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Meta-Analysis
. 2014 Jan;121(1):22-33.
doi: 10.1111/1471-0528.12396. Epub 2013 Aug 7.

Frequency of the congenital transmission of Trypanosoma cruzi: a systematic review and meta-analysis

E J Howard  1 , X Xiong, Y Carlier, S Sosa-Estani, P Buekens
Affiliations
Meta-Analysis

Frequency of the congenital transmission of Trypanosoma cruzi: a systematic review and meta-analysis

E J Howard et al. BJOG. 2014 Jan.

Abstract

Background: Chagas disease is caused by the parasite Trypanosoma cruzi and is endemic in much of Latin America. With increased globalisation and immigration, it is a risk in any country, partly through congenital transmission. The frequency of congenital transmission is unclear.

Objective: To assess the frequency of congenital transmission of T. cruzi.

Search strategy: PubMed, Journals@Ovid Full Text, EMBASE, CINAHL, Fuente Academica and BIREME databases were searched using seven search terms related to Chagas disease or T. cruzi and congenital transmission.

Selection criteria: The inclusion criteria were the following: Dutch, English, French, Portuguese or Spanish language; case report, case series or observational study; original data on congenital T. cruzi infection in humans; congenital infection rate reported or it could be derived. This systematic review included 13 case reports/series and 51 observational studies.

Data collection and analysis: Two investigators independently collected data on study characteristics, diagnosis and congenital infection rate. The principal summary measure--the congenital transmission rate--is defined as the number of congenitally infected infants divided by the number of infants born to infected mothers. A random effects model was used.

Main results: The pooled congenital transmission rate was 4.7% (95% confidence interval: 3.9-5.6%). Countries where T. cruzi is endemic had a higher rate of congenital transmission compared with countries where it is not endemic (5.0% versus 2.7%).

Conclusions: Congenital transmission of Chagas disease is a global problem. Overall risk of congenital infection in infants born to infected mothers is about 5%. The congenital mode of transmission requires targeted screening to prevent future cases of Chagas disease.

Keywords: Chagas disease; Trypanosoma cruzi; congenital infection; meta-analysis; systematic review.

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Conflict of interest statement

Disclosure of Interests

There are no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection process.
Figure 2
Figure 2
Forest plot of congenital T. cruzi transmission rates of the included studies and effect summary. A random effects model was used with a continuity correction of 0.5 added to each study with zero events (Q=45.5, P<0.01, I2=0, df=50). The effect summary includes 51 estimates of congenital transmission, for a total of 819 cases of congenital transmission from 16,537 infants of infected mothers.
Figure 3
Figure 3
Funnel plot, using data from 51 studies of the rate of T. cruzi congenital transmission plotted against the standard error of the rate.
See this image and copyright information in PMC

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