Congenital transmission of Chagas disease in a non-endemic area, is an early diagnosis possible?

RESEARCH ARTICLE Congenital transmission of Chagas disease in a non-endemic area, is an early diagnosis possible? Laura Francisco-González ID1☯, Alba Rubio-San-Simón2☯, Marı́a Isabel González-Tomé2*, Ángela Manzanares2, Cristina Epalza2, Marı́a del Mar Santos3, Teresa Gastañaga4, Paloma Merino5, José Tomás Ramos-Amador6 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Pediatrics, Hospital Clı́nico San Carlos, Complutense University of Madrid, Madrid, Spain, 2 Department of Pediatrics, Hospital Doce de Octubre, Madrid, Spain, 3 Department of Pediatrics, Hospital Gregorio Marañón, Madrid, Spain, 4 Department of Obstetrics and Gynaecology, Hospital Clı́nico San Carlos, Madrid, Spain, 5 Department of Microbiology, Hospital Clı́nico San Carlos, Madrid, Spain, 6 Department of Pediatrics, Hospital Clı́nico San Carlos, Instituto de Investigación Sanitaria del Hospital Clı́nico San Carlos (IdISSC), Complutense University of Madrid, Madrid, Spain ☯ These authors contributed equally to this work. * Abstract OPEN ACCESS Citation: Francisco-González L, Rubio-San-Simón A, González-Tomé MI, Manzanares Á, Epalza C, Santos MdM, et al. (2019) Congenital transmission of Chagas disease in a non-endemic area, is an early diagnosis possible? PLoS ONE 14(7): e0218491. https://doi.org/10.1371/journal. pone.0218491 Editor: Emanuele Nicastri, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, ITALY Received: March 3, 2019 Accepted: June 2, 2019 Published: July 10, 2019 Copyright: © 2019 Francisco-González et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its supporting information files. Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Background Chagas disease (CD) is an emergent disease in Europe, due to immigration. The aims of this study are to describe the epidemiological characteristics of a cohort of Chagas infected pregnant women in Spain, to assess the vertical transmission (VT) rate and evaluate the usefulness of the PCR in the diagnosis of congenital infection in the first months of life. Methods A descriptive, retrospective study including Chagas seropositive pregnant women who were attended at three tertiary hospitals in Madrid, from January 2012 to September 2016. Infants were examined by PCR at birth and 1 month later and serologically studied at 9 months or later. Children were considered infected when the parasite was detected by PCR at any age or when serology remained positive without decline over the age of 9 months. Results We included 122 seropositive-infected pregnant women, 81% were from Bolivia and only 8.2% had been treated before. 125 newborns were studied and finally 109 were included (12.8% lost the follow-up before performing the last serology). The VT rate was 2.75% (95% CI: 0,57–8,8%). Infected infants had positive PCR at birth and 1 month later. All of them were treated successfully with benznidazole (PCR and serology became negative later on). All non-infected children presented negative PCR. The mean age at which uninfected patients had negative serology was 10.5 months. PLOS ONE | https://doi.org/10.1371/journal.pone.0218491 July 10, 2019 1/7 Congenital transmission of Chagas disease, is an early diagnosis possible? Conclusions The VT rate is in keeping with literature and confirms the need to carry out a screening in pregnant women coming from endemic areas. PCR seems to be a useful tool to provide early diagnosis of congenital CD. Introduction Over the past years there has been an increase in migration flows between different geographical areas, causing variations in epidemiological patterns of diseases worldwide. Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, has traditionally been confined to endemic locations in South America, but nowadays is emerging in Europe[1], mainly in Spain, the European country with the highest immigration rate from South America and with the highest number of individuals with CD [2]. Most of new cases of CD in Spain occur through vertical mother-to-child transmission (VT). Murcia L. et al [3] have recently described the effectiveness of treating infected women to prevent congenital CD. The risk of congenital transmission seems to be related to maternal Trypanosoma parasitemia, suggesting that early treatment should be performed in infected women of childbearing age in order to prevent congenital CD. In addition, an early diagnosis is essential as younger infants have better response to treatment [4]. In the last years, a significant effort has been made in Spain to establish a Chagas screening program in pregnant mothers native from endemic areas. For diagnosis of congenital CD in children born to infected mothers Spanish guidelines recommend performing: Polymerase Chain-Reaction (PCR) and /or microhaematocrit detection at birth and 1 month later, and a serological determination at 9 months of age or later[4]. Nowadays, this screening is not universal and therefore misdiagnosis of VT cases may occur. Furthermore, as children born to infected mothers need to be followed up for a prolonged period until the confirmation of a negative serology, a significant proportion of parents may be loss to follow up before the last serology is performed and eventually might be infected. The aims of this study were to describe the epidemiological characteristics of a cohort of Chagas infected pregnant women in our country, to assess the VT rate and evaluate the usefulness of the PCR in the diagnosis of VT of T.cruzi in the first months of life. We purpose that this deep analysis could help to evaluate ways to improve the newborn screening program in our setting. Patients and methods We conducted a descriptive, retrospective study including Chagas seropositive pregnant women who were attended at three tertiary hospitals in Madrid (Spain) and their newborns, from January 2012 to September 2016. Inclusion criteria: all pregnant women with a positive serology performed during pregnancy and follow-up completed for the first year of their newborns. The study was reviewed and approved by the Ethics Committee of the Hospital Clı́nico San Carlos (January 2017), because it has competence over the three participant hospitals. An informed consent was not requested to collect the data for the study because it is a retrospective, observational, risk-free study for patients whose identity was anonymized. The data were treated confidentially in accordance with current local, national and international legislation. PLOS ONE | https://doi.org/10.1371/journal.pone.0218491 July 10, 2019 2/7 Congenital transm (...truncated)