Volume 98, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Compared with South America, there is a lack of epidemiologic studies about the risk of congenital transmission of in Central America and Mexico. It has been suggested that genotypes might differ by region and that congenital transmission might vary according to the parasite’s genotype. Our objective was to compare congenital transmission rates in three countries. We performed an observational prospective study in 2011–2014 enrolling women at delivery in one hospital in Argentina, two hospitals in Honduras, and two hospitals in Mexico. Congenital infection was defined as the presence of one or more of the following criteria: presence of parasites in cord blood (direct parasitological microscopic examination) with positive polymerase chain reaction (PCR) in cord blood, presence of parasites in infant’s blood at 4–8 weeks (direct parasitological microscopic examination), and persistence of -specific antibodies at 10 months, as measured by at least two tests. Among 28,145 enrolled women, 347 had at least one antibody rapid test positive in cord blood and a positive enzyme-linked immunosorbent assay in maternal blood. PCR in maternal blood was positive in 73.2% of the cases, and genotyping identified a majority of non-TcI in the three countries. We found no (0.0%; 95% confidence interval [CI]: 0.0, 2.0) confirmed congenital case in Honduras. Congenital transmission was 6.6% (95% CI: 3.1, 12.2) in Argentina and 6.3% (95% CI: 0.8, 20.8) in Mexico. non-TcI predominated and risks of congenital transmission were similar in Argentina and Mexico.


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  1. World Health Organization, 2015. Chagas disease in Latin America: an epidemiological update based on 2010 estimates. Wkly Epidemiol Rec 90: 3343. [Google Scholar]
  2. Buekens P, Almendares O, Carlier Y, Dumonteil E, Eberhard M, Gamboa-Leon R, James M, Padilla N, Wesson D, Xiong X, , 2008. Mother-to-child transmission of Chagas’ disease in North America: why don’t we do more? Matern Child Health J 12: 283286. [Google Scholar]
  3. Carlier Y, Torrico F, Sosa-Estani S, Russomando G, Luquetti A, Freilij H, Albajar Vinas P, , 2011. Congenital Chagas disease: recommendations for diagnosis, treatment and control of newborns, siblings and pregnant women. PLoS Negl Trop Dis 5: e1250. [Google Scholar]
  4. Howard EJ, Xiong X, Carlier Y, Sosa-Estani S, Buekens P, , 2014. Frequency of the congenital transmission of Trypanosoma cruzi: a systematic review and meta-analysis. BJOG 121: 2233. [Google Scholar]
  5. Guzman-Bracho C, Lahuerta S, Velasco-Castrejon O, , 1998. Chagas disease. First congenital case report. Arch Med Res 29: 195196. [Google Scholar]
  6. Cardoso EJ, 2012. Maternal fetal transmission of Trypanosoma cruzi: a problem of public health little studied in Mexico. Exp Parasitol 131: 425432. [Google Scholar]
  7. Montes-Rincón LM, Galaviz-Silva L, González-Bravo FE, Molina-Garza ZJ, , 2016. Trypanosoma cruzi seroprevalence in pregnant women and screening by PCR and microhaematocrit in newborns from Guanajuato, Mexico. Acta Trop 164: 100106. [Google Scholar]
  8. Olivera Mar A, Guillén Ortega F, Cruz Vidal S, Hernández-Becerril N, Pérez Galdamez E, Córdova Concepción G, Reyes PA, Monteón VM, , 2006. Serological and parasitological screening of Trypanosoma cruzi infection in mothers and newborns living in two Chagasic areas of Mexico. Arch Med Res 37: 774777. [Google Scholar]
  9. Sasagawa E, 2015. Mother-to-child transmission of chagas disease in El Salvador. Am J Trop Med Hyg 93: 326333. [Google Scholar]
  10. Carlier Y, Truyens C, , 2015. Congenital Chagas disease as an ecological model of interactions between Trypanosoma cruzi parasites, pregnant women, placenta and fetuses. Acta Trop 151: 103115. [Google Scholar]
  11. Virreira M, 2006. Congenital Chagas disease in Bolivia is not associated with DNA polymorphism of Trypanosoma cruzi. Am J Trop Med Hyg 75: 871879. [Google Scholar]
  12. Burgos JM, 2007. Direct molecular profiling of minicircle signatures and lineages of Trypanosoma cruzi bloodstream populations causing congenital Chagas disease. Int J Parasitol 37: 13191327. [Google Scholar]
  13. Luquetti AO, Tavares SB, Siriano La R, Oliveira RA, Campos DE, de Morais CA, de Oliveira EC, , 2015. Congenital transmission of Trypanosoma cruzi in central Brazil. A study of 1,211 individuals born to infected mothers. Mem Inst Oswaldo Cruz 110: 369376. [Google Scholar]
  14. Zingales B, 2012. The revised Trypanosoma cruzi subspecific nomenclature: rationale, epidemiological relevance and research applications. Infect Genet Evol 12: 240253. [Google Scholar]
  15. Brenière SF, Waleckx E, Barnabé C, , 2016. Over six thousand Trypanosoma cruzi strains classified into discrete typing units (DTUs): attempt at an inventory. PLoS Negl Trop Dis 10: e0004792. [Google Scholar]
  16. Ramos-Ligonio A, Torres-Montero J, López-Monteon A, Dumonteil E, , 2012. Extensive diversity of Trypanosoma cruzi discrete typing units circulating in Triatoma dimidiata from central Veracruz, Mexico. Infect Genet Evol 12: 13411343. [Google Scholar]
  17. Carlier Y, Sosa-Estani S, Luquetti AO, Buekens P, , 2015. Congenital Chagas disease: an update. Mem Inst Oswaldo Cruz 110: 363368. [Google Scholar]
  18. Gebrekristos HT, Buekens P, , 2014. Mother-to-child transmission of Trypanosoma cruzi. J Pediatr Infect Dis 3 (Suppl 1): S36S40. [Google Scholar]
  19. UNICEF, 2017. Global Databases: Institutional Deliveries. UNICEF. Available at: https://data.unicef.org/topic/maternal-health/delivery-care/. Accessed March 31, 2017.
