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Volume 19, Number 10—October 2013

Synopsis

Chagas Disease and Breast-feeding

Francesca F. NormanComments to Author  and Rogelio López-Vélez
Author affiliations: Ramón y Cajal Hospital–Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain

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Table

Summary of human studies on transmission of Trypanosoma cruzi through breast-feeding*

Reference Phase of infection, mother Methods and findings Comments
Mazza et al, 1936 (5)
Acute
No trypomastigotes detected by direct methods in newborn at d 10. Parasites detected at 3 mo when acute Chagas disease diagnosed in newborn and concomitantly found by direct methods in mothers´ milk
Congenital transmission not adequately ruled out. Detection of parasites in milk may have been due to contamination with maternal blood containing trypomastigotes from a bleeding nipple (29).
Medina-Lopes and Macedo, 1983 (28)
Acute
Wk 5 of maternal acute infection (before delivery): direct examination of colostrum: negative; intraperitoneal inoculation of mice with colostrum and xenodiagnosis: positive. Maternal milk (after delivery) intraperitoneally inoculated into mice and xenodiagnosis: positive
Demonstrated T.cruzi in colostrum and milk. Contamination from blood not mentioned but unlikely as newborn did not breast-feed (assuming intact nipples during sample extraction). Congenital infection ruled out by using 4 different (unspecified) diagnostic methods
Medina-Lopes, 1983 (6)
Chronic
Congenital transmission excluded by unspecified methods. Vectorial transmission excluded. Acute infection diagnosed in 2-mo-old newborn by unspecified methods.
Mother had nipple bleeding: infected blood in milk may have been the source of the infection. Milk direct exam was negative.
Medina-Lopes, 1988 (7)
Chronic
Infection excluded at birth by modified Strout and xenodiagnoses by using cord blood. At 6 mo IFAT and IHA: positive. At 7 mo modified Strout: positive. Transfusional and vectorial transmission excluded (housing inspected for vector)
Mother had positive xenodiagnosis at time of delivery. Mother had nipple fissures 1 wk postpartum; unclear whether breast-feeding occurred at time. No examination of maternal milk performed. Older sibling not infected even though also breast-fed at the same time.
Bittencourt et al., 1988 (22)
Chronic
Milk/colostrum from 78 mothers (101 samples) studied by direct examination and inoculation of mice. Mice tested by direct blood examination, xenodiagnosis, and IFAT for T. cruzi antibodies. No mice infected. Transmission in 97 breast-fed children excluded at birth by direct blood examination-microhematocrit and xenodiagnosis and by serology (IFAT) at 6–24 mo.
5 mothers had positive blood xenodiagnosis at time of milk collection. Mothers recommended to avoid breast-feeding if nipple bleeding. Average time of breast-feeding was 7 mo; unclear whether any infant tested by serology before ending breast-feeding-
Shikanai-Yasuda et al., 1990 (30)
Chronic
Acute Chagas disease diagnosed at 3.5 and 9.5 mo in 2 infants, respectively, by direct examination of peripheral blood.
Vectorial transmission unlikely (urban area). Congenital transmission not investigated. Mother of the 9.5-mo-old infant had nipple fissures and bleeding during breast-feeding.
Amato Neto et al., 1992 (31)
Chronic
Search for T. cruzi in colostrum and breast milk of 40 chronically infected women through direct observation, culture, and inoculation
No evidence of T. cruzi in samples
Rassi et al., 2004 (32) Chronic Identified 2 cases of infection in children 2- and 5-y-old, respectively, detected by at least 2 positive serologic tests (complement fixation, IHA, ELISA, and IFAT) Transfusional and vectorial transmission excluded. Probable congenital infections but both patients also breast-fed and contribution of this factor could not be ruled out

*IFAT, indirect immunofluorescence antibody test; IHA, indirect hemagglutination antibody test.

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