Serological and parasitological screening of Trypanosoma cruzi infection in mothers and newborns living in two Chagasic areas of Mexico.

BACKGROUND: Maternal-fetal transmission of Trypanosoma cruzi generally occurs in 2-12% of pregnant infected mothers. This transmission form has been poorly studied in Mexico where only one case of congenital infection published in 1998 has been reported. METHODS: We screened 145 mothers and their delivered babies in two hospitals of endemic regions in Mexico (states of Chiapas and Veracruz) searching for anti-T. cruzi antibodies and circulating parasites by hemoculture and PCR. RESULTS: In Poza Rica, Veracruz, 3/85 (3.5%) mothers were seropositive for T. cruzi infection and in Palenque, Chiapas, 3/60 (5%) cases. In total 6/145 (4.1%) were seropositive subjects. Although cord blood samples of delivered babies from seropositive mothers have IgG anti-T. cruzi antibodies, none presented PCR and positive hemoculture. CONCLUSIONS: Although a high relative seroprevalence of T. cruzi infection in pregnant women was detected, no case of vertical transmission was recognized. Undoubtedly, further studies of large samples are necessary to evaluate maternal transmission risk in Mexico.

[Chronic Chagasic Cardiomyopathy at the Hospital General de Zona no. 24 IMSS. Poza Rica, Veracruz]. / Cardiopatía chagásica crónica en el Hospital General de Zona No 24 IMSS. Poza Rica, Veracruz.

UNLABELLED: Northern Veracruz has conditions, biotic and abiotic, to support Triatomine bugs and vectorial transmission of Trypanosoma cruzi to human beings. Therefore we explore seroprevalence of antibodies to this parasite and the presence of Chronic Chagasic Cardiopathy (CCC) at Cardiology ward in a General Hospital serving North of Veracruz State, and neighbord states Hidalgo, Puebla San Luis Potosi and Tamaulipas. MATERIAL AND METHODS: We search for consecutive adult patients attending outpatient and beds assigned to Cardiology between March through September, 2003. An epidemiology questionnaire, clinical work up, chest roentgenogram, 12 lead peripheral EKG and transthoracic echocardiogram were performed in 240 female/males patients. All of them were bled to blindly search for T. cruzi antibodies. RESULTS: Seroprevalence was 8%, 49 cases of dilated cardiomyopathy were diagnosed 23 attributed to chronic diseases such as systemic hypertension diabetes mellitus or ischemic heart disease 12 with idiopathic disease and 14 (29%) had CCC. The latter accumulated epidemiologic features suggestive of vectorial infection. Four additional individuals without CCC but having specific antibodies were considered indeterminate Chagasic cases. DISCUSSION AND CONCLUSIONS: This case series identify American Trypanosomiasis among 19 people attending a Cardiology Service, and 14 of them had a severe heart disease linked to progressive and fatal course. This observation points out that Chagas disease could be a regional public health problem in Northern Veracruz.

[Epidemiological and clinical outlook of chronic Chagas' heart disease in Mexico]. / Panorama epidemiológico y clínico de la cardiopatía chagásica crónica en México.

OBJECTIVE: To compare the epidemiological and clinical characteristics of chronic Chagas' heart disease to other dilated cardiomyopathies. METHODS: A study comprising 128 patients from a heart disease center was carried out from 1993 to 2003. Of them, 51 (40%) were Trypasonoma cruzi positive. Epidemiological data was obtained through interviews and clinical and serological data from health services. Statistic analysis was conducted using the Chi-square, Fischer, Mann-Whitney or Students' t-test as well as multivariate analysis. RESULTS: Chronic Chagas' disease patients were older (55+/-10 years old) than those patients with cardiopathy (42+/-17 years old). Most of them were born in rural areas (90% vs 68%), lived in poor (75% vs 16%), crowded households (45% vs 20%), together with domestic animals (71% vs 61%) and were aware of the Chagas' vector (73% vs 25%). Rhythm and conduction ECG abnormalities as well as permanent pacemaker were common among Chagas' patients (84% vs 55%, 78% vs 64% and 24% vs 10%, respectively). Congestive heart failure was more frequent among cardiomiopathy patients (88% vs 71%). Both groups had abnormal myocardial perfusion with normal epicardial arteries. Comorbidities were more frequent in cardiomiopathy patients than in chronic Chagas' disease patient (two cases only). CONCLUSIONS: Chagas' disease is the most common cause of dilated cardiomiopathy in the study hospital. Due to its regional distribution in Mexico, it deserves special attention and control programs proven to be effective in other countries.

