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      Transmisión vectorial y congénita del Trypanosoma cruzi en Las Lomitas, Formosa Translated title: Vectorial and congenital transmission of Trypanosoma cruzi in Las Lomitas, Formosa

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          Abstract

          La enfermedad de Chagas causada por el Trypanosoma cruzi es una causa importante de morbimortalidad en Latino América. El objetivo de este estudio fue describir las tasas de infestación en las viviendas de cuatro comunidades aborígenes de Las Lomitas (Región del Gran Chaco), Formosa, Argentina; la tasa de infección en la población infantil residente en las mismas, en donantes de sangre y en mujeres embarazadas que asistieron al Hospital de Las Lomitas y la tasa de infección congénita de niños nacidos de mujeres infectadas durante el período de estudio. La tasa de infestación en 172 viviendas evaluadas en 2006 alcanzó el 32%. La prevalencia de infección en 445 personas fue de 17.5% y en menores de 5 años de edad fue 8.6%. La tasa de infección en donantes de sangre alcanzó a 18.6% y en mujeres embarazadas fue 29.1%. La tasa de infección considerada congénita en 47 niños nacidos de mujeres infectadas residentes en viviendas bajo vigilancia fue de 17.0%. El estudio mostró, al momento de su inicio, índices compatibles con transmisión vectorial activa. Después del control vectorial con insecticidas, la tasa de infestación se redujo a 3.3%. El sistema de salud local incorporó procedimientos de prevención primaria y secundaria para evitar nuevos casos e instaurar el tratamiento de la población infectada.

          Translated abstract

          Chagas disease, caused by Trypanosoma cruzi, is a major cause of morbidity and mortality in Latin America. The objective of this study was to describe the rate of infestation in four aboriginal communities in Las Lomitas (Great Chaco Region), Formosa, Argentina; the rate of infection in children residing in these communities, in blood donors and in pregnant women who received care at the Hospital Las Lomitas, as well as the rate of congenital infection in children born to women infected during the study period. The rate of infestation of 172 households evaluated in 2006 reached 32%. Prevalence of infection among 445 people was 17.5% and in children under 5 years old it was 8.6%. The rate of infection reached 18.6% in blood donors and 29.1% in pregnant women. The rate of infection among 47 children born to infected women, and living in residences under vectorial surveillance was 17.0%. These infections were considered as congenital. This study showed indexes compatible with active vectorial transmission at the beginning. After vectorial control with insecticides the infestation rate has been reduced to 3.3%. The local health system has introduced high impact procedures of primary and secondary prevention in order to prevent new cases and to treat infected people.

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          Chagas disease: current epidemiological trends after the interruption of vectorial and transfusional transmission in the Southern Cone countries

          Chagas disease, named after Carlos Chagas who first described it in 1909, exists only on the American Continent. It is caused by a parasite, Trypanosoma cruzi, transmitted to humans by blood-sucking triatomine bugs and by blood transfusion. Chagas disease has two successive phases, acute and chronic. The acute phase lasts 6 to 8 weeks. After several years of starting the chronic phase, 20% to 35% of the infected individuals, depending on the geographical area will develop irreversible lesions of the autonomous nervous system in the heart, esophagus, colon and the peripheral nervous system. Data on the prevalence and distribution of Chagas disease improved in quality during the 1980's as a result of the demographically representative cross-sectional studies carried out in countries where accurate information was not available. A group of experts met in Brasília in 1979 and devised standard protocols to carry out countrywide prevalence studies on human T. cruzi infection and triatomine house infestation. Thanks to a coordinated multi-country program in the Southern Cone countries the transmission of Chagas disease by vectors and by blood transfusion has been interrupted in Uruguay in1997, in Chile in 1999, and in 8 of the 12 endemic states of Brazil in 2000 and so the incidence of new infections by T. cruzi in the whole continent has decreased by 70%. Similar control multi-country initiatives have been launched in the Andean countries and in Central America and rapid progress has been recorded to ensure the interruption of the transmission of Chagas disease by 2005 as requested by a Resolution of the World Health Assembly approved in 1998. The cost-benefit analysis of the investments of the vector control program in Brazil indicate that there are savings of US$17 in medical care and disabilities for each dollar spent on prevention, showing that the program is a health investment with good return. Since the inception in 1979 of the Steering Committee on Chagas Disease of the Special Program for Research and Training in Tropical Diseases of the World Health Organization (TDR), the objective was set to promote and finance research aimed at the development of new methods and tools to control this disease. The well known research institutions in Latin America were the key elements of a world wide network of laboratories that received - on a competitive basis - financial support for projects in line with the priorities established. It is presented the time line of the different milestones that were answering successively and logically the outstanding scientific questions identified by the Scientific Working Group in 1978 and that influenced the development and industrial production of practical solutions for diagnosis of the infection and disease control.
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            High prevalence of congenital Trypanosoma cruzi infection and family clustering in Salta, Argentina.

