3·78%) had cCD. The qPCR sensitivity and specificity were higher in PVB (72·73%, 99·15% respectively) than in UCB (66·67%, 96·3%). Positive and negative predictive values were 80 and 98·73% and 50 and 98·11% for PVB and UCB, respectively. The Areas under the Curve (AUC) of ROC analysis for qPCR and micromethod (MM) were 0·81 and 0·67 in UCB and 0·86 and 0·68 in PVB, respectively. Parasitic loads ranged from 37·5 to 23,709 parasite equivalents/mL. Discrete typing Unit Tc V was identified in five cCD patients and in six other cCD cases no distinction among Tc II, Tc V or Tc VI was achieved. INTERPRETATION: This first prospective field study demonstrated that qPCR was more sensitive than MM for early cCD detection and more accurate in PVB than in UCB. Its use, as an auxiliary diagnostic tool to MM will provide more accurate records on cCD incidence. FUNDING: FITS SALUD 001-CHAGAS (FONARSEC, MINCyT, Argentina) to the Public-Private Consortium (INGEBI-CONICET, INP-ANLIS MALBRAN and Wiener Laboratories); ERANET-LAC-HD 328 to AGS and PICT 2015-0074 (FONCYT, MinCyT) to AGS and FA.

Chagas Congenital Screening in Switzerland: Processes of Recognition and Knowledge-Sharing.

Disparities in control mechanisms to prevent the spread of Chagas disease in Switzerland raise questions about the process of its recognition as a public health problem, particularly as it concerns migrant populations. With a focus on congenital screening practices, I explore the way in which health care providers experience, problematize and respond to the disease, acting as key agents not only in the provision of care but also in the recognition of Chagas disease as a problem that needs to be addressed. Such an approach contributes to the understanding of processes of public health agenda creation around neglected tropical diseases in non-endemic countries.

Circulating Cytokine and Chemokine Profiles of Trypanosoma cruzi-Infected Women During Pregnancy and Its Association With Congenital Transmission.

BACKGROUND: Trypanosoma cruzi, the causative agent of Chagas disease, can be transmitted to the offspring of infected women, which constitutes an epidemiologically significant parasite transmission route in nonendemic areas. It is relevant to evaluate differentially expressed factors in T. cruzi-infected pregnant women as potential markers of Chagas congenital transmission. METHODS: Circulating levels of 12 cytokines and chemokines were measured by enzyme-linked immunosorbent assay or cytometric bead array in T. cruzi-infected and uninfected pregnant women in their second trimester of pregnancy and control groups of T. cruzi-infected and uninfected nonpregnant women. RESULTS: Trypanosoma cruzi-infected women showed a proinflammatory Th1-biased profile, with increased levels of tumor necrosis factor (TNF)-α, interleukin (IL)-12p70, IL-15, and monokine induced by interferon-gamma (MIG). Uninfected pregnant women presented a biased response towards Th2/Th17/Treg profiles, with increased plasma levels of IL-5, IL-6, IL-1ß, IL-17A, and IL-10. Finally, we identified that high parasitemia together with low levels of TNF-α, IL-15, and IL-17, low TNF-α/IL-10 ratio, and high IL-12p70 levels are factors associated with an increased probability of Chagas congenital transmission. CONCLUSIONS: Trypanosoma cruzi-infected pregnant women who did not transmit the infection to their babies exhibited a distinct proinflammatory cytokine profile that might serve as a potential predictive marker of congenital transmission.

Congenital chagas disease: Development and assessment of a specific IgM capture-based assay for diagnosis of transmission.

Transplacental transmission by Trypanosoma cruzi (T. cruzi) infection can be effectively treated if parasiticide drugs are administered as early as possible during childhood. Furthermore, an ideal situation would be to diagnose the infection near birth in order to avoid the loss of patients during the subsequent follow-up. These situation are desirable due to the maximum benefit of drugs in early stages which, consequently, implies a relevant contribution to eliminate mother-to-child transmission. However, available techniques for that purpose have limitations as being operator-dependent (microhematocrit), require several months follow-up (IgG detection) or specialized laboratories (PCR). In this study we propose to detect specific IgM antibodies (Ab) by developing a capture-based ELISA employing an improved antigen (Ag) to diagnose the transplacental transmission of T. cruzi, and in consequence, to enhance access to effective treatment. Firstly, a new chimera Ag (CP4) was obtained from the fusion of CP1 and CP3 protein, carrying FRA, SAPA, MAP, TSSAII/V/VI and TcD Ag from T. cruzi. Then, we optimized the assay by capturing IgM Ab with a polyclonal anti-IgM Ab and evaluating three Ag formulations to detect specific IgM bound. The formulations were formed as follows: i) F1: CP1 and CP3; ii) F2: CP1, CP3, B13 and P2ß; iii) F3: by CP4. Detection of Ab-binding Ag was carried out using an anti-His Ab since all Ag were expressed with a His-tag. The evaluation panel consisted of sera from vertically infected children under 1-year-old (6 younger than 15 days, 7 older) and samples from non-infected children of women with chronic Chagas Disease. The ELISA assay employing CP4 showed better performance with notable high sensitivity and specificity (92.3% and 93.9%, respectively). Positive and negative likelihood ratios of the test (15.2 and 0.082) suggest its potential clinical relevance in term of post-test probability of infection. In conclution, we developed a standardized and non-operator dependent test to detect specific anti-T. cruzi IgM Ab. Although increased sample size is needed for its validation, our results indicate that this capture-based technique employing CP4 Ag can certainly improve the diagnosis of connatal infection.

