Comparing tuberculosis in children aged under 5 versus 5 to 14 years old in a rural hospital in southern Ethiopia: an 18-year retrospective cross-sectional study.

BACKGROUND: There are few data available about childhood tuberculosis (TB) in rural hospitals in low-income countries. We assessed differences in epidemiological characteristics and treatment outcomes in children with TB aged 0-4 versus 5-14 years in rural Ethiopia. METHODS: For this retrospective cross-sectional study, we analyzed childhood TB registers from a rural Ethiopian hospital. We collected data on the number of cases, type of TB, and treatment outcomes using standard definitions. By means of binary and logistic regression analyses, data were compared from 1998 to 2015 in children aged under 5 versus those aged 5-14 years. RESULTS: We included 1282 TB patients: 583 (45.5%) were under 5 years old, and 699 (54.5%) were aged 5-14 years. More than half (67.2%, n = 862) had pulmonary TB (PTB), which was more common in younger children (82.5%, 481/583) than in older ones (54.5%, 381/699; p < 0.001). Most cases of PTB (87.5%, 754/862) were smear negative, including virtually all (99.6%, 479/481) younger children and most older ones (72.2%, n = 275/381; p < 0.001). The most common types of extrapulmonary TB (EPTB) were TB adenitis (54.5%, 229/420) and bone TB (20%, 84/420). Children under five showed a lower prevalence of adenitis TB (9.9% [58/583] versus 24.5% [171/699], p < 0.001), bone TB (2.9% [17/583] versus 9.6% [69/699], p < 0.001), and abdominal TB (0.9% [5/583] versus 6.3% [44/699], p < 0.001). Most diagnoses were new cases of TB (98.2%, 1259/1282). Overall, 63.5% (n = 814) of the children successfully completed treatment (< 5 years: 56.6%, 330/583; 5-14 years: 69.2%, 489/699; p < 0.001). In total, 16.3% (n = 209) transferred to another center (< 5 years: 19.4%, 113/583; 5-14 years: 13.7%, 96/699; p = 0.006). Thirteen percent of patients (n = 167) were lost to follow-up (< 5 years: 16.0%, 93/583; 5-14 years: 10.4%, 74/699; p = 0.004). Fifty-two (4.1%) children died (no age differences). Being aged 5-14 years was independently associated with successful treatment outcomes (adjusted odds ratio 1.59; 95% confidence interval: 1.16, 1.94, p = 0.002). CONCLUSIONS: We observed a very low diagnostic yield for spontaneous sputum smear in children with TB. In this rural setting in Ethiopia, very young children tend to present with new cases of smear-negative PTB. They have less EPTB than older children but more TB meningitis and show lower rates of treatment success.

Epidemiological and clinical features of visceral leishmaniasis in children in Alicante Province, Spain.

BACKGROUND: Visceral leishmaniasis (VL) is endemic to the Mediterranean basin. In children, VL often presents with non-specific symptoms and can be life-threatening without proper treatment. AIM: To describe the epidemiological and clinical features of pediatric VL in children in Alicante, Spain. METHODS: The study included all paediatric (<15 years) cases admitted to three hospitals in the province of Alicante from May 1992 to May 2015 with diagnosis of VL (detection was either by anti-Leishmania antibodies in serology or Leishmania in blood and/or bone marrow aspirates). RESULTS: There were 38 cases of pediatric VL (18 aged <24 months, 15 aged 24-59 months and 5 aged ≥5 years). The main symptoms were fever (97.4%), followed by pallor (75.0%) and loss of appetite (46.4%). Eighty-seven per cent of patients were anaemic (haemoglobin < 9 g/dL), 73.7% had neutropenia and 68.4% had thrombocytopenia. Before 2004, 92.3% of patients were treated with meglumine antimoniate (MA) and 7.7% with liposomal amphotericin B (LAmB); after 2004, 84% were treated with LAmB and just one (16%) with MA (p < 0.001). LAmB performed better than MA in terms of mean treatment length (7.4 days vs 25.9 days, p < 0.001), time to becoming afebrile (1.7 vs 13.7 days, p < 0.001), and length of hospital stay (10.9 vs 19.4 days, p = 0.001). CONCLUSION: Paediatric VL in Alicante mainly affects children under five. Children aged ≤24 months present with a lower haemoglobin and white blood cell count. Treatment with LAmB reduces treatment length, time to becoming afebrile and length of hospital stay.

