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Am. J. Trop. Med. Hyg., 79(5), 2008, pp. 755-759
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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SHORT REPORT


Use of a Rapid Test on Umbilical Cord Blood to Screen for Trypanosoma cruzi Infection in Pregnant Women in Argentina, Bolivia, Honduras, and México

Sergio Sosa-Estani*, Miriam Rubi Gamboa-León, Jaime del Cid-Lemus, Fernando Althabe, Jackeline Alger, Olivia Almendares, María L. Cafferata, Jean-Philippe Chippaux, Eric Dumonteil, Luz Gibbons, Nicolás Padilla-Raygoza, Dominique Schneider, José M. Belizán, Pierre Buekens Working Group
Instituto de Efectividad Clínica y Sanitaria, Centro Nacional de Diagnóstico e Investigación de Endemoepidemias (CeNDIE) ANLIS Dr. Carlos G. Malbrán, Ministerio de Salud, Buenos Aires, Argentina; Región Departamental de Salud de Intibucá, La Esperanza, Intibucá, Honduras; Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras; Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Mérida, Yucatán, México; Facultad de Enfermería y Obstetricia de Celaya, Universidad de Guanajuato, Celaya, Guanajuato, México; Research Unit ‘Mother and Child Health in the Tropics’, Institut de Recherche pour le Développement, La Paz, Bolivia; Laboratorio de Parasitología, Instituto Nacional de Laboratorios de Salud, La Paz, Bolivia; Unidad de Investigación Clínica y Epidemiológica Montevideo, Montevideo, Uruguay; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana

 

ABSTRACT

We conducted a cross-sectional study of Chagas disease in five endemic areas in Argentina, Bolivia, Honduras, and México to estimate the prevalence of Trypanosoma cruzi–specific antibodies in pregnant women, and to assess the use of a rapid test (Chagas Stat-Pak) to screen for T. cruzi infection at the time of delivery. The prevalence of antibodies to T. cruzi measured by enzyme-linked immunosorbent assay (ELISA) in maternal blood was 5.5% (a range of 0.8–28.8% among the countries) in 2,495 women enrolled. Compared with ELISA in maternal blood samples, the Chagas Stat-Pak rapid test sensitivity and specificity in umbilical cord blood were 94.6% and 99.0%, respectively. These results show the ability for a rapid determination of the presence of T. cruzi–specific antibodies in umbilical cord blood as a pragmatic strategy to screen for infection in pregnant women.

Received March 27, 2008. Accepted for publication August 1, 2008.

Acknowledgments: The authors thank the following professionals and technicians from the Unidad de Investigación Cl nicaí y Epidemiológica Montevideo for designing the Manual of Operations and for conducting the study data management: Alvaro Ciganda, Marcelo Delgado, and Federico Lachs. Colleagues from Tucumán-Argentina: Ricardo Durango (Resident), Jorge Carranza (Resident), Sebastian Diaz (Technician), Viviana Suarez (Biochemist), Maria Alba Brizuela (Statistics Section), Natalia Tesseira (Assistant), and personnel of the Delivery Ward and Surgical Room from Instituto Maternidad Provincial "Nuestra Sra de las Mercedes." Colleagues from Bolivia: Nadin Alejandra Salas-Clavijo, Mario Romero, Mercedes Galarza, Patricia Oporto, Tatiana Rios, and personnel of Hospital Percy Boland de Santa Cruz. Colleagues from Honduras: personnel from the Labor Unit and Surgical Room and Guillermo Casco (Laboratory Technologist) from Enrique Aguilar Cerrato Hospital, Intibucá; Renato Valenzuela from Instituto Antonio Vidal, Tegucigalpa. Colleagues from Celaya-México: Adriana Plascencia (Technician), Isabel Gutiérrez. Colleagues from Merida-México: Professional of Hospital Materno Infantil of Yucatan and a special thanks to Dr. Luis Roberto Cardenas Hernandez (Director of Maternity), Dr. Benito Argaez Tuz, Chief of Training of Maternity and to the medical student Claudia González Ramírez. The authors thank Andrea Lee Meyer from the SPHTM at Tulane University for her assistance in technical matters, the administrative personnel from the Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina. We are also grateful to Dr. Yves Carlier and Dr. Elsa Leonor Segura for critical review of the manuscript and their suggestions.

