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MATERNAL TRYPANOSOMA CRUZI INFECTION, PREGNANCY OUTCOME, MORBIDITY, AND MORTALITY OF CONGENITALLY INFECTED AND NON-INFECTED NEWBORNS IN BOLIVIA

This work compares the results of two epidemiologic and clinical surveys on the consequences of maternal chronic Trypanosoma cruzi infection. They were conducted in 1992–1994 and 1999–2001 in the same maternity clinic in Bolivia, a country highly endemic for infection with this parasite. In both surveys, the materno-fetal transmission of parasites occurred in 5-6% of the infected mothers. Maternal chronic T. cruzi infection had no effect on pregnancy outcome and health of newborns when there was no materno-fetal transmission of parasites. Comparisons between the older and the more recent surveys highlighted significant reductions in frequencies of symptomatic cases (from 54% to 45%), Apgar scores <7, and low birth weights and prematurity (from 32–50% to 6–16%) among congenitally infected babies. Neonatal mortality related to congenital Chagas disease also decreased from 13% to 2% in the interval between both studies. These results suggest that the decrease in poverty that has occurred in Bolivia between both surveys might have contributed to reduce the morbidity and mortality, but not the transmission rate of T. cruzi congenital infection, which remains a serious public health problem in this country.

Received July 14, 2003. Accepted for publication October 10, 2003.

Acknowledgments: We thank Marisol Cordova and the staff of the German Urquidi maternity clinic (Cochabamba, Bolivia) for the management of patients; Miguel Guzman, Myrian Huanca, Rudy Parrado, and Marco Antonio Solano (Centro Universitario de Medicina Tropical, Universidad Mayor de San Simon, Cochabamba, Bolivia) for the serologic and parasitologic diagnosis of patients; and Corinne Liesnard (Erasmus Hospital, Brussels, Belgium) for performing the serologic analysis of TORCH-related antibodies. We are indebted to Bruno Dujardin, Christine Kirkpatrick, and Anne Pardou for their critical review of the manuscript. Cristina Alonso-Vega is a fellow of the Association pour la Promotion de l’Éducation et la Formation à l’Étranger (Communauté Française de Belgique). Part of this study has been presented at the International Colloquium "Infeccion Congenita por Trypanosoma cruzi: Desde los Mecanismos de Transmision Hasta Una Estrategia de Diagnostico y Control" held on November 6–8, 2002, in Cochabamba, Bolivia.

Financial support: This study was supported by the Conseil Interuni-versitaire de la Communauté Française de Belgique, the Community and Child Health Chagas Control Program (United States Agency for International Development, the Centre de Recherche Interuni-versitaire en Vaccinologie sponsored by the Région Wallonne and GlaxoSmithKline (Rixensart, Belgium), and the Fonds National de la Recherche Scientifique Médicale (Belgium, convention 3.4595.99).

Authors’ addresses: Faustino Torrico, Cristina Alonso-Vega, Eduardo Suarez, Patricia Rodriguez, and Mary-Cruz Torrico, Centro Universitario de Medicina Tropical, Facultad de Medecina, Universidad Mayor de San Simon, Avenida Aniceto Arce 371, Casilla 3023, Cochabamba, Bolivia, Telephone/fax : 591-442-30009. Michèle Dramaix, Laboratoire de Statistiques Médicales, Ecole de SantéPublique, Université Libre de Bruxelles, 808 Route de Lennik, CP 598, B-1070 Bruxelles, Belgium, Telephone: 32-2-555- 4051, Fax : 32-2-555-4047. Carine Truyens and Yves Carlier, Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles, 808 Route de Lennik, CP 616, B-1070 Bruxelles, Belgium, Telephone: 32-2-555-6255, Fax: 32-2-555-6128, E-mail: ycarlier{at}ulb.ac.be.

Reprint requests: Yves Carlier, Laboratoire de Parasitologie, Faculté de Médecine, U.L.B., 808 route de Lennik CP 616, B-1070 Bruxelles, Belgium.

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