Human T-lymphotropic virus type 1 infection and disease in Spain.

: Human T-lymphotropic virus type 1 (HTLV-1) infection is a neglected disease despite roughly 15 million people are chronically infected worldwide. Lifelong less than 10% of carriers develop life-threatening diseases, mostly a subacute myelopathy known as tropical spastic paraparesis (TSP) and a lymphoproliferative disorder named adult T-cell leukemia (ATL). HTLV-1 is efficiently transmitted perinatally (breastfeeding), sexually (more from men to women) and parenterally (transfusions, injection drug user (IDU), and transplants). To date there is neither prophylactic vaccine nor effective antiviral therapy. A total of 327 cases of HTLV-1 infection had been reported at the HTLV-1 Spanish registry until December 2016, of whom 34 had been diagnosed with TSP and 25 with ATL. Overall 62% were Latin American immigrants and 13% were persons of African origin. The incidence of HTLV-1 in Spain has remained stable for nearly a decade with 20-25 new cases yearly. Of the 21 newly diagnosed HTLV-1 cases during year 2016, one was a native Spaniard pregnant woman, and four presented with symptomatic disease, including three with ATL and one with TSP. Underdiagnosis of HTLV-1 in Spain must be high (iceberg model), which may account for the disproportionate high rate of symptomatic cases (almost 20%) and the late recognition of preventable HTLV-1 transmissions in special populations, such as newborns and transplant recipients. Our current estimate is of 10 000 persons living with HTLV-1 infection in Spain. Given the large flux of immigrants and visitors from HTLV-1 endemic regions to Spain, the expansion of HTLV-1 screening policies is warranted. At this time, it seems worth recommending HTLV testing to all donor/recipient organ transplants and pregnant women regardless place of birth. Although current leukoreduction procedures largely prevent HTLV-1 transmission by blood transfusions, HTLV testing of all first-time donors should be cost-effective contributing to unveil asymptomatic unaware HTLV-1 carriers.

Schistosomiasis in European Travelers and Migrants: Analysis of 14 Years TropNet Surveillance Data.

Schistosomiasis remains one of the most prevalent parasitic diseases worldwide and the infection is frequently found in travelers and migrants. The European Network for Tropical Medicine and Travel Health conducted a sentinel surveillance study on imported schistosomiasis between 1997 and 2010. This report summarizes epidemiological and clinical data from 1,465 cases of imported schistosomiasis. Direct pathogen detection and serology were the main diagnostic tools applied. Of these, 486 (33%) cases were identified among European travelers, 231 (16%) among long-term expatriates, and 748 (51%) among non-European immigrants. Overall, only 18.6% of travelers had received pretravel advice; 95% of infections were acquired in the African region. On species level, Schistosoma mansoni was identified in 570 (39%) and Schistosoma haematobium in 318 (22%) cases; 57.5% of patients were symptomatic. Acute symptoms were reported in 27% of patients leading to earlier presentation within 3 months. Praziquantel was used in all patients to treat schistosomiasis. Many infections were detected in asymptomatic patients. In 47.4% of asymptomatic patients infection was detected by microscopy and in 39% by serology or antigen testing. Schistosomiasis remains a frequent infection in travelers and migrants to Europe. Travelers should be made aware of the risk of schistosomiasis infection when traveling to sub-Saharan Africa. Posttravel consultations particularly for returning expatriates are useful given the high potential for detecting asymptomatic infections.

Study of the prevalence of Plasmodium infections by the polymerase chain reaction (PCR) among patients with severe anaemia treated at a rural hospital in southern Ethiopia / Prevalencia de infección por Plasmodium mediante la reacción en cadena de la polimerasa (PCR) en pacientes con anemia grave atendidos en un hospital rural de sudeste de Etiopía

This study was conducted to determine the current burden of Plasmodium infections among patients with severe anaemia attending a rural hospital in southern Ethiopia. A total of 111 patients with severe anaemia (hemoglobin < 7 mg/dL) were included. The Plasmodium species causing the infection were identified using a Semi-nested Multiplex PCR. The mean age of the study population was 15 years and 26 (23.4%) individuals tested positive for malaria. Of these, 18 (16.2%) were infected by P. falciparum, 4 (3.6%) by P. vivax, and 4 by P. ovale. No significant associations between the species of Plasmodium and the sex of the patient or the haemoglobin values were found. This study showed that Plasmodium infections cause severe anaemia in one in four cases.

