Administración Nacional de Laboratorio e Institutos de Salud, Centro Nacional de Diagnóstico e Investigación en Endemo-epidemias, Buenos Aires, Argentina.
Centro de Investigaciones sobre Endemias Nacionales, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina.
Rev Soc Bras Med Trop. 2020;53:e20190560. doi: 10.1590/0037-8682-0560-2019. Epub 2020 Apr 27.
Congenital transmission (CT) of Trypanosoma cruzi has led to globalization of Chagas disease and its growing relevance as a public health problem. Although the occurrence of CT has been associated with several factors, its mechanisms are still unknown. This study aimed to analyze the geographical and familiar variables of mothers and their association with CT of Chagas disease in a population living in non-endemic areas of Argentina for the last decades.
We developed a retrospective cohort study in a sample of 2120 mother-child pairs who attended three reference centers in the cities of Buenos Aires, Santa Fe, and Salta between 2002 and 2015.
The highest CT rates were observed in children born to Argentinean mothers (10.7%) and in children born to mothers from Buenos Aires (11.7%). Considering the areas of origin of the mothers, those from areas of null-low risk for vector-borne infection had higher CT rates than those from areas of medium-high risk (11.1% vs 8.2%). We also observed a significant intra-familiar "cluster effect," with CT rates of 35.9% in children with an infected sibling, compared to 8.2% in children without infected siblings (RR=4.4 95% CI 2.3-8.4).
The associations observed suggest a higher CT rate in children born to mothers who acquired the infection congenitally, with familiar antecedents, and from areas without the presence of vectors. These observations are considered new epidemiological evidence about Chagas disease in a contemporary urban population, which may contribute to the study of CT and may also be an interesting finding for healthcare professionals.
克氏锥虫的先天性传播（CT）导致了恰加斯病的全球化，并且使其作为一个公共卫生问题的重要性日益增加。尽管 CT 的发生与多种因素有关，但其机制仍不清楚。本研究旨在分析过去几十年生活在阿根廷非流行地区的人群中母亲的地理和家族变量及其与克氏锥虫 CT 的关系。
我们对 2120 对母婴进行了回顾性队列研究，这些母婴在 2002 年至 2015 年间参加了布宜诺斯艾利斯、圣达菲和萨尔塔的三个参考中心。
在阿根廷母亲所生的儿童（10.7%）和在布宜诺斯艾利斯母亲所生的儿童（11.7%）中观察到最高的 CT 率。考虑到母亲原籍地区，来自无媒介感染低风险地区的母亲比来自中高风险地区的母亲的 CT 率更高（11.1%比 8.2%）。我们还观察到了家族内的“聚集效应”，与无感染兄弟姐妹的儿童相比，感染兄弟姐妹的儿童 CT 率为 35.9%（RR=4.4 95%CI 2.3-8.4）。
观察到的关联表明，感染先天性传播、有家族史且来自无媒介存在地区的母亲所生的儿童 CT 率更高。这些观察结果被认为是当代城市人群中恰加斯病的新流行病学证据，这可能有助于 CT 的研究，也可能是医疗保健专业人员的一个有趣发现。