Other members of the Perinatal Chagas Disease Working Group include, from the United States: M. James (School of Public Health and Tropical Medicine), Tulane University; from Argentina: G. Garbarino, R. Chahla (Instituto de Maternidad, Tucumán, Argentina); from Bolivia: J.R. Postigo-Ignacio, J. Santalla (Laboratorio de Parasitologia, Instituto Nacional de Laboratorios de Salud, La Paz, Bolivia); from Honduras: D. Amador (Hospital Enrique Aguilar Cerrato, Intibucá), I. Giron (Region Departamental de Salud, Intibucá), C. Ponce and E. Ponce (Laboratorio de Referencia para la Enfermedad de Chagas, Ministry of Health), and C. Zuniga (Programa Nacional de Prevención y Control de la Enfermedad de Chagas, Ministry of Health); from México: C. Gonzalez-Ramirez (Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México)

Financial support: This project was supported by the Tulane University School of Public Health and Tropical Medicine, with partial support provided by the Institute for Clinical Effectiveness and Health Policy in Buenos Aires, Argentina, IRD (France), and the local Health Systems of each country (Argentina, Bolivia, Honduras and México). This study was funded in part by the National Institutes of Health Fogarty International Center grant number D43 TW007784. We are grateful to Chembio, New York for having provided initial samples of Chagas Stat-Paks and Wiener Lab, Rosario, Argentina for having provided all reagents necessary to perform the ELISA tests and for conducting the quality control of serologic diagnoses.

* Address correspondence to Sergio Sosa-Estani, Instituto de Efectividad Clínica y Sanitaria, and Centro Nacional de Diagnóstico e Investigación de Endemoepidemias (CeNDIE) ANLIS "Dr. Carlos G. Malbrán," Av. Paseo Colón 568 (1063), Buenos Aires, Argentina. E-mail: ssosa{at}msal.gov.ar

Authors’ addresses: Sergio Sosa-Estani, Instituto de Efectividad Clínica y Sanitaria, and Centro Nacional de Diagnóstico e Investigación de Endemoepidemias (CeNDIE) ANLIS Dr. "Carlos G. Malbrán," Av. Paseo Colón 568 (1063), Buenos Aires. Argentina, Tel: 54-11-4331-4010, Fax: 54-11-4331-2536, E-mail: ssosa{at}msal.gov.ar. Miriam Rubi Gamboa-León and Eric Dumonteil, Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Ave. Itzaés #490 x 59, CP 97000, Mérida, Yucatán, México, Tel: 52-999-9245910, Fax: 52-999-9236120, E-mails: gleon{at}uady.mx and oliver{at}uady.mx. Jaime del Cid-Lemus, Región Sanitaria No. 10, Barrio El Centro, La Esperanza, Intibucá, Honduras, Tel: 504-7830046, E-mail: jaimedelcid{at}gmail.com. Fernando Althabe, Luz Gibbons, and José Belizán, Instituto de Efectividad Clínica y Sanitaria, Viamonte 2146 (1056), Buenos Aires, Argentina, Tel/Fax: 54-11-4-953-4058, E-mails: althabef{at}gmail.com, belizanj{at}allstat.org, and lgibbons{at}iecs.org.ar. Jackeline Alger, Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, P.O. Box 6177, Tegucigalpa, Honduras, E-mail: malaria{at}cablecolor.hn. Olivia Almendares and Pierre Buekens, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2430, New Orleans, LA 70112, Tel: 504-988-5397, Fax: 504-988-5718, E-mails: olivia.margarita{at}gmail.com and pbuekens{at}tulane.edu. María Luisa Cafferata, Unidad de Investigación Clnica y Epidemiolíógica Montevideo, Hospital de Clínicas, Piso 15, Av. Italia s/n, Montevideo CP11600, Montevideo, Uruguay, Tel/Fax: 598-2-486-4175, E-mail: cafferam{at}gmail.com. Jean-Philippe Chippaux and Dominique Schneider, IRD, CP 9214, La Paz Bolivia, Tel: 591-2-222-1901, E-mails: chippaux{at}ird.fr and dschneider{at}club-internet.fr. Nicolás Padilla-Raygoza, Mutualismo #303, CP 38060, Apdo. Postal 91 Celaya, Guanajuato, México, Tel: 52-461-615-36-48, Fax: 52-461-615-36-65, E-mail: padillawarm{at}gmail.com.






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