Cardiopatía chagásica crónica en el Hospital General de Zona No 24 IMSS. Poza Rica, Veracruz / Chronic Chagasic Cardiomyopathy at the Hospital General de Zona no. 24 IMSS. Poza Rica, Veracruz

Northern Veracruz has conditions, biotic and abiotic, to support Triatomine bugs and vectorial transmission of Trypanosoma cruzi to human beings. Therefore we explore seroprevalence of antibodies to this parasite and the presence of Chronic Chagasic Cardiopathy (CCC) at Cardiology ward in a General Hospital serving North of Veracruz State, and neighbord states Hidalgo, Puebla San Luis Potosi and Tamaulipas. MATERIAL AND METHODS: We search for consecutive adult patients attending outpatient and beds assigned to Cardiology between March through September, 2003. An epidemiology questionnaire, clinical work up, chest roentgenogram, 12 lead peripheral EKG and transthoracic echocardiogram were performed in 240 female/males patients. All of them were bled to blindly search for T. cruzi antibodies. RESULTS: Seroprevalence was 8%, 49 cases of dilated cardiomyopathy were diagnosed 23 attributed to chronic diseases such as systemic hypertension diabetes mellitus or ischemic heart disease 12 with idiopathic disease and 14 (29%) had CCC. The latter accumulated epidemiologic features suggestive of vectorial infection. Four additional individuals without CCC but having specific antibodies were considered indeterminate Chagasic cases. DISCUSSION AND CONCLUSIONS: This case series identify American Trypanosomiasis among 19 people attending a Cardiology Service, and 14 of them had a severe heart disease linked to progressive and fatal course. This observation points out that Chagas disease could be a regional public health problem in Northern Veracruz.

Panorama epidemiológico y clínico de la cardiopatía chagásica crónica en México / Epidemiological and clinical outlook of chronic Chagas' heart disease in Mexico

OBJECTIVO: Comparar las características epidemiológicas y clínicas de la cardiopatía chagásica crónica con otras miocardiopatías dilatadas. MÉTODOS: Se incluyeron a 128 pacientes consecutivos en un hospital de espcialidad, de 1993 a 2003 con miocardiopatías dilatadas, donde 51 (40 por ciento) con anti Tripanosoma cruzi. Se recopiló información epidemiológica por entrevista directa, y datos clínicos en los servicios asistenciales. Se utilizaron la prueba de la Chi-cuadrado o prueba exacta de Fischer, prueba t de Student ó la prueba de U de Mann Whitney y análisis multivariado. RESULTADOS: Los pacientes con cardiopatía chagásica crónica, eran más viejos (55±10 años) que los pacientes con miocardiopatías (42±17 años), nacieron en zonas rurales (90 por ciento vs 68 por ciento), en viviendas precarias (75 por ciento vs 16 por ciento), con hacinamiento (45 por ciento vs 20 por ciento), convivencia con animales domésticos (71 por ciento vs 61 por ciento) y conocían al vector (73 por ciento vs 25 por ciento). Los trastornos del ritmo y de la conducción, así como la colocación de marcapaso definitivo fueron frecuentes en los pacientes con cardiopatía chagásica crónica (84 por ciento vs 55 por ciento, 78 por ciento vs 64 por ciento Y 24 por ciento vs 10 por ciento respectivamente). La insuficiencia cardiaca congestiva venosa fue más frecuente en los pacientes con miocardiopatía seronegativa (88 por ciento vs 71 por ciento) y la perfusión miocárdic anormal con arterias epicárdicas normales fue igual en ambos grupos. Con respecto a co-morbilidad, los pacientes con cardiopatía chagásica crónica tenían sólo dos padecimientos, mientras que en el otro grupo era más amplia. CONCLUSIONES: La enfermedad de Chagas causa la miocardiopatía dilatada específica más común. Debido a su distribución regional en la República Mexicana, merece atención y se recomienda a nivel público adoptar medidas de prevención que ya probaron eficacia en otros países.