TY - JOUR
T1 - Towards a new strategy for diagnosis of congenital Trypanosoma cruzi infection
AU - Abras, Alba
AU - Muñoz, Carmen
AU - Ballart, Cristina
AU - Berenguer, Pere
AU - Llovet, Teresa
AU - Herrero, Mercedes
AU - Tebar, Silvia
AU - Pinazo, María Jesús
AU - Posada, Elizabeth
AU - Martí, Carmen
AU - Fumadó, Victoria
AU - Bosch, Jordi
AU - Coll, Oriol
AU - Juncosa, Teresa
AU - Ginovart, Gemma
AU - Armengol, Josep
AU - Gascón, Joaquim
AU - Portús, Montserrat
AU - Gállego, Montserrat
PY - 2017/5/1
Y1 - 2017/5/1
N2 - 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 congenital Trypanosoma cruzi infection, (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 of T. cruzi infection. 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 congenital T. cruzi infection, 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.
AB - 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 congenital Trypanosoma cruzi infection, (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 of T. cruzi infection. 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 congenital T. cruzi infection, 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.
KW - Congenital chagas disease
KW - Countries of endemicity
KW - Europe
KW - Flowchart
KW - Immigrant population
KW - Serology
KW - Spain
UR - http://www.scopus.com/inward/record.url?scp=85018357183&partnerID=8YFLogxK
U2 - 10.1128/JCM.02248-16
DO - 10.1128/JCM.02248-16
M3 - Article
C2 - 28202792
VL - 55
SP - 1396
EP - 1407
JO - Journal of Clinical Microbiology
JF - Journal of Clinical Microbiology
SN - 0095-1137
IS - 5
ER -