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JAC Advance Access published online on August 13, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg338
© 2003 by The British Society for Antimicrobial Chemotherapy
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© 2003 The British Society for Antimicrobial Chemotherapy

Original article

Aetiological treatment of congenital Chagas' disease diagnosed and monitored by the polymerase chain reaction

Alejandro G. Schijman 1 *, Jaime Altcheh 2 , Juan M. Burgos 1 , Miguel Biancardi 2 , Margarita Bisio 2 , Mariano J. Levin 1 , and Héctor Freilij 2

1 Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Ingeniería Genética y Biología Molecular (INGEBI), Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
2 Laboratorio de Parasitología y Enfermedad de Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina

* Corresponding author. E-mail: schijman{at}dna.uba.ar.

Received 14 January 2003 ; revised 2 April 2003 ; accepted 28 May 2003

Abstract

Objectives: This prospective study focused on the evaluation of anti-parasitic therapy in congenital Chagas' disease, diagnosed and monitored by PCR and conventional diagnosis.

Materials and methods: We studied 152 children born to seroreactive mothers, living in a non-endemic area. Fifty infants aged 0-6 months (GA) were diagnosed by microhaematocrit and PCR and 102 children aged 7 months to 17 years (GB) were diagnosed by serology and PCR. Forty treated patients were monitored for 2 or 3 years by PCR and conventional methods. A competitive-quantitative PCR was used to determine pre-therapy parasitic loads and follow their post-treatment evolution.

Results: In GA, the sensitivities of the PCR and microhaematocrit were 100% and 82.4% and their specificities 97% and 100%, respectively. In GB, the sensitivity of the PCR was 73.8% with a specificity of 100%. Pre-therapy parasitic loads ranged from 12.5 to 125 000 and 12.5 to 125 parasite genomic equivalents/mL of blood in GA and GB, respectively. PCR turned negative in all treated pre-therapy PCR positive patients before or at the end of treatment, which was followed by their seronegativation in 10/10 GA, in 3/5 children initiating therapy at 7 months to 2 years of age but in 0/16 initiating therapy at an older age. Two out of the latter patients were occasionally PCR positive during post-treatment, suggesting no parasitological response. Out of nine pre-therapy PCR negative patients, four turned seronegative after treatment, suggesting that in undetermined patients, undetectable parasitic burdens may lead to better post-treatment prognosis.

Conclusions: PCR was useful for sensitive diagnosis and therapy monitoring, allowing early detection of refractory cases.

Keywords: Trypanosoma cruzi, congenital transmission, kinetoplastid DNA, competitive PCR, parasitological cure
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