title: Treatment of congenital Chagas' disease diagnosed and followed up by the polymerase chain reaction.
abstract: In 1991 and 1992, a prenatal screening of Trypanosoma cruzi infection was carried out using ELISA and indirect immunofluorescence techniques. A total of 840 blood samples from pregnant women, obtained at the Maternity Ward of the Hospital de Clínicas, National University of Asunción (Asunción, Paraguay), and 1,022 samples from the Regional Hospital of the San Pedro Department of Paraguay were examined. It was observed that 7.7% and 10.5%, respectively, of the pregnant women were serologically positive for infection with T. cruzi. When blood samples obtained from newborns on the day of birth or, at the most, on the first few days afterwards were examined by direct microscopic observation, an incidence of congenital transmission of 3% was found. These results are consistent with those of neighboring countries. When a serologic follow-up was conducted on the newborns until six months of age, the incidence of congenital transmission reached 10%. The same incidence rate was obtained when the samples collected during the first days after birth were examined by the polymerase chain reaction (PCR). Fifty-eight infants born to seropositive mothers were followed-up, two of which were positive by direct microscopic observation at birth, and four who were PCR-positive, but microscopy-negative at birth. None of the infants were positive for IgM at birth. The infected babies were treated with benznidazole and were followed-up by serology and PCR for four years. We conclude that the PCR has a clear advantage over conventional techniques for the early detection of congenital transmission of T. cruzi infection, and for monitoring infants undergoing chemotherapy.
authors.affiliation: Departamento de Biologia Molecular, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Paraguay.
authors.forename: G
authors.initials: G
authors.lastname: Russomando
authors.forename: M M
authors.initials: MM
authors.lastname: de Tomassone
authors.forename: I
authors.initials: I
authors.lastname: de Guillen
authors.forename: N
authors.initials: N
authors.lastname: Acosta
authors.forename: N
authors.initials: N
authors.lastname: Vera
authors.forename: M
authors.initials: M
authors.lastname: Almiron
authors.forename: N
authors.initials: N
authors.lastname: Candia
authors.forename: M F
authors.initials: MF
authors.lastname: Calcena
authors.forename: A
authors.initials: A
authors.lastname: Figueredo
mesh_terms: D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D014355:Chagas Disease / Q000151:congenital* / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D016054:DNA, Protozoan / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005500:Follow-Up Studies; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D015994:Incidence; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D009593:Nitroimidazoles / Q000627:therapeutic use; D010239:Paraguay / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014349:Trypanosoma cruzi / Q000235:genetics* / Q000276:immunology
chemical_list: D000913:Antibodies, Protozoan; D016054:DNA, Protozoan; D007075:Immunoglobulin M; D009593:Nitroimidazoles; D014344:Trypanocidal Agents; C009999:benzonidazole