Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia.
Citation: Clinical Infectious Diseases. 61(6):918-26, 2015 Sep 15.PMID: 26063720Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, N.I.H., Extramural | Research Support, Non-U.S. Gov'tSubject headings: *Chagas Disease/ep [Epidemiology] | *Chagas Disease/tm [Transmission] | *Infectious Disease Transmission, Vertical | *Insect Vectors/gd [Growth & Development] | *Parasitemia/ep [Epidemiology] | *Trypanosoma cruzi/ip [Isolation & Purification] | Adolescent | Adult | Animals | Antibodies, Protozoan/bl [Blood] | Bolivia | Chagas Disease/cn [Congenital] | Chagas Disease/im [Immunology] | DNA, Protozoan/bl [Blood] | Electrocardiography | Female | Humans | Infant | Infant, Newborn | Middle Aged | Parasitemia/im [Immunology] | Polymerase Chain Reaction | Pregnancy | Risk Assessment | Serologic Tests | Th2 Cells/im [Immunology] | Trypanosoma cruzi/im [Immunology] | Young AdultYear: 2015Local holdings: Available online from MWHC library: June 1997 - present, Available in print through MWHC library: 1999 - Winter 2007ISSN:- 1058-4838
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 26063720 | Available | 26063720 |
Available online from MWHC library: June 1997 - present, Available in print through MWHC library: 1999 - Winter 2007
BACKGROUND: We studied women and their infants to evaluate risk factors for congenital transmission and cardiomyopathy in Trypanosoma cruzi-infected women.
CONCLUSIONS: We hypothesize that repeated vector-borne infection sustains antigen exposure and the consequent inflammatory response at a higher chronic level, increasing cardiac morbidity, but possibly enabling exposed women to control parasitemia in the face of pregnancy-induced Th2 polarization.Copyright © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].
METHODS: Women provided data and blood for serology and quantitative polymerase chain reaction (PCR). Infants of infected women had blood tested at 0 and 1 month by microscopy, PCR and immunoblot, and serology at 6 and 9 months. Women underwent electrocardiography (ECG).
RESULTS: Of 1696 women, 456 (26.9%) were infected; 31 (6.8%) transmitted T. cruzi to their infants. Women who transmitted had higher parasite loads than those who did not (median, 62.0 [interquartile range {IQR}, 25.8-204.8] vs 0.05 [IQR, 0-29.6]; P < .0001). Transmission was higher in twin than in singleton births (27.3% vs 6.4%; P = .04). Women who had not lived in infested houses transmitted more frequently (9.7% vs 4.6%; P = .04), were more likely to have positive results by PCR (65.5% vs 33.9%; P < .001), and had higher parasite loads than those who had lived in infested houses (median, 25.8 [IQR, 0-64.1] vs 0 [IQR, 0-12.3]; P < .001). Of 302 infected women, 28 (9.3%) had ECG abnormalities consistent with Chagas cardiomyopathy; risk was higher for older women (odds ratio [OR], 1.06 [95% confidence interval {CI}, 1.01-1.12] per year) and those with vector exposure (OR, 3.7 [95% CI, 1.4-10.2]). We observed a strong dose-response relationship between ECG abnormalities and reported years of living in an infested house.
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