Maternal infection and congenital transmission of Trypanosoma cruzi in Santa Cruz de la Sierra, Bolivia Open Access
Tarleton, Jessica Leigh (2011)
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
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