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Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting

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dc.contributor.author Messenger, Louisa A.
dc.contributor.author Gilman, Robert H.
dc.contributor.author Verastegui, Manuela
dc.contributor.author Galdos-Cardenas, Gerson
dc.contributor.author Sanchez, Gerardo
dc.contributor.author Valencia, Edward
dc.contributor.author Sanchez, Leny
dc.contributor.author Malaga, Edith
dc.contributor.author Rendell, Victoria R.
dc.contributor.author Jois, Malasa
dc.contributor.author Shah, Vishal
dc.contributor.author Santos, Nicole
dc.contributor.author Abastoflor, Maria Del Carmen
dc.contributor.author LaFuente, Carlos
dc.contributor.author Colanzi, Rony
dc.contributor.author Bozo, Ricardo
dc.contributor.author Bern, Caryn
dc.date.accessioned 2019-01-25T16:03:22Z
dc.date.available 2019-01-25T16:03:22Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4782
dc.description.abstract Background: Congenital Trypanosoma cruzi transmission is now estimated to account for 22% of new infections, representing a significant public health problem across Latin America and internationally. Treatment during infancy is highly efficacious and well tolerated, but current assays for early detection fail to detect >50% of infected neonates, and 9-month follow-up is low. Methods: Women who presented for delivery at 2 urban hospitals in Santa Cruz Department, Bolivia, were screened by rapid test. Specimens from infants of infected women were tested by microscopy (micromethod), quantitative PCR (qPCR), and immunoglobulin (Ig)M trypomastigote excreted-secreted antigen (TESA)-blots at birth and 1 month and by IgG serology at 6 and 9 months. Results: Among 487 infants of 476 seropositive women, congenital T. cruzi infection was detected in 38 infants of 35 mothers (7.8%). In cord blood, qPCR, TESA-blot, and micromethod sensitivities/specificities were 68.6%/99.1%, 58.3%/99.1%, and 16.7%/100%, respectively. When birth and 1-month results were combined, cumulative sensitivities reached 84.2%, 73.7%, and 34.2%, respectively. Low birthweight and/or respiratory distress were reported in 11 (29%) infected infants. Infants with clinical signs had higher parasite loads and were significantly more likely to be detected by micromethod. Conclusions: The proportion of T. cruzi-infected infants with clinical signs has fallen since the 1990s, but symptomatic congenital Chagas disease still represents a significant, albeit challenging to detect, public health problem. Molecular methods could facilitate earlier diagnosis and circumvent loss to follow-up but remain logistically and economically prohibitive for routine screening in resource-limited settings. en_US
dc.language.iso eng
dc.publisher Oxford University Press
dc.relation.ispartof urn:issn:1537-6591
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Early Diagnosis en_US
dc.subject Endemic Diseases en_US
dc.subject Adult en_US
dc.subject Antibodies, Protozoan/blood en_US
dc.subject Antigens, Protozoan/blood/immunology en_US
dc.subject Bolivia en_US
dc.subject Chagas disease en_US
dc.subject Chagas Disease/congenital/diagnosis/immunology/transmission en_US
dc.subject congenital en_US
dc.subject diagnostics en_US
dc.subject Enzyme-Linked Immunosorbent Assay/methods en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Immunoglobulin G/blood en_US
dc.subject Immunoglobulin M/blood en_US
dc.subject Infant en_US
dc.subject Infant, Low Birth Weight en_US
dc.subject Infant, Newborn en_US
dc.subject Infectious Disease Transmission, Vertical en_US
dc.subject Male en_US
dc.subject Mothers en_US
dc.subject Parasite Load en_US
dc.subject Real-Time Polymerase Chain Reaction en_US
dc.subject Trypanosoma cruzi en_US
dc.subject Trypanosoma cruzi/genetics/immunology en_US
dc.title Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1093/cid/cix277
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08


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