title: Risk factors and primary prevention of congenital Chagas disease in a nonendemic country.
abstract: BACKGROUND
  In this longitudinal cohort study we evaluated the congenital transmission of Chagas disease (CD) in a nonendemic area. The aim of this work was to analyze the predictive value of a Trypanosoma cruzi-positive polymerase chain reaction (PCR) result in pregnant women for the diagnosis of vertical transmission and to evaluate the use of PCR as a tool for early detection of infection.
  
  
  METHODS
  The offspring of 59 seropositive pregnant mothers were followed up. The parasitological status of mothers was studied by PCR in a total of 64 pregnancies; 10 of these women had received treatment before pregnancy. Sixty-five infants (including a pair of twins) were monitored at 0, 6, 9, and 12 months of age by PCR and serology. In cases of congenital transmission, hemoculture and parasite lineage typing were performed.
  
  
  RESULTS
  Nine infants had acquired CD congenitally. This represents a transmission rate of 13.8% among seropositive mothers (9 infected newborns of 65 total live births). All infants were infected with T. cruzi discrete typing unit V strain. A statistically significant correlation was found between T. cruzi vertical transmission and a positive PCR result during pregnancy (31%; 9 infected newborns in 29 live births). No infected infants were detected among 10 mothers who were treated before they became pregnant, compared with 16.4% (9 of 55 live births) among untreated mothers.
  
  
  CONCLUSIONS
  PCR is a useful tool for the detection of congenital CD, and the treatment of infected women of childbearing age seems to be useful for preventing vertical transmission.
authors.affiliation: Unidad Regional de Medicina Tropical, Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca, Palmar Murcia, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Murcia
authors.forename: Bartolomé
authors.initials: B
authors.lastname: Carrilero
authors.forename: M Jose
authors.initials: MJ
authors.lastname: Munoz-Davila
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Thomas
authors.forename: Manuel C
authors.initials: MC
authors.lastname: López
authors.forename: Manuel
authors.initials: M
authors.lastname: Segovia
mesh_terms: D000293:Adolescent; D000328:Adult; D001838:Bolivia; D014355:Chagas Disease / Q000635:transmission*; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D010239:Paraguay; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods* / Q000592:standards; D012307:Risk Factors; D014349:Trypanosoma cruzi / Q000235:genetics / Q000302:isolation & purification*; D055815:Young Adult