Tripanosomiasis en el embarazo / Trypanosomiasis in pregnancy

OBJETIVO: describir la morbimortalidad materna y perinatal causada por la tripanosomiasis en las gestantes que asisten a control en el Servicio Prenatal de la Maternidad “Concepción Palacios” y al Hospital Central de Biscucuy. MÉTODOS: Se incluyó una muestra de 828 pacientes, 178 de la zona rural y 650 de la urbana. Se realizó la pesquisa para tripanosomiasis mediante prueba rápida y confirmación por serología, de las madres positivas para tripanosomiasis. Se tomó muestra de la sangre del cordón umbilical para determinar la transmisión congénita de la enfermedad. RESULTADOS: Fueron positivas para enfermedad de Chagas 6 pacientes, para una frecuencia global de 0,72 %. Cinco de las pacientes provenían de la zona rural (2,8.%) y una del medio urbano (0,15 %). Entre las 6 pacientes positivas, 83,3 % provenía de la zona rural y 16,7 % de la urbana. La serología de los recién nacidos fue positiva en cuatro casos del medio rural y un caso del medio urbano. La reacción en cadena de la polimerasa fue positiva en 2 de los 6 neonatos de madres con la enfermedad. Las pruebas parasitológicas fueron negativas en el 100.% de los neonatos en riesgo. CONCLUSIONES: La frecuencia de tripanosomiasis fue de 0,72 %. No hubo transmisión congénita de la enfermedad.

OBJECTIVE: to describe maternal and perinatal morbidity and mortality caused by trypanosomiasis in pregnant women attending prenatal control in the obstetric service of Maternidad “Concepcion Palacios” and Hospital Central de Biscucuy. METHODS: A sample of 828 patients was included from both areas, 178 in rural and 650 urban. Research was performed by rapid test for trypanosomiasis and confirmation by serology, from mothers positive for trypanosomiasis. Sample was taken from the umbilical cord blood to determine congenital transmission of the disease. RESULTS: Were positive for Chagas disease 6 patients, for an overall frequency of 0.72 %. Five of the patients were from rural areas (2.8 %) and in urban areas (0.15 %). Between 6 positive patients, 83.3 % came from rural and 16.7 % urban areas. The newborns serology was positive in four cases of rural and urban case. The chain reaction polymerase was positive in 2 of the 6 infants of mothers with the disease. Parasitological tests were negative in 100 % of infants at risk. CONCLUSIONS: The frequency of trypanosomiasis was 0.72 %. There was not congenital transmission of the disease.

Congenital transmission of Trypanosoma cruzi in non-endemic areas: evaluation of a screening program in a tertiary care hospital in Barcelona, Spain.

The impact of Chagas disease is no longer restricted to endemic areas. The aim of this study is to evaluate a 2-year period of a vertical transmission screening program of Trypanosoma cruzi infection in a tertiary care hospital in Barcelona (Spain). Two enzyme-linked immunosorbent assays (recombinant and crude antigen) were performed in parallel to pregnant women at risk of T. cruzi infection. Discordant results were confirmed by a third diagnostic test. In the case of a positive result, the newborn was tested at birth and after 8 months of life. A total of 1,473 women met the inclusion criteria for the screening program with a resulting seroprevalence for T. cruzi of 3.5% (2.2-5.2% 95% confidence interval [95% CI]). One case of congenital infection was identified. Screening programs for vertically transmitted T. cruzi acute infection are beneficial in non-endemic areas for early detection and treatment of acute infection.

Early diagnosis of congenital Trypanosoma cruzi infection, using shed acute phase antigen, in Ushuaia, Tierra del Fuego, Argentina.

Chagas' disease, or American trypanosomiasis, is caused by the protozoan parasite Trypanasoma cruzi. It is estimated that 15,000 new cases of congenital T. cruzi transmission occur in the Americas each year. The aim of this study was to estimate the rate of congenital T. cruzi infection in infants born to infected women living in Ushuaia, Argentina, as well to assess a serologic test using Shed Acute Phase Antigen (SAPA) for a timely diagnosis of congenital infection. The rate of congenital infection among children in the study was 4.4% (3/68). Our results show that for infants younger than 30 days of age, matched blood samples from mother and infant were capable of identifying congenital transmission of infection using an enzyme-linked immunosorbent assay with SAPA. For infants older than 3 months, congenital infection could be ruled out using the same procedure.

Congenital trypanosomiasis.

The last successfully treated case of congenital trypanosomiasis in Zambia was in October 1978, with detailed analysis of immunoglobulins, illustrating the waning of blood and serum levels of IgA, IgG, and IgM during treatment, up to 99 days after treatment. Twenty-five years later, we report on a case of congenital trypanosomiasis. The disease is now rare and can be missed or dismissed as retroviral disease, particularly in adults. The main unusual symptoms were the prolonged intermittent convulsions in an otherwise well infant. Management of the disease is now more interdisciplinary, resources for laboratory support are fewer, lumbar puncture is more relevant, and antitrypanosomal drugs are more difficult to obtain. The mother died within one week of hospitalization and the infant initially responded to three doses of suramin and 3 weeks of melsopropol. Convulsions ceased during the second round of melsopropol. Unfortunately, the infant died of nosocomial infection.

Congenital trypanosomiasis in a child born in London.

A female infant of 22 months was referred to the Hospital for Sick Children, London, because of delayed psychomotor development. Extensive investigations revealed no cause, but eventually trypanosomiasis was diagnosed. The infant had not been outside the UK, but her mother came from Zaire, where the disease is endemic, but had lived in Kinshasa, where there is no sleeping sickness. It is thought, that the mother may have been asymptomatically infected by a fresh-blood transfusion four years earlier, since no other source of infection was apparent.