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Other fetal/neonatal factors susceptible to interfere with the development of congenital Chagas disease

As discussed for mothers, the familial clustering of congenital T. cruzi infections (see section: Epidemiological features specific to congenital infection with Trypanosoma cruzi) suggests that some neonates might be predisposed to a lower capacity of immune responses, raising the question of a possible role of fetal/neona- tal genetic background (different from the maternal one, since it also derives from the father) and/or environmental factors (e.g., malnutrition, poverty, bacterial gut colonization—see section: Other maternal factors involved in transmission of congenital infection) in the susceptibility and outcome of congenital Chagas disease.

Fetal sex is probably not a risk factor for congenital infection, since most studies report similar frequency in both sexes.19,55,62,135

It has been shown that living in areas of high vector density during pregnancy (resulting in multiple re-infections with metacyclic trypomasigotes in a previously established chronic infection) is associated with a serious risk of more severe and

mortal congenital Chagas disease.93,136

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