title: Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting.
abstract: BACKGROUND
  Congenital Trypanosoma cruzi transmission is now estimated to account for 22% of new infections, representing a significant public health problem across Latin America and internationally. Treatment during infancy is highly efficacious and well tolerated, but current assays for early detection fail to detect >50% of infected neonates, and 9-month follow-up is low.
  
  
  METHODS
  Women who presented for delivery at 2 urban hospitals in Santa Cruz Department, Bolivia, were screened by rapid test. Specimens from infants of infected women were tested by microscopy (micromethod), quantitative PCR (qPCR), and immunoglobulin (Ig)M trypomastigote excreted-secreted antigen (TESA)-blots at birth and 1 month and by IgG serology at 6 and 9 months.
  
  
  RESULTS
  Among 487 infants of 476 seropositive women, congenital T. cruzi infection was detected in 38 infants of 35 mothers (7.8%). In cord blood, qPCR, TESA-blot, and micromethod sensitivities/specificities were 68.6%/99.1%, 58.3%/99.1%, and 16.7%/100%, respectively. When birth and 1-month results were combined, cumulative sensitivities reached 84.2%, 73.7%, and 34.2%, respectively. Low birthweight and/or respiratory distress were reported in 11 (29%) infected infants. Infants with clinical signs had higher parasite loads and were significantly more likely to be detected by micromethod.
  
  
  CONCLUSIONS
  The proportion of T. cruzi-infected infants with clinical signs has fallen since the 1990s, but symptomatic congenital Chagas disease still represents a significant, albeit challenging to detect, public health problem. Molecular methods could facilitate earlier diagnosis and circumvent loss to follow-up but remain logistically and economically prohibitive for routine screening in resource-limited settings.
authors.affiliation: Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Louisa A
authors.initials: LA
authors.lastname: Messenger
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Manuela
authors.initials: M
authors.lastname: Verastegui
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Gerson
authors.initials: G
authors.lastname: Galdos-Cardenas
authors.affiliation: Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Sanchez
authors.affiliation: Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Edward
authors.initials: E
authors.lastname: Valencia
authors.affiliation: Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Leny
authors.initials: L
authors.lastname: Sanchez
authors.affiliation: Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Edith
authors.initials: E
authors.lastname: Malaga
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Victoria R
authors.initials: VR
authors.lastname: Rendell
authors.affiliation: Division of Internal Medicine, Brown University, Providence, Rhode Island.
authors.forename: Malasa
authors.initials: M
authors.lastname: Jois
authors.affiliation: Department of Medicine, New York University, New York.
authors.forename: Vishal
authors.initials: V
authors.lastname: Shah
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco.
authors.forename: Nicole
authors.initials: N
authors.lastname: Santos
authors.affiliation: Hospital Universitario Japones, Santa Cruz.
authors.forename: Maria Del Carmen
authors.initials: MDC
authors.lastname: Abastoflor
authors.affiliation: Hospital Universitario Japones, Santa Cruz.
authors.forename: Carlos
authors.initials: C
authors.lastname: LaFuente
authors.affiliation: Hospital Universitario Japones, Santa Cruz.
authors.forename: Rony
authors.initials: R
authors.lastname: Colanzi
authors.affiliation: Hospital Municipal Camiri, Plurinational State of Bolivia.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Bozo
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco.
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
mesh_terms: D000328:Adult; D000913:Antibodies, Protozoan / Q000097:blood; D000953:Antigens, Protozoan / Q000097:blood / Q000276:immunology; D014355:Chagas Disease / Q000151:congenital* / Q000175:diagnosis* / Q000276:immunology / Q000635:transmission; D042241:Early Diagnosis; D019353:Endemic Diseases; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D009035:Mothers; D059208:Parasite Load; D060888:Real-Time Polymerase Chain Reaction; D014349:Trypanosoma cruzi / Q000235:genetics / Q000276:immunology*
chemical_list: D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: Bolivia; Chagas disease; Trypanosoma cruzi; congenital; diagnostics