title: Towards a New Strategy for Diagnosis of Congenital Trypanosoma cruzi Infection.
abstract: The immigration of Latin American women of childbearing age has spread the congenital transmission of Chagas disease to areas of nonendemicity, and the disease is now a worldwide problem. Some European health authorities have implemented screening programs to prevent vertical transmission, but the lack of a uniform protocol calls for the urgent establishment of a new strategy common to all laboratories. Our aims were to (i) analyze the trend of passive IgG antibodies in the newborn by means of five serological tests for the diagnosis and follow-up of congenitalTrypanosoma cruziinfection, (ii) assess the utility of these techniques for diagnosing a congenital transmission, and (iii) propose a strategy for a prompt, efficient, and cost-effective diagnosis ofT. cruziinfection. In noninfected newborns, a continuous decreasing trend of passive IgG antibodies was observed, but none of the serological assays seroreverted in any the infants before 12 months. From 12 months onwards, serological tests achieved negative results in all the samples analyzed, with the exception of the highly sensitive chemiluminescent microparticle immunoassay (CMIA). In contrast, in congenitally infected infants, the antibody decline was detected only after treatment initiation. In order to improve the diagnosis of congenitalT. cruziinfection, we propose a new strategy involving fewer tests that allows significant cost savings. The protocol could start 1 month after birth with a parasitological test and/or a PCR. If negative, a serological test would be carried out at 9 months, which if positive, would be followed by another at around 12 months for confirmation.
authors.affiliation: Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain.|ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain.|Laboratori d'Ictiologia Genètica, Departament de Biologia, Universitat de Girona, Girona, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Abras
authors.affiliation: Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain cmunoz@santpau.cat.|Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.|Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Muñoz
authors.affiliation: Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain.|ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ballart
authors.affiliation: Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Berenguer
authors.affiliation: Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.|Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Llovet
authors.affiliation: Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Herrero
authors.affiliation: Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain.|ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Tebar
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain.
authors.forename: María-Jesús
authors.initials: MJ
authors.lastname: Pinazo
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Posada
authors.affiliation: Unitat de Microbiologia, Hospital General de Granollers, Granollers, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Martí
authors.affiliation: Servei de Pediatria, Unitat de Medicina Importada, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Fumadó
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain.|Servei de Microbiologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Departament de Medicina Materno-Fetal, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Coll
authors.affiliation: Servei de Microbiologia, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Juncosa
authors.affiliation: Unitat de Neonatologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Ginovart
authors.affiliation: Servei de Ginecologia i Obstetrícia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Armengol
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gascón
authors.affiliation: Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Portús
authors.affiliation: Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Barcelona, Spain.|ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Gállego
mesh_terms: D000913:Antibodies, Protozoan / Q000097:blood* / Q000276:immunology; D014355:Chagas Disease / Q000175:diagnosis* / Q000469:parasitology; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D006801:Humans; D007112:Immunity, Maternally-Acquired / Q000276:immunology*; D007074:Immunoglobulin G / Q000097:blood* / Q000276:immunology; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008403:Mass Screening / Q000379:methods; D016133:Polymerase Chain Reaction / Q000379:methods; D012698:Serologic Tests; D013030:Spain; D014349:Trypanosoma cruzi / Q000276:immunology*
chemical_list: D000913:Antibodies, Protozoan; D007074:Immunoglobulin G
keywords: Europe; Spain; congenital Chagas disease; countries of endemicity; flowchart; immigrant population; serology