Maternal infection and congenital transmission of Trypanosoma cruzi in Santa Cruz de la Sierra, Bolivia Público

Abstract

Introduction: The parasite Trypanosoma cruzi is the causative agent of Chagas disease,
which is a major cause of morbidity and mortality in Latin American
countries. Although aggressive vector control has reduced the spread of the disease,
congenital (mother-to-child) transmission perpetuates the disease in populations. Bolivia
has the highest prevalence of T. cruzi infection in the world, with an estimated 1500 new
congenital infections each year.

Objectives: First, we sought to identify factors associated with risk of T. cruzi infection
in pregnant women in Santa Cruz de la Sierra, Bolivia. Second, we examined
demographic, epidemiologic, and biologic risk factors for congenital transmission from
T. cruzi-infected women to their infants. Third, we examined the sensitivity, specificity,
and feasibility of different approaches to maternal and infant diagnosis.

Methods: Women presenting for delivery at Hospital Japonés in Santa Cruz de la Sierra,
Bolivia were asked to participate. Cord blood was taken, and characteristics of the
delivery and neonatal exam were recorded. Diagnosis of mother and infant involved a
combination of standard serologic tests, microhematocrit, and an experimental rapid
diagnostic test. Infants of infected mothers followed up until 9 months to rule out
congenital infection.

Results: Of 467 women, 97 (20.8%) were infected with T. cruzi, and 7 (7.2%) of these
transmitted the parasite to their infants. Lower levels of education, older age (OR 1.070,
95% CI 1.036, 1.105), and years spent in an infested house (OR 1.021, 95% CI 1.002,
1.041) were associated with maternal infection. Premature rupture of membranes is
marginally associated with congenital transmission (p=0.0725). The majority of infants
were diagnosed by micromethod by 30 days of age, but only 25% of infants of infected
mothers completed 9 months of follow up.

Table of Contents

Table of contents

Introduction………………………………………………………………… 1
Review of the Literature…………………………………………….. 5
Methods…………………………………………………………………….. 16
Results………………………………………………………………........ 19
Conclusions and Recommendations…………………………… 24
References…………………………………………………………....…. 34
Tables and Figures………………………………………………...…. 40

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	congenital infection Chagas disease
Committee Chair / Thesis Advisor	Bern, Caryn, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs CDC

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