Trypanosoma cruzi loop-mediated isothermal amplification (Trypanosoma cruzi Loopamp) kit for detection of congenital, acute and Chagas disease reactivation.

A Trypanosoma cruzi Loopamp kit was recently developed as a ready-to-use diagnostic method requiring minimal laboratory facilities. We evaluated its diagnostic accuracy for detection of acute Chagas disease (CD) in different epidemiological and clinical scenarios. In this retrospective study, a convenience series of clinical samples (venous blood treated with EDTA or different stabilizer agents, heel-prick blood in filter paper or cerebrospinal fluid samples (CSF)) from 30 infants born to seropositive mothers (13 with congenital CD and 17 noninfected), four recipients of organs from CD donors, six orally-infected cases after consumption of contaminated guava juice and six CD patients coinfected with HIV at risk of CD reactivation (N = 46 patients, 46 blood samples and 1 CSF sample) were tested by T. cruzi Loopamp kit (Tc LAMP) and standardized quantitative real-time PCR (qPCR). T. cruzi Loopamp accuracy was estimated using the case definition in the different groups as a reference. Cohen's kappa coefficient (κ) was applied to measure the agreement between Tc LAMP (index test) and qPCR (reference test). Sensitivity and specificity of T. cruzi Loopamp kit in blood samples from the pooled clinical groups was 93% (95% CI: 77-99) and 100% (95% CI: 80-100) respectively. The agreement between Tc LAMP and qPCR was almost perfect (κ = 0.92, 95% CI: 0.62-1.00). The T. cruzi Loopamp kit was sensitive and specific for detection of T. cruzi infection. It was carried out from DNA extracted from peripheral blood samples (via frozen EDTA blood, guanidine hydrochloride-EDTA blood, DNAgard blood and dried blood spots), as well as in CSF specimens infected with TcI or TcII/V/VI parasite populations. The T. cruzi Loopamp kit appears potentially useful for rapid detection of T. cruzi infection in congenital, acute and CD reactivation due to HIV infection.

Seroprevalence of Trypanosoma cruzi Infection in Pregnant Women Suggests a High Risk for Congenital Transmission in Central Veracruz, Mexico.

PURPOSE: The state of Veracruz, Mexico, is a well-recognized endemic region for Chagas disease, but congenital transmission has not been extensively studied. We estimated here the prevalence and the risk of congenital transmission of Trypanosoma cruzi in pregnant women from 27 municipalities of central Veracruz. METHODS: 528 sera from pregnant women were analyzed by ELISA and IFA assays for the detection of IgG antibodies against T. cruzi. RESULTS: The presence of anti-T. cruzi antibodies was identified in women from 17 municipalities, obtaining an overall seroprevalence of 17.0%. A higher seropositivity was observed in the municipalities of Orizaba (25.2%), Nogales (13.6%), and Río Blanco (10.5%). The results suggest that there is a high risk of congenital transmission of T. cruzi in the region. CONCLUSION: There are currently limited actions for the surveillance and control of congenital transmission of Chagas disease in Veracruz.

Epidemiology of Chagas disease in pregnant women and congenital transmission of Trypanosoma cruzi in the Americas: systematic review and meta-analysis.

