TY  - BOOK
AU  - Marcus, Rachel
TI  - Sustained Domestic Vector Exposure Is Associated With Increased Chagas Cardiomyopathy Risk but Decreased Parasitemia and Congenital Transmission Risk Among Young Women in Bolivia
SN  - 1058-4838
PY  - 2015///
KW  - *Chagas Disease/ep [Epidemiology]
KW  - *Chagas Disease/tm [Transmission]
KW  - *Infectious Disease Transmission, Vertical
KW  - *Insect Vectors/gd [Growth & Development]
KW  - *Parasitemia/ep [Epidemiology]
KW  - *Trypanosoma cruzi/ip [Isolation & Purification]
KW  - Adolescent
KW  - Adult
KW  - Animals
KW  - Antibodies, Protozoan/bl [Blood]
KW  - Bolivia
KW  - Chagas Disease/cn [Congenital]
KW  - Chagas Disease/im [Immunology]
KW  - DNA, Protozoan/bl [Blood]
KW  - Electrocardiography
KW  - Female
KW  - Humans
KW  - Infant
KW  - Infant, Newborn
KW  - Middle Aged
KW  - Parasitemia/im [Immunology]
KW  - Polymerase Chain Reaction
KW  - Pregnancy
KW  - Risk Assessment
KW  - Serologic Tests
KW  - Th2 Cells/im [Immunology]
KW  - Trypanosoma cruzi/im [Immunology]
KW  - Young Adult
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
KW  - Research Support, N.I.H., Extramural
KW  - Research Support, Non-U.S. Gov't
N1  - Available online from MWHC library: June 1997 - present, Available in print through MWHC library: 1999 - Winter 2007
N2  - BACKGROUND: We studied women and their infants to evaluate risk factors for congenital transmission and cardiomyopathy in Trypanosoma cruzi-infected women; CONCLUSIONS: We hypothesize that repeated vector-borne infection sustains antigen exposure and the consequent inflammatory response at a higher chronic level, increasing cardiac morbidity, but possibly enabling exposed women to control parasitemia in the face of pregnancy-induced Th2 polarization.Copyright © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com; METHODS: Women provided data and blood for serology and quantitative polymerase chain reaction (PCR). Infants of infected women had blood tested at 0 and 1 month by microscopy, PCR and immunoblot, and serology at 6 and 9 months. Women underwent electrocardiography (ECG); RESULTS: Of 1696 women, 456 (26.9%) were infected; 31 (6.8%) transmitted T. cruzi to their infants. Women who transmitted had higher parasite loads than those who did not (median, 62.0 [interquartile range {IQR}, 25.8-204.8] vs 0.05 [IQR, 0-29.6]; P < .0001). Transmission was higher in twin than in singleton births (27.3% vs 6.4%; P = .04). Women who had not lived in infested houses transmitted more frequently (9.7% vs 4.6%; P = .04), were more likely to have positive results by PCR (65.5% vs 33.9%; P < .001), and had higher parasite loads than those who had lived in infested houses (median, 25.8 [IQR, 0-64.1] vs 0 [IQR, 0-12.3]; P < .001). Of 302 infected women, 28 (9.3%) had ECG abnormalities consistent with Chagas cardiomyopathy; risk was higher for older women (odds ratio [OR], 1.06 [95% confidence interval {CI}, 1.01-1.12] per year) and those with vector exposure (OR, 3.7 [95% CI, 1.4-10.2]). We observed a strong dose-response relationship between ECG abnormalities and reported years of living in an infested house
UR  - http://dx.doi.org/10.1093/cid/civ446
ER  -