Our objective was to apply new tools to identify weak points in current screening algorithms, and find ways to improve them. Methods Women presenting for delivery were screened by rapid and conventional serological tests. For infants of infected mothers, blood specimens obtained on days 0, 7, 21, 30, 90, , and were concentrated and examined microscopically; serological tests were performed for the day 90, , and specimens. Maternal and infant specimens, including umbilical tissue, were tested by polymerase chain reaction PCR targeting the kinetoplast minicircle and by quantitative PCR.
|Published (Last):||17 February 2015|
|PDF File Size:||5.30 Mb|
|ePub File Size:||15.83 Mb|
|Price:||Free* [*Free Regsitration Required]|
Published online Jul Received Jan 9; Accepted May This article has been cited by other articles in PMC. Abstract Bolivia is one of the most endemic countries for Chagas disease. Data of shows that incidence is around 1.
In this article, we report results obtained during the implementation of the congenital Chagas program, one of the biggest casuistry in congenital Chagas disease, led by National Program of Chagas and Belgian cooperation from to Throughout the length of the program, a total of , pregnant women were screened and In this work, we show that it is possible to implement, with limited resources, a National Congenital Chagas Program and to integrate it into the Bolivian health system.
Keys of success are population awareness, health personnel motivation, and political commitment at all levels. Author Summary Congenital Chagas disease is the infection resulting of the transmission of T. This represents a relevant public health issue in endemic and non-endemic countries. The infected newborn detected at birth or before one year old, if treated, can be completely cured. In this work, we report results obtained from to during the implementation of a National Program based on PAHO recommendations; the implementation strategy has been adapted into the Bolivian context and integrated into the National Mother and Child Health program.
Our conclusions show that it is necessary to test all newborns from positive mothers three times before one year of age. The infant, if positive and treated with a 30 day Benznidazole course, has excellent chances of cure. Introduction Chagas' disease or American trypanosomiasis, is an antropozoonosis caused by the protozoan Trypanosoma cruzi — a blood and tissue parasite.
It currently affects 15 million people, produces more than 15 deaths each year and is the most socially and economically impacting parasitic disease in the Americas  . The infection can be contracted by vector transmission — through the feces of haemophagic vectors of the reduvidae family and the triatominae sub-family, via blood transfusion or organ transplants, via vertical or congenital transmission from an infected mother to her new born child or fetus and by oral transmission.
Other transmission mechanisms, with a minor epidemiological importance, include organ transplantation or laboratory accidents. The progressing vector control, along with the migration tendencies within and from endemic countries, has modified the distribution of the Chagas disease within the last years, and it has augmented the relative importance of the congenital transmission route.
According to a report from the Chagas scientific work team in , the annual incidence of congenital Chagas would be of over 14, newborns.
The disease is now present and has become a public health concern in the whole American continent, Europe, Japan and Australia  ,  ,  ,  , . The congenital transmission of Chagas disease was documented for the first time in , by Carlos Chagas, who had found parasites in the necropsies of two twins with convulsion episodes that died a few days after birth. Later, Dao in Venezuela , Jorg in Argentina , Howard in Chile and Bittencout and Rezende in Brazil , all describe the first cases in their respective countries .
Chagas congenital disease has also been reported in other endemic countries such as Uruguay, Paraguay, Colombia, Guatemala, Honduras and Mexico. Since then numerous articles have been published regarding congenital Chagas disease: epidemiological and clinical studies, evaluation of different diagnostic methods  , congenital Chagas as an imported disease cases reported in Spain, USA, Switzerland , and above all, highlighting the importance of the disease in terms of public health and the need for health programs concerned with its diagnosis and treatment in all the endemic countries  ,  ,  ,  ,  ,  , .
However, the initiatives for control and management of congenital Chagas in endemic countries are far from achieving total geographic coverage  ,  ,  ,  ,  ,  , . Such initiatives are not only necessary in endemic countries, but should, in a targeted way, also be implemented in countries that receive or have received significant migration flows from Latin America such as USA, Spain, Switzerland and others  ,  , .
The first congenital record in Bolivia is accredited to Azogue and col. The same authors have published various articles on studies carried out in the 80s, in which they highlight the importance of detecting congenital Chagas in areas where the vector is controlled.
Also they recommend the treatment of women in fertile age, they found hepatosplenomegaly as the most common sign in newborns and used the Strout technique in cord blood as a sensitive and less expensive diagnosis technique  , . Between and , the Chagas control program of the National Health Department of Bolivia detected a maternal seroprevalence of The results of this project, along with the investigations of international experts on congenital Chagas, were discussed in a conference which took place in Cochabamba,  , .
After that, the PAHO organized a technical meeting in Montevideo Uruguay, , where a sustainable and effective strategy for detection and treatment of congenital Chagas was designed. In this article, we report results attained from to during the implementation of the congenital Chagas program in Bolivia, and present recommendations of the course to follow in order to maintain and improve this program.
The activities revolve around three axes of action: health personnel training, laboratory diagnosis and IEC. Diagnosis of infection in pregnant women The detection of infection in pregnant women was achieved by prenatal serological screening. If at the moment of delivery the woman did not have a result on the test or had not been studied, an intravenous blood sample was taken pre-partum, postpartum or the sample was taken from the cord blood in order to perform Chagas serology.
The serological test results were noted in the women's clinical history and prenatal ID card; women with positive results had to be followed up for the monitoring of their child until 12 months of age.
Monitoring children born from a Chagas' positive mother If the woman was positive at the moment of birth, a blood sample was taken from the umbilical cord in a heparinized tube. Alternatively, a peripheral blood sample was taken from the newborn in 4 heparinized capillary tubes. This blood sample was taken to the laboratory and immediately tested using the micromethod technique as described in the literature,  ,  ,  , .
Samples had to be less than 12 hours old; samples that were over 12 hours old were discarded and a new peripheral blood sample was taken from the child in heparinized capillary tubes. This analysis was carried out by personnel who was trained in the detection of T. In case of a positive micromethod, the result was to be immediately communicated to the doctor or pediatrician on duty and treatment of the newborn was started before the mother and child left the maternity unit.
If the micromethod was negative at the time of birth, another micromethod was carried out normally between 15 days and 2 months of delivery but definitely before 6 months. Starting from 6 months and up to 12 months of age, if both micromethods were negative, a quantified serology was carried out on the child. The IHA method was employed due to its ease of use and accessibility at most of the laboratories.
Figure 1. In practice, the cases of an inconclusive serology generally happened between 6 and 8 months, starting from 8 months onward, the serology usually turns out negative or strongly positive data not show.
Información general: Enfermedad de Chagas
Methods: Retrospective study of pregnant women diagnosed of Chagas' disease in HULP and the clinical tracking of their children. Results: In the HULP, five cases of new borns with mothers affected of Chagas' disease have been reported without a vertical transmission being detected. Discussion: The diagnosis of Chagas' disease in the new born is complicated because of the difficulty for detecting parasites in blood and the presence of maternal antibodies. Treatment is only effective if it is administered during the first months of life.
Palabras-clave: Recien nacidos. Trypanosoma cruzi. Chagas Bolivia. The follow-up was done at 7, 15, 30 and60 days afterbirth, and with xenodiagnosis 15 days later. In 27 newborn 3. In the control group, constituted by NB which were negative to both methods, there was no positivisation at all during the follow-up period.