The burden of congenital Chagas disease and implementation of molecular diagnostic tools in Latin America

Abstract

It is estimated that between 8000 and 15 000 Trypanosoma cruzi infected babies are born every year to infected mothers in Chagas disease endemic countries. Currently, poor access to and performance of the current diagnostic algorithm, based on microscopy at birth and serology at 8–12 months after delivery, is one of the barriers to congenital Chagas disease (CCD) control. Detection of parasite DNA using molecular diagnostic tools could be an alternative or complement to current diagnostic methods, but its implementation in endemic regions remains limited. Prompt diagnosis and treatment of CCD cases would have a positive clinical and epidemiological impact. In this paper, we analysed the burden of CCD in Latin America, and the potential use of molecular tests to improve access to early diagnosis and treatment of T. cruzi infected newborns.

WHF IASC Roadmap on Chagas Disease

“…Healthcare personnel are often unfamiliar with the risk of congenital transmission [52]. Screening of pregnant women is far from universal, and totally absent in some affected countries [53,54,55], despite the demonstrated cost-effectiveness of these programmes in both endemic and non-endemic settings [53,55,56]. The regional initiative Eliminating Mother to Child Transmission Plus, launched by PAHO in 2017 [57], works to strengthen health systems in participating countries to interrupt congenital transmission of CD along with other congenitally transmitted infectious diseases, although the recommendations in this document are far from being widely adopted in the region.…”

“…If negative, a serologic test is required after the tenth month of age, when maternally transferred IgG antibodies have disappeared. In many regions, the required schedule of testing can make follow-up difficult, due to barriers to healthcare as well as migratory flows of populations [55,68,75]. This may account in part for the estimation that one in two of all congenital infections with CD are missed [76].…”

Comparison of the Bacterial Gut Microbiome of North American Triatoma spp. With and Without Trypanosoma cruzi

“…Chagas disease is estimated to affect approximately 6 million people across the Americas (World Health Organization [WHO], 2015) and is a significant cause of cardiovascular death in endemic areas (Rassi et al, 2009). Caused by the hemoflagellate protist Trypanosoma cruzi, the principal method of transmission is via the infective feces of hematophagous triatomine insect vectors within the family Reduviidae, with a fewer number of cases transmitted congenitally, through blood transfusion, organ transplantation, and direct ingestion (Kjos et al, 2008;Bern et al, 2011;Picado et al, 2018). While the majority of T. cruzi infection cases occur in Latin America, there has been a rise in reports of Chagas disease in the United States and Europe (Lescure et al, 2008;Bern and Montgomery, 2009;Jackson et al, 2009;Pérez de Ayala et al, 2009;Bern et al, 2011;Pérez-Ayala et al, 2011).…”

Trypanosoma cruzi loop-mediated isothermal amplification (Trypanosoma cruzi Loopamp) kit for detection of congenital, acute and Chagas disease reactivation

“…In fact, microscopy observation is highly operator dependent and low sensitive, haemoculture and xenodiagnoses are cumbersome methods that may take several months before a result can be reported. On the other hand, serological assays for T. cruzi infection are not always applicable; for serodiagnosis of infants born to seropositive mothers it is necessary to wait until at least nine months of age [9], and in severely immunocompromised CD patients, false seronegative results may be obtained [4].…”