OBJECTIVE: To estimate the prevalence of Chagas disease in pregnant women and the vertical transmission of the disease. METHODS: Observational studies were identified from eight electronic databases, and details on study design, population and prevalence of Chagas disease were extracted. The data were pooled using a random-effects model, and choropleth maps were created based on geopolitical regions and countries. RESULTS: The search identified 7788 articles, of which 50 were eligible. We observed a 9% prevalence of Chagas disease among pregnant women in the Americas (95% confidence interval [CI]: 8-10, I2  = 99.96%). High disease prevalence was identified in pregnant women in South American countries (12%, 95% CI: 11-13), while lower values were identified in pregnant women in North America (2%, 95% CI: 1-3). Countries with medium Human Development Index (HDI) had a higher prevalence of Chagas disease in pregnant women (15%, 95% CI: 13-16, I2  = 99.98%) than countries with high HDI (3%, 95% CI: 2-3). The rate of vertical transmission in the continent was 2% (95% CI: 1-2). The statistical analysis showed that this heterogeneity was explained by the study design, region of the Americas and mean income of the country. CONCLUSION: South and Central American countries have a high prevalence and vertical transmission of Chagas disease. Therefore, systematic screens for this disease during the prenatal period are necessary in addition to the diagnosis and treatment of children at risk for Trypanosoma cruzi infection.

OBJECTIF: Estimer la prévalence de la maladie de Chagas chez les femmes enceintes et la transmission verticale de la maladie. MÉTHODES: Des études d'observation ont été identifiées à partir de huit bases de données électroniques et des détails sur la concept de l'étude, la population et la prévalence de la maladie de Chagas ont été extraits. Les données ont été regroupées à l'aide d'un modèle à effets aléatoires et des cartes choroplèthes ont été créées en fonction des régions et des pays géopolitiques. RÉSULTATS: La recherche a identifié 7.788 articles, dont 50 étaient éligibles. Nous avons observé une prévalence de 9% de la maladie de Chagas chez les femmes enceintes dans les Amériques (intervalle de confiance [IC] à 95%: 8-10, I2 = 99,96%). Une prévalence élevée de la maladie a été identifiée chez les femmes enceintes dans les pays d'Amérique du Sud (12%, IC95%: 11-13), tandis que des valeurs plus faibles ont été identifiées chez les femmes enceintes d'Amérique du Nord (2%, IC95%: 1-3). Les pays à indice de développement humain (IDH) moyen présentaient une prévalence plus élevée de la maladie de Chagas chez les femmes enceintes (15%, IC95%: 13-16, I2 = 99,98%) que les pays à IDH élevé (3%, IC95%: 2 -3). Le taux de transmission verticale sur le continent était de 2% (IC95%: 1-2). L'analyse statistique a montré que cette hétérogénéité s'expliquait par le concept d'étude, la région des Amériques et le revenu moyen du pays. CONCLUSION: Les pays d'Amérique du Sud et d'Amérique centrale ont une prévalence élevée et de transmission verticale de la maladie de Chagas. Par conséquent, des dépistages systématiques de cette maladie pendant la période prénatale sont nécessaires en plus du diagnostic et du traitement des enfants à risque d'infection par Trypanosoma cruzi.

Pregnancy and Chagas Disease: Benznidazole's Impact on Pregnancy and Newborns: A Report of Four Cases.

In recent decades and because of migration, Chagas disease has become a global public health problem. A significant focus has been placed on pregnant women who can transmit the disease to their offspring. Here, we report four cases of women who did not know that they were pregnant while they were being treated with benznidazole. A diagnosis was established according to serology and Trypanosoma cruzi polymerase chain reaction (PCR)-standardized tests. Treatment was discontinued when pregnancy was confirmed, and a thorough follow-up was carried out. Although each case was different, none of the mothers developed health problems during pregnancy, and their newborns were delivered without any teratogenic effects.

Congenital Chagas Disease in the United States: The Effect of Commercially Priced Benznidazole on Costs and Benefits of Maternal Screening.

Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors, and through transfusions, transplants, insect feces in food, and mother to child during gestation. An estimated 30% of infected persons will develop lifelong, potentially fatal cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment for Chagas disease in the United States, including the cost of commercially available benznidazole. We compare costs of testing and treatment for mothers and infants with the lifetime societal costs without testing and consequent morbidity and mortality due to lack of treatment or late treatment. We constructed a decision-analytic model, using one tree that shows the combined costs for every possible mother-child pairing. Savings per birth in a targeted screening program are $1,314, and with universal screening, $105 per birth. At current screening costs, universal screening results in $420 million in lifetime savings per birth-year cohort. We found that a congenital Chagas screening program in the United States is cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence greater than 0.06% compared with no screening program.

