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Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia

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dc.contributor.author Kaplinski, Michelle
dc.contributor.author Jois, Malasa
dc.contributor.author Galdos-Cardenas, Gerson
dc.contributor.author Rendell, Victoria R.
dc.contributor.author Shah, Vishal
dc.contributor.author Do, Rose Q.
dc.contributor.author Marcus, Rachel
dc.contributor.author Pena, Melissa S. Burroughs
dc.contributor.author Abastoflor, Maria del Carmen
dc.contributor.author LaFuente, Carlos
dc.contributor.author Bozo, Ricardo
dc.contributor.author Valencia, Edward
dc.contributor.author Verastegui Pimentel, Manuela Renee
dc.contributor.author Colanzi, Rony
dc.contributor.author Gilman, Robert Hugh
dc.contributor.author Bern, Caryn
dc.date.accessioned 2019-02-06T14:52:17Z
dc.date.available 2019-02-06T14:52:17Z
dc.date.issued 2015
dc.identifier.uri https://hdl.handle.net/20.500.12866/5291
dc.description.abstract BACKGROUND: We studied women and their infants to evaluate risk factors for congenital transmission and cardiomyopathy in Trypanosoma cruzi-infected women. METHODS: Women provided data and blood for serology and quantitative polymerase chain reaction (PCR). Infants of infected women had blood tested at 0 and 1 month by microscopy, PCR and immunoblot, and serology at 6 and 9 months. Women underwent electrocardiography (ECG). RESULTS: Of 1696 women, 456 (26.9%) were infected; 31 (6.8%) transmitted T. cruzi to their infants. Women who transmitted had higher parasite loads than those who did not (median, 62.0 [interquartile range {IQR}, 25.8-204.8] vs 0.05 [IQR, 0-29.6]; P < .0001). Transmission was higher in twin than in singleton births (27.3% vs 6.4%; P = .04). Women who had not lived in infested houses transmitted more frequently (9.7% vs 4.6%; P = .04), were more likely to have positive results by PCR (65.5% vs 33.9%; P < .001), and had higher parasite loads than those who had lived in infested houses (median, 25.8 [IQR, 0-64.1] vs 0 [IQR, 0-12.3]; P < .001). Of 302 infected women, 28 (9.3%) had ECG abnormalities consistent with Chagas cardiomyopathy; risk was higher for older women (odds ratio [OR], 1.06 [95% confidence interval {CI}, 1.01-1.12] per year) and those with vector exposure (OR, 3.7 [95% CI, 1.4-10.2]). We observed a strong dose-response relationship between ECG abnormalities and reported years of living in an infested house. CONCLUSIONS: We hypothesize that repeated vector-borne infection sustains antigen exposure and the consequent inflammatory response at a higher chronic level, increasing cardiac morbidity, but possibly enabling exposed women to control parasitemia in the face of pregnancy-induced Th2 polarization. en_US
dc.language.iso eng
dc.publisher Oxford University Press
dc.relation.ispartofseries Clinical Infectious Diseases
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Adolescent en_US
dc.subject Adult en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Young Adult en_US
dc.subject Trypanosoma cruzi en_US
dc.subject Infant en_US
dc.subject Middle Aged en_US
dc.subject Animals en_US
dc.subject Pregnancy en_US
dc.subject Risk Assessment en_US
dc.subject Chagas disease en_US
dc.subject Bolivia en_US
dc.subject Infant, Newborn en_US
dc.subject Polymerase Chain Reaction en_US
dc.subject Antibodies, Protozoan/blood en_US
dc.subject Electrocardiography en_US
dc.subject Infectious Disease Transmission, Vertical en_US
dc.subject cardiomyopathy en_US
dc.subject Chagas Disease/congenital/epidemiology/immunology/transmission en_US
dc.subject DNA, Protozoan/blood en_US
dc.subject infectious disease transmission en_US
dc.subject vertical en_US
dc.subject Insect Vectors/growth & development en_US
dc.subject Parasitemia/epidemiology/immunology en_US
dc.subject Serologic Tests en_US
dc.subject Th2 Cells/immunology en_US
dc.subject Trypanosoma cruzi/immunology/isolation & purification en_US
dc.title Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1093/cid/civ446
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1537-6591


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