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Maternal factors involved in transmission and development of Trypanosoma cruzi infection

Parasitic load during pregnancy and transmission of congenital infection

A lot of data has now well established that blood parasite amount during pregnancy is a key factor for congenital transmission. Although parasitemia slightly increases during pregnancy (on second and third trimesters),78,79 congenital transmission during chronic infection increases with parasitemias and occurs mainly in women displaying around 10—20p/mL (i.e., 10—20 times higher than in non-transmitting women.62,66,80- 84 Transmission rates are much higher in acute infection (in 6/11—54% of reported cases in acutely infected mothers17,61) and reactivated Chagas disease (100%, in case of coinfection with HIV85,86), displaying extremely high and huge parasitemias, respectively (Fig. 23.2).

Maternal—fetal transmission rates of T. cruzi infection, according to the clinical phase/form of infection in pregnant women

Figure 23.2 Maternal—fetal transmission rates of T. cruzi infection, according to the clinical phase/form of infection in pregnant women.

Source: Reactivated Chagas disease: data according to Freilij H, Altcheh J, Muchinik G. Perinatal human immunodeficiency virus infection and congenital Chagas’ disease. Pediatr Infect Dis 1995;14:161-162 and Scapellato PG, Bottaro EG, Rodriguez-Brieschke MT. Mother-child transmission of Chagas disease: could coinfection with human immunodeficiency virus increase the risk? Rev Soc Bras Med Trop 2009;42:107—109; acute Chagas disease: data according to Bittencourt AL. Possible risk factors for vertical transmission of Chagas’ disease. Rev Inst Med Trop Sao Paulo 1992;34:403—408 and Moretti E, Basso B, Castro I, Carrizo P, Chaul M, Barbieri G, et al. Chagas’ disease: study of congenital transmission in cases of acute maternal infection. Rev Soc Bras Med Trop 2005;38:53—55; chronic Chagas disease: average transmission rates in endemic and nonendemic countries (EC and NEC, respectively) according to Howard EJ,

Xiong X, Carlier Y, Sosa-Estani S, Buekens P. Frequency of the congenital transmission of Trypanosoma cruzi: a systematic review and meta-analysis. Brit J Obst Gyn 2014;121:22—33.

 
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