Altcheh Jaime, Biancardi M, Lapeña A, Ballering G, Freilij Hector
Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños R Gutiérrez, Gallo 1330 (1425), Buenos Aires, Argentina.
Rev Soc Bras Med Trop. 2005;38 Suppl 2:41-5.
Epidemiological, clinical, diagnostic, and therapeutic data from children who were born to mothers infected with T. cruzi who came to our hospital are presented. In addition, we exhibit the preliminary results of a technique that detects the anti F2/3 antibodies: these would be able to confirm the cure earlier than conventional serology. We also show the results of PCR diagnosis. Most of the mothers (76,1%) resided in Argentina, the rest were from Bolivia and Paraguay The median average age at diagnosis of the patients was 8,5 months (range 15 days-10 years). Out of 168 children, 64,98% were asymptomatic at diagnosis. The diagnosis criteria were: T. cruzi observation by microhematocrit technique in patients less than 7 month old. Two reactive serological tests in patients older than 8 months. A nifurtimox dose used in these patients was 10-13 mg/kg/d during 60 days. Although 31% presented side effects, none of them had to be dropped from the treatment. Cure criteria was conventional serology negativization. Of the patient population, we cured 87,2% of them, 98% of those under 3 years, and 100% of those who received treatment before age 8 months. We compared the time of negativization between conventional serology and anti F2/3 in 21 children. The latter were very useful to demonstrate (p>0,001) the success of the treatment, in those that started treatment after 8 months of age. PCR testing of a group of all patients, showed a diagnostic sensibility of 80,3% and a specificity of 97,8%.
本文呈现了我院收治的母亲感染克氏锥虫的患儿的流行病学、临床、诊断和治疗数据。此外,我们展示了一种检测抗F2/3抗体技术的初步结果:该技术能够比传统血清学更早地确认治愈情况。我们还展示了PCR诊断结果。大多数母亲(76.1%)居住在阿根廷,其余来自玻利维亚和巴拉圭。患者诊断时的中位平均年龄为8.5个月(范围15天至10岁)。在168名儿童中,64.98%在诊断时无症状。诊断标准为:7个月以下患者采用微量血细胞比容技术观察克氏锥虫;8个月以上患者进行两次反应性血清学检测。这些患者使用的硝呋替莫剂量为10 - 13mg/kg/天,持续60天。尽管31%的患者出现了副作用,但无一例因副作用而中断治疗。治愈标准为传统血清学转阴。在患者群体中,我们治愈了87.2%的患者,3岁以下患者的治愈率为98%,8个月龄前接受治疗的患者治愈率为100%。我们比较了21名儿童传统血清学和抗F2/3转阴的时间。在8个月龄后开始治疗的患者中,抗F2/3抗体对于证明治疗成功非常有用(p>0.001)。对一组所有患者进行的PCR检测显示,诊断敏感性为80.3%,特异性为97.8%。