Kemmerling Ulrike, Osuna Antonio, Schijman Alejandro Gabriel, Truyens Carine
Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Grupo de Bioquímica y Parasitología Molecular, Departamento de Parasitología, Instituto de Biotecnología, Universidad de Granada, Granada, Spain.
Front Microbiol. 2019 Aug 14;10:1854. doi: 10.3389/fmicb.2019.01854. eCollection 2019.
Chagas disease (CD), caused by the protozoan parasite , is considered a neglected tropical disease by the World Health Organization. Congenital transmission of CD is an increasingly relevant public health problem. It progressively becomes the main transmission route over others and can occur in both endemic and non-endemic countries. Though most congenitally infected newborns are asymptomatic at birth, they display higher frequencies of prematurity, low birth weight, and lower Apgar scores compared to uninfected ones, and some suffer from severe symptoms. If not diagnosed and treated, infected newborns are at risk of developing disabling and life-threatening chronic pathologies later in life. The success or failure of congenital transmission depends on interactions between the parasite, the placenta, the mother, and the fetus. We review and discuss here the current knowledge about these parameters, including parasite virulence factors such as exovesicles, placental tropism, potential placental defense mechanisms, the placental transcriptome of infected women, gene polymorphism, and the maternal and fetal/neonatal immune responses, that might modulate the risk of congenital transmission.
恰加斯病（CD）由原生动物寄生虫引起，被世界卫生组织视为一种被忽视的热带病。CD的先天性传播是一个日益重要的公共卫生问题。它逐渐成为比其他传播途径更主要的传播方式，并且在流行国家和非流行国家都可能发生。尽管大多数先天性感染的新生儿在出生时无症状，但与未感染的新生儿相比，他们早产、低出生体重和阿氏评分较低的发生率更高，有些还会出现严重症状。如果不进行诊断和治疗，受感染的新生儿在以后的生活中有发展为致残和危及生命的慢性疾病的风险。先天性传播的成败取决于寄生虫、胎盘、母亲和胎儿之间的相互作用。我们在此回顾并讨论关于这些参数的现有知识，包括诸如外囊泡等寄生虫毒力因子、胎盘嗜性、潜在的胎盘防御机制、感染妇女的胎盘转录组、基因多态性以及母婴和胎儿/新生儿免疫反应，这些可能会调节先天性传播的风险。
