Ten percent or more of mothers with chronic Trypanosoma cruzi infection give birth to infected infants, many of whom will develop life-threatening sequelae of Chagas disease at birth, shortly after birth or later in life. Until recently, congenital Chagas disease has been neglected as a public health problem. Now that regional Chagas disease control programs have begun to dramatically reduce the incidence of vector-borne and transfusion-associated transmission, maternal-to-infant transmission is the most frequent route in many endemic areas. There are 10-12 million persons living with chronic T. cruzi infection in Latin America; hundreds of thousands of Latin American immigrants to the United States and other industrialized countries are infected as well. Perhaps a third of these are women and girls under the age of 45 years who can transmit the parasite to their offspring during sequential pregnancies because infection is lifelong. Recent studies have demonstrated that treatment of congenitally infected infants with antitrypanosomal drugs shortly after birth is highly effective. However, cure is increasingly difficult to achieve as the child grows older. The Pan American Health Organization recommends diagnosis and treatment of all infants with congenital Chagas disease, but technical, logistical, and economical obstacles have prevented any country from implementing a nationwide congenital Chagas disease intervention program. In the majority of infected infants, congenital Chagas disease is subclinical or presents with subtle nonspecific findings. Therefore, the most promising approach to congenital Chagas disease is universal laboratory-based screening of infants for T. cruzi infection. At present, there is no sufficiently sensitive and logistically feasible diagnostic test for congenital Chagas disease in the first days of life. The goal of this application is develop a sensitive and specific diagnostic assay for congenital Chagas disease that could be used for mass screening of newborns. We will also study the epidemiology of congenital Chagas disease in Santa Cruz, Bolivia and identify maternal and infant risk factors for congenital transmission of T. cruzi, in order to develop strategies for efficient targeting and implementation of screening programs, and to provide the basis for developing other novel approaches to decrease the prevalence and adverse sequelae. ? ? ?

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Exploratory/Developmental Grants (R21)
Project #
Application #
Study Section
Clinical Research and Field Studies of Infectious Diseases Study Section (CRFS)
Program Officer
Rao, Malla R
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
Zip Code
GarcĂ­a, H H; Gonzalez, A E; Rodriguez, S et al. (2010) Neurocysticercosis: unraveling the nature of the single cysticercal granuloma. Neurology 75:654-8
Verani, Jennifer R; Seitz, Amy; Gilman, Robert H et al. (2009) Geographic variation in the sensitivity of recombinant antigen-based rapid tests for chronic Trypanosoma cruzi infection. Am J Trop Med Hyg 80:410-5
Bern, Caryn; Verastegui, Manuela; Gilman, Robert H et al. (2009) Congenital Trypanosoma cruzi transmission in Santa Cruz, Bolivia. Clin Infect Dis 49:1667-74
Fitzwater, Sean; Calderon, Maritza; Lafuente, Carlos et al. (2008) Polymerase chain reaction for chronic Trypanosoma cruzi infection yields higher sensitivity in blood clot than buffy coat or whole blood specimens. Am J Trop Med Hyg 79:768-70