Chagas congénito en atención primaria de la salud en la Provincia de Santa Fe / Congenital Chagas disease in primary health care in Santa Fe province

Actualmente, la transmisión transplacentaria es la vía más frecuente de infección por Trypanosoma cruzi. El diagnóstico y tratamiento temprano de hijos infectados evita el riesgo de desarrollar miocardiopatía y las niñas dejan de ser potenciales fuentes de transmisión congénita. En este estudio se evaluó el seguimiento de hijos de mujeres infectadas por T. cruzi en Centros de Salud de la provincia de Santa Fe. Se estudiaron 19 madres y sus 51 hijos. 45% (23/51) de los hijos no habían sido estudiados previamente, y de éstos 21/23 resultaron negativos mientras que dos niñas de 3 y 7 años estaban infectadas. Los 28 niños restantes ya habían sido estudiados en los Centros de Salud, siendo positivas dos gemelas de 22 meses y una niña de 9 años; los otros 25/28 hijos no estaban infectados. Un 47% (9/19) de las madres tenían como único antecedente la serología materna positiva, y de las 4 mujeres que transmitieron la infección, tres pertenecían a este grupo. La edad promedio de diagnóstico fue: 20±6 años en las madres y 7,4±6,7 años en los hijos. Se requieren estrategias sanitarias que favorezcan el estudio para la infección por T. cruzi en mujeres antes del embarazo y el seguimiento de todos los hijos para no perder la oportunidad de tratamiento

Transplacental transmission is currently the most frequent route of infection by Trypanosoma cruzi. Early diagnosis and treatment of infected children avoids the risk of developing cardiomyopathy, and girls are no longer potential sources of congenital transmission. This study evaluated the follow-up of children of women infected with T. cruzi in Primary Care Centres of the province of Santa Fe. Nineteen mothers and their 51 children were studied. Among the 51 children, 23 had no previous diagnosis (45%). Of these, 21 were negative while 2 girls, ages 3 and 7, were infected. The remaining 28 children already had a diagnosis at the Health Centres, with 2 twins of 22 months and a 9-year-old girl who were positive; the other 25 children were not infected. Among the 19 mothers, 9 (47%) had the positive maternal serology as the only antecedent. Of the 4 women who transmitted the infection, 3 belonged to this group. The average age of diagnosis was: 20 ± 6 years in mothers and 7.4 ± 6.7 years in children. Health strategies are required to promote the detection of infected women before pregnancy and the monitoring of all children so as not to miss the opportunity for treatment

Informe especial: Transmisión vertical de Chagas: situación epidemiológica de Chagas en embarazo y Chagas congénito en la maternidad Sardá: Primer semestre de 2018 / Special report: Vertical transmission of Chagas: epidemiological situation of Chagas in pregnancy and congenital Chagas in Sardá Maternity: first semester of 2018

Hasta la Semana Epidemiológica 36 de 2018 se notificaron en la Ciudad de Buenos Aires 104 casos de Chagas congénito, de los cuales se confirmaron 6 (5,8%), se descartaron 6 y el 88% restante aún no cuenta con el cierre de caso. Las comunas del sur de la Ciudad acumulan el 56% de los casos. Durante el primer semestre de 2018 se diagnosticaron en la Maternidad Sardá 67 mujeres con Chagas en el embarazo, de un total de 2972 partos realizados en la institución en ese periodo, lo que representa una prevalencia de 22,54 por cada mil embarazadas En este informe se busca describir la situación de la transmisión vertical de la enfermedad de Chagas en el primer semestre de 2018, entre SE 1 y 26; describir la modalidad de notificación de los casos por la Unidad de Promoción y Protección de la Salud (P y P); y reforzar la importancia de la notificación de Enfermedades de Notificación Obligatoria debido a su relevancia en la Salud Pública. Se presentan los casos de Chagas en embarazo por grupo etario, y según provincia de residencia, y se detallan propuestas para la optimización de resultados.

Congenital Chagas Disease in the Ecuadorian Amazon: Maternal Screening at Delivery and Evaluation of Risk Factors Associated with Vector Exposure.

Congenital infection with Trypanosoma cruzi remains a major route for Chagas disease transmission in endemic and non-endemic regions. We evaluated an intervention strategy aimed to detect congenital Chagas disease cases at a major hospital in the Ecuadorian Amazon via cord blood analysis at the time of delivery. All women giving birth at the hospital during the study period (191) were invited to participate. Among them, two (1.0%) did not adjust to the inclusion criteria and four (2.1%) declined to participate in the study, showing the intervention had good acceptability among the mothers. It was possible to obtain cord blood samples during 146 of the deliveries, and only one woman was found to be seropositive, without evidence of transmission to the newborn at delivery or 8 months later. In addition, sociodemographic and economic characterization of the study population revealed that few women had previous knowledge about Chagas disease (16.1%) whereas more than half (62.5%) recognized the vector. Recognizing the vector and having seen it indoors were associated with women from rural families, involved in agriculture, and hunting in the forest. Interestingly, most women (87.3%) reported having easy access to Ecuador's national health system, suggesting serological screening during prenatal visits would be of value in this province. With a proper prenatal screening system in place, cord blood screening would allow for timely detection of T. cruzi infection in newborns from both seropositive women and the minority (2.1%) of women who do not comply with prenatal care visits.