RESUMO
BACKGROUND: According to the Chagas congenital transmission guides, the diagnosis of infants, born to Trypanosoma cruzi infected mothers, relies on the detection of parasites by INP micromethod, and/or the persistence of T. cruzi specific antibody titers at 10-12 months of age. METHODOLOGY AND PRINCIPAL FINDINGS: Parasitemia levels were quantified by PCR in T. cruzi-infected children, grouped according to the results of one-year follow-up diagnosis: A) Neonates that were diagnosed in the first month after delivery by microscopic blood examination (INP micromethod) (n = 19) had a median parasitemia of 1,700 Pe/mL (equivalent amounts of parasite DNA per mL); B) Infants that required a second parasitological diagnosis at six months of age (n = 10) showed a median parasitemia of around 20 Pe/mL and 500 Pe/mL at 1 and 6 months old, respectively, and C) babies with undetectable parasitemia by three blood microscopic observations but diagnosed by specific anti - T. cruzi serology at around 1 year old, (n = 22), exhibited a parasitemia of around 5 Pe/mL, 800 Pe/mL and 20 Pe/mL 1, 6 and 12 month after delivery, respectively. T. cruzi parasites were isolated by hemoculture from 19 congenitally infected children, 18 of which were genotypified as DTU TcV, (former lineage TcIId) and only one as TcI. SIGNIFICANCE: This report is the first to quantify parasitemia levels in more than 50 children congenitally infected with T. cruzi, at three different diagnostic controls during one-year follow-up after delivery. Our results show that the parasite burden in some children (22 out of 51) is below the detection limit of the INP micromethod. As the current trypanocidal treatment proved to be very effective to cure T. cruzi - infected children, more sensitive parasitological methods should be developed to assure an early T. cruzi congenital diagnosis.
Assuntos
Doença de Chagas/congênito , Doença de Chagas/diagnóstico , DNA de Protozoário/isolamento & purificação , Técnicas de Diagnóstico Molecular/métodos , Parasitemia/congênito , Parasitemia/diagnóstico , Trypanosoma cruzi/isolamento & purificação , DNA de Protozoário/genética , Diagnóstico Precoce , Feminino , Humanos , Lactente , Recém-Nascido , Carga Parasitária/métodos , GravidezRESUMO
This is a report of the first Plasmodium vivax congenital malaria case in Guatemala and the first case in Latin America with genotypical, histological and clinical characterization. The findings show that maternal P. vivax infection still occurs in areas that are in the pathway towards malaria elimination, and can be associated with detrimental health effects for the neonate. It also highlights the need in very low transmission areas of not only maintaining, but increasing awareness of the problem and developing surveillance strategies, based on population risk, to detect the infection especially in this vulnerable group of the population.
Assuntos
Malária Vivax/congênito , Doenças Endêmicas , Feminino , Sangue Fetal/parasitologia , Guatemala/epidemiologia , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Malária Vivax/epidemiologia , Malária Vivax/transmissão , Parasitemia/congênito , Parasitemia/parasitologia , Plasmodium vivax/genética , Plasmodium vivax/isolamento & purificação , Vigilância da População , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Complicações Parasitárias na Gravidez/parasitologia , Adulto JovemRESUMO
Congenital malaria is a condition rarely diagnosed, even in endemic countries. This tropical disease is associated with high mortality in the absence of timely recognition and prompt therapy, particularly when is due to Plasmodium falciparum, however Plasmodium vivax can also lead to relevant morbidity and mortality. We report an unusual case of a 19- day-old male newborn with neonatal vivax malaria, suspected primarily on the basis of positive maternal history, which presented with low birth weight, thrombocytopenia and a significant parasitemia. He responded satisfactorily to chloroquine antimalarial therapy, being successfully discharged 10 days after admission. Blood smears remained negative during the first 2 months of follow up. At 8 weeks of follow-up, she showed remarkable weight gain and was developing normally with age-appropriate anthropometry with no subsequent complications.
