Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia
© 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: journals.permissionsoup.com..
BACKGROUND: We studied women and their infants to evaluate risk factors for congenital transmission and cardiomyopathy in Trypanosoma cruzi-infected women.
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.
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.
| Errataetall: |
CommentIn: Clin Infect Dis. 2016 Feb 1;62(3):407-8. - PMID 26420798 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2015 |
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| Erschienen: |
2015 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:61 |
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| Enthalten in: |
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America - 61(2015), 6 vom: 15. Sept., Seite 918-26 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kaplinski, Michelle [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 06.06.2016 Date Revised 16.03.2022 published: Print-Electronic CommentIn: Clin Infect Dis. 2016 Feb 1;62(3):407-8. - PMID 26420798 Citation Status MEDLINE |
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| doi: |
10.1093/cid/civ446 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Kaplinski, Michelle |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia |
| 264 | 1 | |c 2015 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 06.06.2016 | ||
| 500 | |a Date Revised 16.03.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Clin Infect Dis. 2016 Feb 1;62(3):407-8. - PMID 26420798 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 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: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: We studied women and their infants to evaluate risk factors for congenital transmission and cardiomyopathy in Trypanosoma cruzi-infected women | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Chagas disease | |
| 650 | 4 | |a Trypanosoma cruzi | |
| 650 | 4 | |a cardiomyopathy | |
| 650 | 4 | |a infectious disease transmission; vertical | |
| 650 | 7 | |a Antibodies, Protozoan |2 NLM | |
| 650 | 7 | |a DNA, Protozoan |2 NLM | |
| 700 | 1 | |a Jois, Malasa |e verfasserin |4 aut | |
| 700 | 1 | |a Galdos-Cardenas, Gerson |e verfasserin |4 aut | |
| 700 | 1 | |a Rendell, Victoria R |e verfasserin |4 aut | |
| 700 | 1 | |a Shah, Vishal |e verfasserin |4 aut | |
| 700 | 1 | |a Do, Rose Q |e verfasserin |4 aut | |
| 700 | 1 | |a Marcus, Rachel |e verfasserin |4 aut | |
| 700 | 1 | |a Pena, Melissa S Burroughs |e verfasserin |4 aut | |
| 700 | 1 | |a Abastoflor, Maria del Carmen |e verfasserin |4 aut | |
| 700 | 1 | |a LaFuente, Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Bozo, Ricardo |e verfasserin |4 aut | |
| 700 | 1 | |a Valencia, Edward |e verfasserin |4 aut | |
| 700 | 1 | |a Verastegui, Manuela |e verfasserin |4 aut | |
| 700 | 1 | |a Colanzi, Rony |e verfasserin |4 aut | |
| 700 | 1 | |a Gilman, Robert H |e verfasserin |4 aut | |
| 700 | 1 | |a Bern, Caryn |e verfasserin |4 aut | |
| 700 | 0 | |a Working Group on Chagas Disease in Bolivia and Peru |e verfasserin |4 aut | |
| 700 | 1 | |a Sanchez, Leny |e investigator |4 oth | |
| 700 | 1 | |a Ferrufino, Lisbeth |e investigator |4 oth | |
| 700 | 1 | |a Malaga, Edith |e investigator |4 oth | |
| 700 | 1 | |a Quispe, Sara |e investigator |4 oth | |
| 700 | 1 | |a Hinojosa, Edith |e investigator |4 oth | |
| 700 | 1 | |a Ramirez, Margot |e investigator |4 oth | |
| 700 | 1 | |a Saenza, Eliana |e investigator |4 oth | |
| 700 | 1 | |a Flores-Franco, Jorge Luis |e investigator |4 oth | |
| 700 | 1 | |a Acosta, Janet |e investigator |4 oth | |
| 700 | 1 | |a Sanchez, Gerardo |e investigator |4 oth | |
| 700 | 1 | |a Suxo, Maribel |e investigator |4 oth | |
| 700 | 1 | |a Roncales, Hilsen |e investigator |4 oth | |
| 700 | 1 | |a Ramirez, Fernando |e investigator |4 oth | |
| 700 | 1 | |a Escalera, Nazaret Bozo |e investigator |4 oth | |
| 700 | 1 | |a Espinoza, Celia |e investigator |4 oth | |
| 700 | 1 | |a Vizcarra, Janet |e investigator |4 oth | |
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