  20. Buekens P, 2013. Congenital transmission of Trypanosoma cruzi in Argentina, Honduras, and Mexico: study protocol. Reprod Health 10: 55. [Google Scholar]
  21. Torrico MC, Solano M, Guzmán JM, Parrado R, Suarez E, Alonzo-Vega C, Truyens C, Carlier Y, Torrico F, , 2005. Estimation of the parasitemia in Trypanosoma cruzi human infection: high parasitemias are associated with severe and fatal congenital Chagas disease. Rev Soc Bras Med Trop 38 (Suppl 2): 5861. [Google Scholar]
  22. Virreira M, Torrico F, Truyens C, Alonso-Vega C, Solano M, Carlier Y, Svoboda M, , 2003. Comparison of polymerase chain reaction methods for reliable and easy detection of congenital Trypanosoma cruzi infection. Am J Trop Med Hyg 68: 574582. [Google Scholar]
  23. Cencig S, Coltel N, Truyens C, Carlier Y, , 2013. Fertility, gestation outcome and parasite congenital transmissibility in mice infected with TcI, TcII and TcVI genotypes of Trypanosoma cruzi. PLoS Negl Trop Dis 7: e2271. [Google Scholar]
  24. BLAST, 2015. Basic Local Alignment Search Tool. Available at: http://blast.ncbi.nlm.nih.gov/Blast.cgi. Accessed November 9, 2016.
  25. Tamura K, Peterson D, Peterson N, Stecher G, Nei M, Kumar S, , 2011. MEGA5: molecular evolutionary genetics analysis using maximum likelihood, evolutionary distance, and maximum parsimony methods. Mol Biol Evol 28: 27312739. [Google Scholar]
  26. Kaplinski M, 2015. Sustained domestic vector exposure is associated with increased Chagas cardiomyopathy risk but decreased parasitemia and congenital transmission risk among young women in Bolivia. Clin Infect Dis 61: 918926. [Google Scholar]
  27. Bua J, Volta BJ, Velazquez EB, Ruiz AM, Rissio AM, Cardoni RL, , 2012. Vertical transmission of Trypanosoma cruzi infection: quantification of parasite burden in mothers and their children by parasite DNA amplification. Trans R Soc Trop Med Hyg 106: 623628. [Google Scholar]
  28. Torrico F, Alonso-Vega C, Suarez E, Rodriguez P, Torrico M, Dramaix M, Truyens C, Carlier Y, , 2004. Maternal Trypanosoma cruzi infection, pregnancy outcome, morbidity, and mortality of congenitally infected and non-infected newborns in Bolivia. Am J Trop Med Hyg 70: 201209. [Google Scholar]
  29. Manne JM, Snively CS, Ramsey JM, Salgado MO, Bärnighausen T, Reich MR, , 2013. Barriers to treatment access for Chagas disease in Mexico. PLoS Negl Trop Dis 7: e2488. [Google Scholar]
  30. Dumonteil E, Nouvellet P, Rosecrans K, Ramirez-Sierra MJ, Gamboa-León R, Cruz-Chan V, Rosado-Vallado M, Gourbière S, , 2013. Eco-bio-social determinants for house infestation by non-domiciliated Triatoma dimidiata in the Yucatan Peninsula, Mexico. PLoS Negl Trop Dis 7: e2466. [Google Scholar]
  31. Gamboa-León R, Ramirez-Gonzalez C, Pacheco-Tucuch FS, O’Shea M, Rosecrans K, Pippitt J, Dumonteil E, Buekens P, , 2014. Seroprevalence of Trypanosoma cruzi among mothers and children in rural Mayan communities and associated reproductive outcomes. Am J Trop Med Hyg 91: 348353. [Google Scholar]
  32. Sosa-Estani S, 2008. Use of a rapid-test on umbilical cord blood to screen for Trypanosoma cruzi infection in pregnant women in Argentina, Bolivia, Honduras, and México. Am J Trop Med Hyg 79: 755759. [Google Scholar]
  33. Guzmán-Gómez D, López-Monteon A, de la Soledad Lagunes-Castro M, Álvarez-Martínez C, Hernández-Lutzon MJ, Dumonteil E, Ramos-Ligonio A, , 2015. Highly discordant serology against Trypanosoma cruzi in central Veracruz, Mexico: role of the antigen used for diagnostic. Parasit Vectors 8: 466. [Google Scholar]
  34. Bern C, 2009. Congenital Trypanosoma cruzi transmission in Santa Cruz, Bolivia. Clin Infect Dis 49: 16671674. [Google Scholar]
  35. Buekens P, Kaminski M, , 1988. Epidemiological evaluation of prenatal screening procedures. Eur J Obstet Gynecol Reprod Biol 28 (Suppl): 5367. [Google Scholar]