Assuntos
Malária Vivax/congênito , Plasmodium vivax/isolamento & purificação , Antimaláricos/administração & dosagem , Cloroquina/administração & dosagem , Humanos , Recém-Nascido , Malária Vivax/tratamento farmacológico , Masculino , Parasitemia/congênito , Parasitemia/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: Congenital malaria has been considered a rare event; however, recent reports have shown frequencies ranging from 3% to 54.2% among newborns of mothers who had suffered malaria during pregnancy. There are only a few references concerning the epidemiological impact of this entity in Latin-America and Colombia. OBJECTIVE: The aim of the study was to measure the prevalence of congenital malaria in an endemic Colombian region and to determine some of its characteristics. METHODS: A prospective, descriptive study was carried out in the mothers who suffered malaria during pregnancy and their newborns. Neonates were clinically evaluated at birth and screened for Plasmodium spp. infection by thick smear from the umbilical cord and peripheral blood, and followed-up weekly during the first 21 days of postnatal life through clinical examinations and thick smears. RESULTS: 116 newborns were included in the study and 80 umbilical cord samples were obtained. Five cases of congenital infection were identified (four caused by P. vivax and one by P. falciparum), two in umbilical cord blood and three in newborn peripheral blood. One case was diagnosed at birth and the others during follow-up. Prevalence of congenital infection was 4.3%. One of the infected newborns was severely ill, while the others were asymptomatic and apparently healthy. The mothers of the newborns with congenital malaria had been diagnosed with malaria in the last trimester of pregnancy or during delivery, and also presented placental infection. CONCLUSIONS: Congenital malaria may be a frequent event in newborns of mothers who have suffered malaria during pregnancy in Colombia. An association was found between congenital malaria and the diagnosis of malaria in the mother during the last trimester of pregnancy or during delivery, and the presence of placental infection.
Assuntos
Malária Falciparum/congênito , Malária Falciparum/epidemiologia , Malária Vivax/congênito , Malária Vivax/epidemiologia , Plasmodium falciparum/isolamento & purificação , Plasmodium vivax/isolamento & purificação , Adolescente , Adulto , Sangue/parasitologia , Colômbia/epidemiologia , Feminino , Humanos , Recém-Nascido , Malária Falciparum/diagnóstico , Malária Vivax/diagnóstico , Masculino , Parasitemia/congênito , Parasitemia/diagnóstico , Parasitemia/epidemiologia , Gravidez , Estudos Prospectivos , Adulto JovemRESUMO
Research on this form of transmission was carried out on female rats intradermally injected, before mating, with 1 x 10(4) metacyclic trypomastigotes of T. cruzi strains from dog (Pr) and human (YBM). The infected rats, as well as their offspring, were given parasitological, immunological and histopathological examinations during and after gestation. Healthy gestating rats were used as controls. Rats infected with T. cruzi strains showed clear signs of infection between 18 and 45 days post-inoculation (pi). Of 44 offspring from mothers infected with Pr, 4 males (9.1%) showed high parasitemia (432 and 240 tryps./mm3 of blood) at 30 and 40 days after birth, while direct blood examination, hemoculture and xenodiagnosis showed no infection in the other 40, or in the 52 offspring of rats infected with YBM. Anti-T. cruzi antibodies were found in appreciable quantities in infected mothers and in 44 out of 92 (47.8%) of the offspring, with titers that fluctuated between 1:32 and 1:2048 respectively. Histopathological studies of rats sacrificed at the end of gestation showed acute myocarditis and myositis of varying intensity and extent, characterized by abundant inflammatory infiltrate, in some cases associated with nests of amastigotes. The placentas showed moderate cellular infiltrate without parasites in the vascular stroma and amniotic fluid. The offspring of mothers infected with Chagas' disease were reinoculated and showed an acute phase characterized by low parasitemia (p < 0.05); after 60 days, the beginnings of chronic myocarditis and myositis could be observed, of a similar intensity to that observed in offspring born to infected mothers that were subsequently infected. These results confirm that T. cruzi can be transmitted vertically in Wistar rats; that a small number of offspring contract Chagasic infection congenitally; that anti-T. cruzi antibodies can pass from the mother and that these can modify the immune response in the offspring; that the pathogenicity of the strains of T. cruzi plays an important role in congenital transmission independently of origin or geographical location.