El estudio se ha llevado a cabo para conocer el impacto de la infección por especies de spp Plasmodium entre los pacientes con anemia grave atendidos en un hospital rural del sudeste de Etiopía. Se incluyeron en el estudio 111 pacientes con anemia grave (hemoglobina < 7 mg/dL). La infección por Plasmodium spp. se llevó a cabo mediante una PCR Semi-nested Multiplex. La media de edad de la población de estudio fue de 15 años; 26 pacientes presentaban infección por Plasmodium spp. (23.4%): 18 (16.2%) fueron para P. falciparum, 4 (3.6%) para P. vivax, and 4 (3.6%) para P. ovale. No encontramos asociación entre el tipo de Plasmodium con el sexo y el los valores de hemoglobina. Este estudio reveló la importancia que la infección por Plasmodium es responsable de la anemia grave en uno de cada cuatro pacientes evaluados.

Sevoflorano como coadyuvante en la sedación durante ventilación mecánica en pacientes médicos de Unidad de Cuidados Intensivos: resultados preliminares en una serie de casos / Sevoflorane as adjuvant for sedation during mechanical ventilation in intensive care unit medical patients: Preliminary results of a series of cases

Objective: To disclose our preliminary experience in inhalation sedation with sevoflorane in a standardized manner using the Anesthetic Conserving Device in intubated, critically ill patients in our ICU. Patients: It has been used in nine cases of adult patients, six men and three women, over 24 months. Results: A proper implementation of the protocol by physicians and the nursing staff has been achieved, meeting the goals established for sedation (RASS 0, -2) free of hepatic or renal adverse outcomes or side effects. Conclusions: In our limited experience, adjuvant inhalation sedation with sevoflorane in the ICU is safe and complementary to the use of intravenous drugs such as propofol, remifentanil and midazolam, which are currently commonly used to achieve goal-directed sedation.

Objetivo: Explicar nuestra experiencia preliminar en la utilización de sedación inhalatoria de manera estandarizada con sevoflorano mediante dispositivo Anesthetic Conserving Device en pacientes críticos intubados en nuestra UCI. Pacientes: se ha utilizado en 9 casos, en pacientes adultos, 6 hombres y 3 mujeres, durante un periodo de 24 meses. Resultados: se ha conseguido una adecuada implantación del protocolo por parte de médicos y personal de enfermería, logrando los objetivos de sedación fijados en un primer momento (RASS 0, -2) y sin obtener resultados adversos ni efectos secundarios a nivel hepático y/o renal. Conclusiones: en nuestra limitada experiencia, la sedación inhalatoria con sevoflorano coadyuvante en UCI es una técnica segura y complementaria al uso de fármacos intravenosos, como propofol, remifentanilo y midazolam, utilizados habitualmente, para lograr una sedación guiada por objetivos.

ESPGHAN 2012 Guidelines for Coeliac Disease Diagnosis: Validation Through a Retrospective Spanish Multicentric Study.

OBJECTIVES: A large retrospective multicentre study was conducted in Spain to evaluate the efficiency of the new European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) criteria for the diagnosis of coeliac disease (CD). METHODS: The study protocol was approved by the ethics committee of Hospital Universitari i Politècnic La Fe (Valencia, Spain). The present study included 2177 children (ages 0.6-15.9 years) with small bowel biopsy (SBB) performed for diagnostic purposes (from 2000 to 2009) and with a minimum 2-year follow-up after biopsy. RESULTS: CD was diagnosed in 2126 patients (97.5%) and excluded in 51 (2.5%). Tissue transglutaminase antibodies (TG2A), anti-endomysial antibodies (EMA), and human leukocyte antigen (HLA) were reported in 751 patients, 640 symptomatic and 111 asymptomatic. TG2A levels >10 times the upper limit of normal, plus positive EMA and HLA DQ2 and/or DQ8 haplotypes, were found in 336 symptomatic patients, all of them with final diagnosis of CD. In 65 of 69 asymptomatic patients, 65 had confirmed CD and 4 did not have CD. According to the 2012 ESPGHAN guidelines, SBB may have been omitted in 52% of the symptomatic patients with CD with serologic and HLA available data. Gluten challenge was performed in 158 children, 75 of them <2 years at first biopsy. Only 1 patient in whom according to the new proposed diagnostic criteria gluten challenge would not have been mandatory did not relapse. CONCLUSIONS: Our results support the new ESPGHAN 2012 guidelines for diagnosis of CD can be safely used without the risk of overdiagnosis. A prospective multicentre study is needed to confirm our results.

