ABSTRACT
En el marco de las acciones del Programa Nacional de Chagas (PNCh), los criterios de atención del infectado chagásico contemplan la detección precoz de la infección por Trypanosoma cruzi e el tratamiento específico en la población infantil. El presente trabajo busca evaluar la cobertura detratamiento etiológico para Chagas en niños menores de 1 año -Chagas congénito- e entre 1 y 14 añosfase crónica recient durante el período 2003 al 2006. Los datos fueron aportados por los referentes de la Red de Laboratorios de Chagas provinciales e jefes de Programas Provinciales e Jurisdicciones Nacionales de Chagas de la República Argentina, a la Coordinación Nacional de Control de Vectores (CNCV). Se estudiaron 13.866 niños menores de 1 año, con métodos parasitológicos e/o duplasserológicas para la infección por T. cruzi, de los cuales fueron positivos 1.016 niños (7,33por cento) e se trataron 529 (52,07por cento). Por estudios serológicos poblacionales se analizaron 158.640 niños menores de 15 años, de áreas endémicas, se detectaron 4.549 niños positivos (2,87por cento) e se trataron 1.526 (33,55por cento). Del análisis global de los datos (grupos 1 e 2) se observa una heterogeneidad en la cobertura de tratamiento, entre las provincias, siendo en general inadecuada (menor al 50por cento)...
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Vector Control of Diseases , Chagas Disease/etiology , Chagas Disease/therapy , Trypanosoma cruzi , ArgentinaABSTRACT
Congenital transmission (CT) has acquired relevance in Chagas disease (CHD). A cohort of pregnant CHD women (4,355) and their babies were studied in the period 1994-2004. Children were excluded when they had received blood transfusions, or were born or had been in endemic areas; CT rate was 6.1%. Babies were diagnosed between months 1 and 5 in 68.9% of the cases and between months 6 and 12 in 31.1%. In the latter group, parasitemia was detected in 94% and serology in 74.7%. Between months 6 and 9, parasitemia diagnosed 36.2% (P = 0.000) more cases than serology. If serology had been the diagnosis method, those children would have been considered CT free. Taking the overall outcomes, 38.1% of babies were CT free, and 55.8% did not complete the follow-up. Establishing CT as a public health priority and improving first-line health service, congenital CHD coverage could be more efficient in endemic countries.
Subject(s)
Chagas Disease/congenital , Pregnancy Complications, Parasitic/epidemiology , Trypanosoma cruzi , Urban Population , Adult , Animals , Antibodies, Protozoan/blood , Argentina/epidemiology , Chagas Disease/epidemiology , Female , Humans , Infant , Infant, Newborn , Population Surveillance , Pregnancy , Seroepidemiologic Studies , Time Factors , Trypanosoma cruzi/immunologyABSTRACT
Most congenital transmissions of Trypanosoma cruzi are not detected. As the levels of mediators regulating the immune response might be different in the absence or in the presence of transmission, we explored the levels of tumor necrosis factor (TNF) and soluble TNF receptors TNF-R1 and -R2 in T. cruzi-infected pregnant women and the neonates. We previously found that the circulating levels of TNF were higher in non-transmitting than in transmitting pregnant women. This observation has now been extended to the spontaneous release of TNF by peripheral blood leukocytes (PBLs) that was also higher in non-transmitting than in transmitting pregnant women. As their mothers, non-infected neonates had higher circulating levels of TNF than congenitally infected children. The circulating levels of sTNF-R1 increased in non-transmitting and transmitting mothers and in infected and non-infected neonates. The circulating levels of sTNF-R2 were approximately 60% higher in infected than in non-infected neonates (1,635 +/- 101 and 1,027 +/- 100 pg/mL, respectively) and remained higher at 1 year of age. This important increase, only observed in infected neonates, could be useful to orientate to the presence of vertical transmission of T. cruzi infection.
