Chagas disease, produced by the protozoan Trypanosoma cruzi (T. cruzi), is one of the most frequent endemic diseases in Latin America. In spite the fact that in the past few years T. cruzi congenital transmission has become of epidemiological importance, studies about this mechanism of infection are scarce. In order to explore some morphological aspects of this infection in the placenta, we analyzed placentas from T. cruzi-infected mothers by immunohistochemical and histochemical methods. Infection in mothers, newborns, and placentas was confirmed by PCR and by immunofluorescence in the placenta. T. cruzi-infected placentas present destruction of the syncytiotrophoblast and villous stroma, selective disorganization of the basal lamina, and disorganization of collagen I in villous stroma. Our results suggest that the parasite induces reorganization of this tissue component and in this way may regulate both inflammatory and immune responses in the host. Changes in the ECM of placental tissues, together with the immunological status of mother and fetus, and parasite load may determine the probability of congenital transmission of T. cruzi.

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The group of doctors who finished their basic studies in 1962 in the Facultad de Medicina of the Universidad de Chile will never forget the official reception we received when we began the program in March, 1955. It was our first day in the Faculty, and we were received in the Anatomy Auditorium by Dr. Gustavo Hoecker. We soon had him as a professor in the first year Biology course, and in meetings on Saturday afternoons in Borgoño 1470, the site of the former Parasitology Hall of Dr. Amador Neghme. Years later some of us joined forces with Dr. Hoecker in research projects on Chagas disease in which he led the group. We took many field trips to the different endemic areas of the IV Region; Tulahuén, Río Hurtado, El Palqui and Huatulame, among others. We left early in the morning and usually returned late at night. In these interactions I got to know the real Dr. Hoecker; intelligent, lively, discerning and with a great group spirit. When my class of 1962 celebrated our 40 th year as doctors in June, 2002, we did so with a solemn ceremony in the Facultad de Medicina, in the same auditorium where he received us on our first day of classes. In this ceremony we gave recognition to two professors, Gustavo Hoecker and Carlos Oberti (Histology Professor), which faithfully reflected the opinion of his former students. Dr. Hoecker is no longer with us, but his spirit is. In modest homage to him, we dedicate our most recent research on congenital Chagas disease, a subject which united us on more than one occasion.

Given the increasing travel of pregnant women from areas were Trypanosoma cruzi is endemic, the congenital transmission of the parasite has become a global public-health problem. In a recent pilot study, which ran in Chile from 2006 to 2010, three strategies for exploring and managing T. cruzi-infected mothers and their infected or uninfected neonates were investigated. Any protocols applied to the investigation of such mother-and-child pairs need to include the detection of infection in pregnant women, the detection of infection, if any, in the children born to the women, the appropriate treatment of the infected neonates, and the serological-parasitological follow-up of all of the neonates until their medical discharge.

Objectives To assess recent trends in susceptibility to antibiotics among urinary isolates isolated in European emergency departments (EDs) and to identify isolates with a high (90% or more) predicted probability of susceptibility to fluoroquinolones or third-generation cephalosporins (3GCs). Methods In this cross-sectional study, we included urine cultures obtained from adult patients between 2010 and 2016 in 24 European EDs. Temporal trends were assessed using time-series analysis and multivariate logistic models. Multivariate logistic models were also used to predict susceptibility to fluoroquinolones or 3GCs from patient age and sex, year, month and ED. Results We included 88242 isolates. Time-series analysis found a significant increase in susceptibility to fluoroquinolones and no significant trend for susceptibility to 3GCs. Adjusting for patient age and sex, ED and organism, multivariate models showed that susceptibility to 3GCs decreased from 2014 to 2016, while susceptibility to fluoroquinolones increased in 2015 and 2016. Among isolates from 2016, multivariate models predicted high probability of susceptibility to fluoroquinolones in 11% of isolates (positive predictive value 91%) and a high probability of susceptibility to 3GCs in 35% of isolates (positive predictive value 94%). Conclusions Susceptibility of ED urinary isolates to fluoroquinolones increased from 2014, while susceptibility to 3GCs decreased from 2015. Predictive models identified isolates with a high probability of susceptibility to fluoroquinolones or 3GCs. The ability of such models to guide the empirical treatment of pyelonephritis in the ED remains to be determined.