  36. Lo YM, Lau TK, Chan LY, Leung TN, Chang AM, , 2000. Quantitative analysis of the bidirectional fetomaternal transfer of nucleated cells and plasma DNA. Clin Chem 46: 13011309. [Google Scholar]
  37. Schijman AG, Altcheh J, Burgos JM, Biancardi M, Bisio M, Levin MJ, Freilij H, , 2003. Aetiological treatment of congenital Chagas’ disease diagnosed and monitored by the polymerase chain reaction. J Antimicrob Chemother 52: 441449. [Google Scholar]
  38. Messenger LA, 2017. Towards improving early diagnosis of congenital Chagas disease in an endemic setting. Clin Infect Dis 65: 268275. [Google Scholar]
  39. Velázquez EB, Rivero R, De Rissio AM, Malagrino N, Esteva MI, Riarte AR, Ruiz AM, , 2014. Predictive role of polymerase chain reaction in the early diagnosis of congenital Trypanosoma cruzi infection. Acta Trop 137: 195200. [Google Scholar]
  40. Herrera CP, Licon MH, Nation CS, Jameson SB, Wesson DM, , 2015. Genotype diversity of Trypanosoma cruzi in small rodents and Triatoma sanguisuga from a rural area in New Orleans, Louisiana. Parasit Vectors 8: 123. [Google Scholar]
  41. Ibanez-Cervantes G, Martinez-Ibarra A, Nogueda-Torres B, Lopez-Orduna E, Alonso AL, Perea C, Maldonado T, Hernandez JM, Leon-Avila G, , 2013. Identification by Q-PCR of Trypanosoma cruzi lineage and determination of blood meal sources in triatomine gut samples in Mexico. Parasitol Int 62: 3643. [Google Scholar]
  42. Garcia MN, Burroughs H, Gorchakov R, Gunter SM, Dumonteil E, Murray KO, Herrera CP, , 2017. Molecular identification and genotyping of Trypanosoma cruzi DNA in autochthonous Chagas disease patients from Texas, USA. Infect Genet Evol 49: 151156. [Google Scholar]
  43. Risso MG, 2011. Immunological identification of Trypanosoma cruzi lineages in human infection along the endemic area. Am J Trop Med Hyg 84: 7884. [Google Scholar]
  44. Dirección General de Programa Integrado de Salud Provincia de Tucumán, 2015. Proceso de Certificación de la Interrupción de la Transmisión Vectorial y Transfusional del T. cruzi en la Provincia de Tucumán. Tucumán, Argentina.
  45. Hashimoto K, Schofield CJ, , 2012. Elimination of Rhodnius prolixus in Central America. Parasit Vectors 5: 45. [Google Scholar]
  46. Carabarin-Lima A, González-Vázquez MC, Rodríguez-Morales O, Baylón-Pacheco L, Rosales-Encina JL, Reyes-López PA, Arce-Fonseca M, , 2013. Chagas disease (American trypanosomiasis) in Mexico: an update. Acta Trop 127: 126135. [Google Scholar]
  47. Torrico F, Vega C, Suarez E, Tellez T, Brutus L, Rodriguez P, Torrico M, Schneider D, Truyens C, Carlier Y, , 2006. Are maternal re-infections with Trypanosoma cruzi associated with higher morbidity and mortality of congenital Chagas disease? Trop Med Int Health 11: 628635. [Google Scholar]
  48. Instituto Nacional de Estadísticas y Censos, 2010. Censo Nacional de Población, Hogares y Viviendas 2010, República Argentina. Available at: http://www.indec.gov.ar/nivel4_default.asp?id_tema_1=2&id_tema_2=41&id_tema_3=135. Accessed August 25, 2017.
  49. Instituto Nacional de Estadística, 2013. XVII Censo Nacional de Población y VI de Vivienda 2013, Honduras. Available at: http://www.ine.gob.hn/index.php/component/content/article?id=81. Accessed August 25, 2017.
  50. Instituto Nacional de Estadística y Geografía, 2010. Censo de Población y Vivienda 2010, Estados Unidos de México. Available at: http://www.beta.inegi.org.mx/contenidos/proyectos/ccpv/2010/tabulados/Basico/04_02B_MUNICIPAL_31.pdf. Accessed August 26, 2017.

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  • Received : 28 Jun 2017
  • Accepted : 21 Oct 2017
  • Published online : 04 Dec 2017

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