Whipple's disease diagnosed during anti-tumor necrosis factor alpha treatment: two case reports and review of the literature.

INTRODUCTION: Whipple's disease is a rare infectious disease caused by Tropheryma whipplei with protean clinical manifestations. This infection may mimic chronic inflammatory rheumatisms. CASE PRESENTATION: We report two cases of Whipple's disease diagnosed in the context of an inflammatory disease with anti-tumor necrosis factor alpha failure. The first patient was a 58-year-old white man with psoriatic spondylarthritis, who was treated with adalimumab, etanercept, infliximab, tocilizumab and golimumab. The second was a 73-year-old white man with rheumatoid arthritis, who received treatment with infliximab, then etanercept and rituximab. CONCLUSIONS: Whipple's disease should be suspected in all patients diagnosed with chronic inflammatory rheumatism, partially controlled or not controlled by treatment with tumor necrosis factor alpha blockers, whose condition worsens after treatment.

Use of the Barthel index, activities of daily living, in dermatologic surgery in patients aged 80 years and older.

BACKGROUND: Dermatologists often attend elderly patients with non-melanoma skin cancer (NMSC). There is a lack of information regarding the optimum treatment for elderly patients with NMSC. METHODS: The objective of this study was to describe changes in the Barthel Index (BI) after dermatologic surgery for NMSC in patients aged 80 years and older. A prospective observational study was carried out in patients aged 80 years and older diagnosed with NMSC and treated with conventional dermatologic surgery. BI was performed by direct interview with the patients and/or their caregiver before the surgery, seven and 30 days after the surgery. RESULTS: A total of 180 dermatologic surgeries were performed in 144 patients. The average age of the patients was 84.2 years. There were 84 men (58.3%) and 60 women (41.7%). Mean BI score was 85.9 at baseline, 85.3 on day 7 after surgery, and 85.6 on day 30, showing minimal changes after dermatologic surgery. Changes in the BI occurred mainly in dressing, toilet use, transfers, mobility (on level surfaces) and walking stairs. CONCLUSIONS: Activities of daily living were not significantly affected in patients aged 80 years and older, after dermatologic surgery for NMSC.

[Infection due to Rothia mucilaginosa. A respiratory pathogen?]. / Infección por Rothia mucilaginosa. ¿Un patógeno respiratorio?

INTRODUCTION: To describe the spectrum of infections caused by Rothia mucilaginosa. METHODS: Retrospective study of 20 cases diagnosed with R. mucilaginosa from 2009 to 2012. RESULTS: Pulmonary infection was the most frequent clinical presentation (n=14, 70%): bronchiectasis infected (10), followed by pleural empyema (2), pneumonia (1) and acute bronchitis (1). Two episodes were of gastrointestinal origin: cholangitis secondary to biliary drainage and secondary peritonitis. Two episodes included bacteremia in patients with hematological malignancy. One patient had a surgical wound infection with bacteremia, and another had a bacteremic urinary tract infection in a patient with nephrostomy. DISCUSSION: R. mucilaginosa may be responsible for infections of the lower respiratory tract in predisposed patients.

Hospital admissions in Alicante (Spain): a comparative analysis of foreign citizens from high-income countries, immigrants from low-income countries, and Spanish citizens.