            Trypanosoma cruzi, the causative agent of Chagas' disease, is transmitted mainly by insect vectors, but congenital and transfusion-borne infections occasionally occur. The factors that are involved in transmission from mother to offspring are not well understood. The objective of this study was to study the presence of T cruzi infection in children who were born to infected mothers and in the children's siblings to evaluate the epidemiologic risk factors associated with congenital transmission of Chagas' disease. Congenital T cruzi infection was studied in 340 children who were born to chronically infected mothers in Salta, Argentina. Infection was detected in 31 children, who were selected for additional study as infected index cases (IIC). Of the 309 noninfected children, 31 were taken as noninfected index cases (NIIC). We compared the prevalence of congenital T cruzi transmission in the remaining siblings of the IIC and NIIC. Data and blood samples were collected in house-to-house visits. Diagnosis of infection was established mainly by serologic methods, indirect hemmagglutination, and enzyme-linked immunosorbent assay. The prevalence was 31.4% (32 of 102 children) for IIC siblings, whereas no infected siblings were found in families with NIIC (0 of 112). Clustering of congenital infection was found in 14 families, in which >1 child was infected. Second-generation congenital transmission (from grandmother to mother to newborn) was established in 4 families. The association among low weight at birth, prematurity, and congenital transmission was highly significant. An important observation was the absence of pathologic findings in a high proportion of infected children. The detection of asymptomatic infections was a consequence of population screening, as opposed to hospital-based diagnosis, for which symptomatic cases predominate. Congenital transmission was associated with the geographic origin of mothers: women from areas where insect vectors proliferate were less likely to give birth to infected offspring than women from areas under active vector control. Siblings of an infant infected with T cruzi are at high risk for infection themselves and, even in the absence of symptoms, should also be screened for infection. The findings of family clustering of infection and of second-generation congenital infection in vector-free areas suggest that new modalities of transmission, other than classic vector-borne spread, may occur both in endemic and in nonendemic areas.
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              Congenital transmission of Trypanosoma cruzi: an operational outline for detecting and treating infected infants in north-western Argentina.

              We designed a set of procedures for first-line local health services to detect and treat the congenital transmission of Trypanosoma cruzi at a province-wide scale, and field-tested the programme in the province of Tucumán, northwestern Argentina, from 1992 to 1994. The programme consists of routine screening of pregnant women for seroreactivity to T. cruzi, serological and parasitological follow-up of the newborn at least twice during the first year of age, treatment of the infected infants, and evaluation of the outcome. 927 (5.5%) of 16 842 pregnant women were seroreactive to T. cruzi by indirect haemagglutination assay and ELISA. Twenty-one (6.7%) of 315 newborns to seroreactive mothers were diagnosed as infected with T. cruzi parasites microhaematocrit concentration before 30 days of age. Five newborns who initially tested negative had a T. cruzi infection detected by microhaematocrit and/or serological techniques at 3 or 6 months of age. Thus, congenital infection was diagnosed in 26 (7.1%) infants born to seroreactive women and residing in houses free of triatomine bugs. Four of 6 infants born to seroreactive mothers died during the first year of age and had some evidence of T. cruzi infection; one of the deaths was attributed to T. cruzi based on clinical evidence. After specific treatment with nifurtimox or benznidazole, 30 of 32 infants remained parasitologically and serologically negative. This study shows the feasibility of controlling the incidence of congenitally acquired T. cruzi infections at a province-wide scale by means of a specific screening programme at first-line health services level.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                medba
                Medicina (Buenos Aires)
                Medicina (B. Aires)
                Fundación Revista Medicina (Ciudad Autónoma de Buenos Aires, , Argentina )
                0025-7680
                1669-9106
                October 2009
                : 69
                : 4
                : 424-430
                Affiliations
                [01] orgnameAdministración Nacional de Laboratorios e Institutos de Salud (ANLIS) Dr. Carlos G. Malbrán orgdiv1Centro Nacional de Diagnóstico e Investigación de Endemo-epidemias (CeNDIE)
                [03] Buenos Aires orgnameConsejo Nacional de Investigaciones Científicas y Técnicas (CONICET)
                [04] Formosa orgnameHospital Las Lomitas orgdiv1Atención Primaria de la Salud
                Article
                S0025-76802009000500002
                86470332-6728-40d0-a4dd-6bc85e1e032b

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 10 March 2009
                : 10 March 2008
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 7
                Product

                SciELO Argentina


                Triatomino,Chagas disease,Congenital transmission,Triatomine,Argentina,Trypanosoma cruzi,Enfermedad de Chagas,Transmisión congénita

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