Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting
Toward Improving Early Diagnosis of Congenital Chagas Disease in an Endemic Setting
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DOI：
10.1093/cid/cix277
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发表时间：
2017-07-15
影响因子：
11.8
通讯作者：
Bern, Caryn
中科院分区：
文献类型：
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作者：
Messenger, Louisa A.;Gilman, Robert H.;Bern, Caryn
背景据估计，先天性克氏锥虫传播占新感染的22%，这是拉丁美洲和国际上的一个重大公共卫生问题。婴儿期的治疗非常有效且耐受性良好，但目前用于早期检测的检测方法未能检测到>50%的感染新生儿，并且9个月的随访率较低。在玻利维亚的圣克鲁斯省的2家城市医院分娩的妇女通过快速测试进行筛查。在出生时和1个月时对感染妇女的婴儿标本进行显微镜检查（微量法）、定量PCR（qPCR）和免疫球蛋白（IG）M锥虫排泄-分泌抗原（TESA）印迹检测，并在6个月和9个月时进行IgG血清学检测。在476名血清学阳性妇女的487名婴儿中，先天性T。在35名母亲的38名婴儿中检测到克氏病毒感染（7.8%）。在脐带血中，qPCR、TESA-blot和微量法的灵敏度/特异性分别为68.6%/99.1%、58.3%/99.1%和16.7%/100%。当结合出生和1个月的结果时，累积灵敏度分别达到84.2%、73.7%和34.2%。11名（29%）感染婴儿报告出生体重低和/或呼吸窘迫。有临床症状的婴儿有较高的寄生虫载量，并显着更有可能被检测到的微量方法。T.自1990年代以来，有临床症状的克氏锥虫病感染婴儿的比例有所下降，但有症状的先天性锥虫病仍然是一个重大的公共卫生问题，尽管很难发现。分子方法可以促进早期诊断，避免后续损失，但在资源有限的情况下，常规筛查在后勤和经济上仍然是禁止的。
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.