Trypanocide Treatment of Women Infected with Trypanosoma cruzi and Its Effect on Preventing Congenital Chagas

With the control of the vectorial and transfusional routes of infection with Trypanosoma cruzi, congenital transmission has become an important source of new cases. This study evaluated the efficacy of trypanocidal therapy to prevent congenital Chagas disease and compared the clinical and serological evolution between treated and untreated infected mothers. We conducted a multicenter, observational study on a cohort of mothers infected with T. cruzi, with and without trypanocidal treatment before pregnancy. Their children were studied to detect congenital infection. Among 354 “chronically infected mother-biological child” pairs, 132 were treated women and 222 were untreated women. Among the children born to untreated women, we detected 34 infected with T. cruzi (15.3%), whose only antecedent was maternal infection. Among the 132 children of previously treated women, no infection with T. cruzi was found (0.0%) (p<0.05). Among 117 mothers with clinical and serological follow up, 71 had been treated and 46 were untreated. The women were grouped into three groups. Group A: 25 treated before 15 years of age; Group B: 46 treated at 15 or more years of age; Group C: untreated, average age of 29.2±6.2 years at study entry. Follow-up for Groups A, B and C was 16.3±5.8, 17.5±9.2 and 18.6±8.6 years respectively. Negative seroconversion: Group A, 64.0% (16/25); Group B, 32.6% (15/46); Group C, no seronegativity was observed. Clinical electrocardiographic alterations compatible with chagasic cardiomyopathy: Group A 0.0% (0/25); B 2.2% (1/46) and C 15.2% (7/46). The trypanocidal treatment of women with chronic Chagas infection was effective in preventing the congenital transmission of Trypanosoma cruzi to their children; it had also a protective effect on the women's clinical evolution and deparasitation could be demonstrated in many treated women after over 10 years of follow up.Fil: Fabbro, Diana Lucrecia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas; ArgentinaFil: Danesi, Emmaría. Administración Nacional de Laboratorios e Institutos de Salud. Centro Nacional de Diagnóstico e Investigaciones Endemo-epidemicas. Buenos Aires; ArgentinaFil: Olivera, Lorena Veronica. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas; ArgentinaFil: Codebó, Maria Olenka. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud “Dr. C.G. Malbrán”. Instituto Nacional de Parasitología “Dr. M. Fatala Chabén”; ArgentinaFil: Denner, Susana. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas; ArgentinaFil: Heredia, Cecilia. Administración Nacional de Laboratorios e Institutos de Salud. Centro Nacional de Diagnóstico e Investigaciones Endemo-epidemicas. Buenos Aires; ArgentinaFil: Streiger, Mirtha. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas; ArgentinaFil: Sosa-Estani, Sergio Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Administración Nacional de Laboratorios e Institutos de Salud. Centro Nacional de Diagnóstico e Investigaciones Endemo-epidemicas. Buenos Aires; Argentina. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud “Dr. C.G. Malbrán”. Instituto Nacional de Parasitología “Dr. M. Fatala Chabén”; Argentin

Flowchart of the study.

<p>Flowchart of the study.</p

Evolution of electrocardiographic alterations compatible with chronic Chagas cardiomyopathy (CCC) that appeared during follow-up in women treated and untreated with trypanocides, Argentina.

<p>*Age at start of ECG alterations.</p>†<p>Wolf-Parkinson-White Syndrome.</p><p>RBBB: Complete Right Bundle-Branch Block.</p><p>LAFB: Left Anterior Fascicular Block.</p><p>fVE: Frequent Ventricular Extrasystoles.</p><p>AHT: Arterial Hypertension.</p><p>Evolution of electrocardiographic alterations compatible with chronic Chagas cardiomyopathy (CCC) that appeared during follow-up in women treated and untreated with trypanocides, Argentina.</p

Kaplan-Meier curve showing serological reactivity rate during follow-up among 117 treated and untreated women.

<p>Kaplan-Meier curve showing serological reactivity rate during follow-up among 117 treated and untreated women.</p

Kaplan-Meier curve showing serological reactivity rate by age during follow-up in 71 treated women.

<p>Kaplan-Meier curve showing serological reactivity rate by age during follow-up in 71 treated women.</p

Method for detection of <i>T. cruzi</i> infection in 144 mothers.

<p>Method for detection of <i>T. cruzi</i> infection in 144 mothers.</p

Sociodemographic description and exposure of 144 women treated and untreated with trypanocidal drug.

a)<p>Comparison of frequencies by Chi² test or Fisher test. Comparison of means by Student's T test or Bonferroni test.</p>b)<p>Only for Argentinian provinces, according to the denomination used by the Programa Nacional de Chagas (last viewed 29/10/13).</p><p>*Variable with N lower than total population.</p><p>Sociodemographic description and exposure of 144 women treated and untreated with trypanocidal drug.</p

Epidemiological data.

<p>Birth weight, gestational age and type of delivery of the children with or without infection by <i>Trypanosoma cruzi</i> born to infected women treated and untreated with trypanocidal. Argentina.</p><p>Fisher's exact test, p>0.05.</p><p>*Student's t test, p>0.05.</p><p>Epidemiological data.</p

Distribution of 117 women with chronic infection of <i>T. cruzi,</i> treated and untreated with nifurtimox or benznidazole, by age group and time of follow-up equal to or greater than 8 years, Argentina.

<p>Distribution of 117 women with chronic infection of <i>T. cruzi,</i> treated and untreated with nifurtimox or benznidazole, by age group and time of follow-up equal to or greater than 8 years, Argentina.</p