BACKGROUND: Over the last decade, the number of foreign citizens (FCs) in Spain has increased. There is no doubt that their health has become a relevant subject from the point of view of public healthcare. Our study aimed to describe hospital admission rates, diagnoses at hospital discharge, and mortality during hospital admissions in FCs from high-income countries (FCHICs), FCs from low-income countries (FCLICs), and autochthonous citizens (ACs). METHODS: A cross-sectional study was performed at two public hospitals in the city of Alicante (Spain) and its surrounding area. Utilization rates were estimated. Multivariate analysis adjusting for age and sex was performed on hospital admission rates, diagnoses at hospital discharge, service of admission, and mortality during hospital admission in FCHICs and FCLICs compared with ACs (adjusted odds ratio [AOR] with 95% confidence intervals [CI]). RESULTS: 42,839 patients ≥15 years were discharged from the hospitals. The utilization rate was lower in FCs than ACs, whose crude rate ratio was 0.676 (95% CI: 0.656-0.696). FCHICs had more risk of being diagnosed at discharge in the categories of the circulatory system (AOR: 1.55; 95% CI: 1.35-1.77), neoplasms (AOR: 1.21; 95% CI: 1.03-1.42), and injury and poisoning (AOR: 1.33; 95% CI: 1.11-1.58). FCLICs had more risk of being diagnosed in the categories of pregnancy, childbirth & puerperium (AOR: 1.33; 95% CI: 1.29-1.59), and injury and poisoning (AOR: 1.19; 95% CI: 1.03-1.36), and less risk in the mental disorder category (AOR: 0.32; 95% CI: 0.22-0.45). The length of hospitalization (in days) was lower in FCLICs (median: 3; IQR: 2-6) than both ACs (median: 4; IQR: 2-8) and FCHICs (median: 4; IQR: 2-8) (p < 0.001). The mortality rates on admission of ACs, FCHICs, and FCLICs were 4.2%, 3.3%, and 1.3%, respectively, but after adjusting for age and sex, the mortality rate risks were similar in FCHICs and FCLICs. CONCLUSION: First, FCs utilized hospitalization less when compared with ACs. Second, the hospitalization profile for FCHICs was similar to ACs, with more problems in the circulatory system, and the hospitalization profile for FCLICs was different compared with ACs, with more admissions for pregnancy, childbirth & puerperium.

Characteristics and outcome in nonagenarians admitted in general internal medicine and other specialties.

UNLABELLED: To describe the characteristics of nonagenarians admitted to the surgical and medical divisions at a tertiary hospital and compare them with nonagenarians admitted to other hospital care services. METHODS: A retrospective study of all hospital discharge episodes via the registry of the Basic Minimum Data Set at the Hospital General Universitario de Alicante from January 2007 until December 2011. RESULTS: Of the 165,870 hospitalizations, 2461 (1.5%) were nonagenarians. The highest number of admitted nonagenarians was in the Division of General Internal Medicine (DGIM) (n=751), followed by the short stay unit (SSU) (n=633). The rate of nonagenarians per 100 admissions to the DGIM was 10.2, significantly higher than that of those admitted to the SSU (6.2) (p<0.001), the service of orthopedic and trauma surgery (2.2) (p<0.001), and other specialties. Females comprised 64.8% of the nonagenarians. Mortality was 17% for the nonagenarians admitted, while for those admitted to the DGIM it was 27.7%. Those hospitalized in the SSU had a lower risk of death during hospitalization (8.1%) (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.16-0.32) and a greater risk of being admitted for diseases and disorders of the circulatory system (OR: 1.58, 95% CI: 1.22-2.05), particularly for heart failure and shock (OR: 1.82, 95% CI: 1.30-2.53), and being discharged with home hospitalization (OR: 8.05, 95% CI: 5.5-11.8). CONCLUSIONS: Nonagenarian patients represent a tenth of those admitted to the DGIM. The profile of nonagenarians admitted to the DGIM is different from other hospital services. Hospital mortality for nonagenarians admitted to the DGIM is high and superior to other hospital services.

Association between HLA alleles and HAM/TSP in individuals infected with HTLV-1.

HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) develops in less than 5 % of HTLV-1 carriers. It is unclear which factors trigger the development of disease. The aim of this study was to explore the influence of HLA alleles on the development of HAM/TSP. A total of 40 HTLV-1-infected individuals belonging to the Spanish HTLV-1 cohort were examined. HTLV-1 proviral load was measured by real-time polymerase chain reaction. HLA class I (A, B, C) and class II (DRB1, DQB1) alleles were genotyped using the bead array technology. Median HTLV-1 proviral load in 12 HAM/TSP patients was greater than in 28 asymptomatic carriers (637 vs. 71 copies per 10(4) peripheral blood mononuclear cells; p = 0.006). Moreover, HAM/TSP was significantly associated with HLA-B 07 and HLA-DRB1 01:01 (p = 0.039). Interestingly, individuals with these HLA alleles had greater HTLV-1 proviral load than asymptomatic carriers (p = 0.036). In summary, HLA testing should be considered in asymptomatic HTLV-1 individuals and close monitoring of HTLV-1 proviral load along with periodic neurological evaluations should be prioritized in HLA-DRB1 01:01 and HLA-B 07 carriers.

