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Congenital Transmission of Trypanosoma cruzi in Argentina, Honduras, and Mexico: An Observational Prospective Study
Pierre Buekens
Pierre Buekens
Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;
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María Luisa Cafferata
María Luisa Cafferata
Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay;
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Jackeline Alger
Jackeline Alger
Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras;
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Fernando Althabe
Fernando Althabe
Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina;
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José M. Belizán
José M. Belizán
Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina;
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Norma Bustamante
Norma Bustamante
Región Departamental de Salud, Santa Bárbara, Honduras;
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Yves Carlier
Yves Carlier
Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;
Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium;
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Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium;
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Alvaro Ciganda
Alvaro Ciganda
Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay;
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Jaime H. del Cid
Jaime H. del Cid
Centro de Salud Vicente Mejía Colindres, Intibucá, Honduras;
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Eric Dumonteil
Eric Dumonteil
Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;
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Rubí Gamboa-León
Rubí Gamboa-León
Universidad Autónoma de San Luis Potosí, Tamazunchale, México;
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Jorge A. García
Jorge A. García
Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras;
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Luz Gibbons
Luz Gibbons
Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina;
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Olga Graiff
Olga Graiff
Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina;
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Jesús Gurubel Maldonado
Jesús Gurubel Maldonado
Centro de Investigaciones Regionales “Dr. Hideyo Noguchi,” Universidad Autónoma de Yucatán, Mérida, México;
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Claudia Herrera
Claudia Herrera
Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;
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Elizabeth Howard
Elizabeth Howard
Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;
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Laura Susana Lara
Laura Susana Lara
Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina;
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Benjamín López
Benjamín López
Región Departamental de Salud, Santa Bárbara, Honduras;
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María Luisa Matute
María Luisa Matute
Laboratorio Nacional de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras;
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María Jesús Ramírez-Sierra
María Jesús Ramírez-Sierra
Centro de Investigaciones Regionales “Dr. Hideyo Noguchi,” Universidad Autónoma de Yucatán, Mérida, México;
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María Cecilia Robles
María Cecilia Robles
Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina;
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Sergio Sosa-Estani
Sergio Sosa-Estani
Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina;
Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben,” CONICET, ANLIS, Buenos Aires, Argentina
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Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben,” CONICET, ANLIS, Buenos Aires, Argentina
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Carine Truyens
Carine Truyens
Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium;
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Christian Valladares
Christian Valladares
Laboratorio Nacional de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras;
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Dawn M. Wesson
Dawn M. Wesson
Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;
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Concepción Zúniga
Concepción Zúniga
Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras;
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for the Congenital Chagas Working Group
for the Congenital Chagas Working Group
Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;
Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay;
Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras;
Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina;
Región Departamental de Salud, Santa Bárbara, Honduras;
Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium;
Centro de Salud Vicente Mejía Colindres, Intibucá, Honduras;
Universidad Autónoma de San Luis Potosí, Tamazunchale, México;
Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina;
Centro de Investigaciones Regionales “Dr. Hideyo Noguchi,” Universidad Autónoma de Yucatán, Mérida, México;
Laboratorio Nacional de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras;
Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben,” CONICET, ANLIS, Buenos Aires, Argentina
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Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay;
Hospital Escuela Universitario, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras;
Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina;
Región Departamental de Salud, Santa Bárbara, Honduras;
Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium;
Centro de Salud Vicente Mejía Colindres, Intibucá, Honduras;
Universidad Autónoma de San Luis Potosí, Tamazunchale, México;
Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina;
Centro de Investigaciones Regionales “Dr. Hideyo Noguchi,” Universidad Autónoma de Yucatán, Mérida, México;
Laboratorio Nacional de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras;
Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben,” CONICET, ANLIS, Buenos Aires, Argentina
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Compared with South America, there is a lack of epidemiologic studies about the risk of congenital transmission of Trypanosoma cruzi in Central America and Mexico. It has been suggested that T. cruzi genotypes might differ by region and that congenital transmission might vary according to the parasite’s genotype. Our objective was to compare T. cruzi 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 T. cruzi 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 T. cruzi-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. Trypanosoma cruzi non-TcI predominated and risks of congenital transmission were similar in Argentina and Mexico.
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Author Notes
The members of the Congenital Chagas Working Group are listed in the Appendix.
Financial support: This work was supported by the National Institute of Allergy and Infectious Diseases (grant number R01AI083563) and the Eunice Kennedy Shriver National Institute of Child Health & Human Development (grant number T32HD057780).
Authors’ addresses: Pierre Buekens, Eric Dumonteil, Claudia Herrera, Elizabeth Howard, and Dawn M. Wesson, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, E-mails: pbuekens@tulane.edu, edumonte@tulane.edu, cherrera@tulane.edu, ehoward3@tulane.edu, and wesson@tulane.edu. María Luisa Cafferata and Alvaro Ciganda, Unidad de Investigación Clínica y Epidemiológica Montevideo (UNICEM), Montevideo, Uruguay, E-mails: marialuisa.cafferata@gmail.com and aciganda@unicem-web.org. Jackeline Alger and Jorge A. García, Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras, E-mails: jackelinealger@yahoo.es and jalgar62_84@yahoo.com.ar. Fernando Althabe, José M. Belizán, and Luz Gibbons, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina, E-mails: falthabe@iecs.org.ar, belizanj@iecs.org.ar, and lgibbons@iecs.org.ar. Norma Bustamante and Benjamín López, Región Departamental de Salud, Barrio Abajo, Santa Bárbara, Honduras, E-mails: hebuno@yahoo.com and benjalot@gmail.com. Yves Carlier, Université Libre de Bruxelles (ULB), Brussels, Belgium, and Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, E-mail: ycarlier@ulb.ac.be. Jaime H. del Cid, Centro de Salud Vicente Mejía Colindres, Barrio El Centro, Intibucá, Honduras, E-mail: jaimedelcid@gmail.com. Rubí Gamboa-León, Coordinación Académica Región Huasteca Sur, Universidad Autónoma de San Luis Potosí, Tamazunchale, San Luis Potosí, México, E-mail: miriamrubi2012@gmail.com. Olga Graiff, Laura Susana Lara, and María Cecilia Robles, Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina, E-mails: bichi96@yahoo.com.ar, laura_lara09@yahoo.com.ar, and ceciro1203@hotmail.com. Jesús Gurubel Maldonado and María Jesús Ramírez-Sierra, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi,” Universidad Autónoma de Yucatán, Mérida, Mexico, E-mails: jesgurubel@gmail.com and rsierra@correo.uady.mx. María Luisa Matute and Christian Valladares, Laboratorio Nacional de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras, E-mails: marialuisamatuteg@yahoo.com.mx and christianvalladares22@yahoo.com. Sergio Sosa-Estani, Instituto Nacional de Parasitología “Dr. Mario Fatala Chaben,” CONICET, ANLIS, Buenos Aires, Argentina, and Instituto de Efectividad Clinica y Sanitaria (IECS), Buenos Aires, Argentina, E-mail: ssosaestani@gmail.com. Carine Truyens, Laboratory of Parasitology, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium, E-mail: ctruyens@ulb.ac.be. Concepción Zúniga, Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Hospital Escuela Universitario, Tegucigalpa, Honduras, E-mail: concepcionzuniga@gmail.com.
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