Negative effect of immunosuppressive therapy in the performance of the QuantiFERON gold in-tube test in patients with immune-mediated inflammatory diseases.

To compare the tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFG) for the detection of latent tuberculosis infection among patients with immune-mediated inflammatory diseases before antitumor necrosis factor-α therapy. A prospective study including 153 consecutive patients with rheumatoid arthritis (n = 53), psoriasis (n = 45), inflammatory bowel disease (n = 25), and spondyloarthropathy (n = 22) were included. QFG and TST were performed simultaneously. TST was positive in 43/153 (28.1 %) patients. QFG (cutoff ≥ 0.35 IU/ml) was positive in 15/153 (9.8 %) patients, and indeterminate in one (0.7 %). QFG (cutoff ≥ 0.10 IU/ml) was positive in 25/153 (16.3 %). 59.5 % of the patients were on immunosuppressive therapy at the time of testing. There was a significant difference in the rate of positive QFG between patients with and without immunosuppressive therapy after adjustment for age and gender (cutoff ≥ 0.35 IU/ml, 4.6 vs. 17.4 %; adjusted odds ratio [AOR], 0.2; 95 % confidence interval [CI], 0.06-0.8; p = 0.03 and cutoff ≥ 0.10 IU/ml, 11.2 vs. 24.2 %; AOR, 0.3; 95 % CI, 0.1-0.93; p = 0.04). Agreement between TST and QFG was 'fair' (κ = 0.354 and κ = 0.365, for cutoffs ≥ 0.35 and ≥0.10 IU/ml, respectively). Among patients without immunosuppressive therapy, the concordance between TST and QFG was 'moderate-substantial' (κ = 0.593 and κ = 0.690, for cutoffs ≥ 0.35 IU/ml and ≥0.10 IU/ml, respectively). By contrast, among patients on immunosuppressive therapy the concordance was 'poor' (κ = 0.085; κ = 0.041, respectively). Immunosuppressive therapy affects negatively QFG performance. In patients with immune-mediated inflammatory diseases, QFG may have a limited role for screening of latent tuberculosis infection.

Development of tropical spastic paraparesis in human T-lymphotropic virus type 1 carriers is influenced by interleukin 28B gene polymorphisms.

Interleukin 28B (IL28B) rs12979860 polymorphisms were examined in 41 individuals with human T-lymphotrophic virus type 1 (HTLV-1). The alleles CT/TT were more frequent in 12 individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis than in 29 asymptomatic carriers (80% vs 20%; P = .03), and median HTLV-1 proviral load was greater in CT/TT than CC carriers (P = .01). Thus, IL28B testing and closer follow-up of HTLV-1 asymptomatic CT/TT carriers is warranted.

Chagas disease in Latin American pregnant immigrants: experience in a non-endemic country.

PURPOSE: Chagas disease is a systemic chronic parasitic infection by Trypanosoma cruzi endemic in Latin America. Migration of women of childbearing age from Latin America to developed countries may spread the disease to non-endemic areas through vertical transmission. METHODS: Prospective study of seroprevalence of T. cruzi infection in immigrant Latin American pregnant women during a 5-year period (from 2006 to 2010) in Spain. RESULTS: Seven out of 545 participants were seropositive for T. cruzi [prevalence 1.28%, 95% confidence interval (CI) 0.06-2.56]. Four (57%) were from Bolivia and three (43.%) from Paraguay. The seroprevalence in pregnant women from Bolivia was 10.26% (95% CI 4.06-23.58) and in participants from Paraguay was 6.52% (95% CI 2.24-17.5). No congenital transmission occurred. CONCLUSIONS: Seroprevalence of T. cruzi infection in Latin American pregnant women coming from Bolivia and Paraguay is high. Those women should be screened for T. cruzi to control mother-to-child transmission in non-endemic areas.