Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
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

Main Article

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.

Main Article

References
  1. Organización Panamericana de la salud. Estimación cuantitativa de la enfermedad de Chagas en las Américas. OPS/HDM/CD/425–06. Montevideo (Uruguay); 2006.
  2. Oliveira  I, Torrico  F, Muñoz  J, Gascon  J. Congenital transmission of Chagas disease: a clinical approach. Expert Rev Anti Infect Ther. 2010;8:945–56. DOIPubMedGoogle Scholar
  3. Brutus  L, Castillo  H, Bernal  C, Salas  NA, Schneider  D, Santalla  JA, Detectable Trypanosoma cruzi parasitemia during pregnancy and delivery as a risk factor for congenital Chagas disease. Am J Trop Med Hyg. 2010;83:1044–7. DOIPubMedGoogle Scholar
  4. Carlier  Y, Torrico  F, Sosa-Estani  S, Russomando  G, Luquetti  A, Freilij  H, Congenital Chagas disease: recommendations for diagnosis, treatment and control of newborns, siblings and pregnant women. PLoS Negl Trop Dis. 2011;5:e1250. DOIPubMedGoogle Scholar
  5. Mazza  S, Montaña  A, Benitez  C, Janzi  EC. Transmisión de Schizotrypanum cruzi al niño por leche de la madre con enfermedad de Chagas. Mis Est Patol Reg Arg (M.E.P.R.A) 1936; 28: 41–6. In: Medina-Lopes MD, Macedo V. Trypanossoma cruzi no colostro humano. Rev Soc Bras Med Trop. 1983;16:170.
  6. Medina-Lopes  MD. Transmissao materno-infantil da doença de Chagas. Brasilia, 1983 (Dissertaçao de Mestrado-Nucleo de Medicina Tropical e Nutriçao da Universidade de Brasilia). In: Bittencourt AL. Possible risk factors for vertical transmission of Chagas’ disease. Rev Inst Med Trop Sao Paulo. 1992;34:403–8 .PubMedGoogle Scholar
  7. Medina-Lopes M das D. Transmissao do. Trypanosoma cruzi em um caso durante o aleitamento, em área nao endémica. Rev Soc Bras Med Trop. 1988;21:151–3. DOIPubMedGoogle Scholar
  8. Carlier  Y, Truyens  C. Maternal-fetal transmission of Trypanosoma cruzi. In: Telleria J, Tibayrenc M, editors. American trypanosomiasis: Chagas disease—one hundred years of research. New York: Elsevier Inc.;2010.pp. 539–82.
  9. United Nations Children’s Fund (UNICEF). Infant and young children feeding [cited 2013 Aug 9]. 2012 May 25. www.unicef.org/nutrition/index_breastfeeding.html
  10. Schijman  AG, Altcheh  J, Burgos  JM, Biancardi  M, Bisio  M, Levin  MJ, Aetiological treatment of congenital Chagas' disease diagnosed and monitored by the polymerase chain reaction. J Antimicrob Chemother. 2003;52:441–9. DOIPubMedGoogle Scholar
  11. Altcheh  J, Moscatelli  G, Moroni  S, Garcia-Bournissen  F, Freilij  H. Adverse events after the use of benznidazole in infants and children with Chagas disease. Pediatrics. 2011;127:e212–8. DOIPubMedGoogle Scholar
  12. Nattan-Larrier  L. Sur le passage des trypanosomes dans le lait. Rev Pathol Comp. 1913;13:282–5.
  13. Disko  R, Krampitz  HE. Das Auftreten von Trypanosoma cruzi in der Milch infizierter Mause. Z Tropenmed Parasitol. 1971;22:56–66 .PubMedGoogle Scholar
  14. Miles  MA. Trypanosoma cruzi–milk transmission of infection and immunity from mother to young. Parasitology. 1972;65:1–9. DOIPubMedGoogle Scholar
  15. Campos  R, Pinto  PLS, Moreira  AA, Amato Neto  V, Duarte  MI, de SantÁna  EJ, Experimental study on the transmission of Chagas´ disease by milk [in Portuguese]. Rev Hosp Clin Fac Med Sao Paulo. 1988;43:146–7 .PubMedGoogle Scholar
  16. Moreno  EA, Quintero  AC, Alarcón  ME, Lugo de Yarbuh  A, Moreno  SC, Araujo  S, Investigaciones sobre la transmisión vertical de Trypanosoma cruzi en ratas Wistar crónicamente infectadas [cited 2012 Oct 3]. Boletín de Malariología y Salud Ambiental. 2006;46. http://www.scielo.org.ve/scielo.php?script=sci_arttext&pid=S1690-46482006000200007&lng=es
  17. Martins  LP, Castanho  RE, Nogueira  AB, Silva  OT, Gusmao  AS. Incidence of Trypanosoma cruzi transmission through breastfeeding during acute experimental Chagas disease. Braz J Infect Dis. 2011;15:116–8 .PubMedGoogle Scholar
  18. Fine  J. Is trypanosomiasis in the lactating rat transmitted to the suckling young? Ann Trop Med Parasitol. 1933;27:180–1.
  19. Werner  H. Uber die Frage der placentaren Trypanosomen Infektionen und Ubertragung von Trypanosomen und Antikorpern durch die Milch auf das Neugeborene. Zeitschriff Tropenmed Parasitol. 1954;5:422–42.
  20. Pinto  PLS, Campos  R, Santana  EJ, Moreira  AAB, Amato-Neto  V, Duarte  MYS, Estudo experimental sobre a transmissão da doença de Chagas por meio do leite. Rev Inst Med Trop Sao Paulo. 1989;31(Suppl.7):S15.
  21. Moreno  EA, Rivera  IM, Moreno  SC, Alarcón  ME, Lugo-Yarbuh  A. Transmisión vertical de Trypanosoma cruzi en ratas Wistar durante la fase aguda de la infección. Invest Clin. 2003;44:241–54 .PubMedGoogle Scholar
  22. Bittencourt  AL, Sadigursky  M, Da Silva  AA, Menezes  CA, Marianetti  MM, Guerra  SC, Evaluation of Chagas disease transmission through breast-feeding. Mem Inst Oswaldo Cruz. 1988;83:37–9. DOIPubMedGoogle Scholar
  23. Ferreira  CS, Martinho  PC, Amato Neto  V, Cruz  RR. Pasteurization of human milk to prevent transmission of Chagas disease. Rev Inst Med Trop Sao Paulo. 2001;43:161–2 and. DOIPubMedGoogle Scholar
  24. Santos Ferreira  C, Amato Neto  V, Gakiya  E, Bezerra  RC, Alarcón  RS. Microwave treatment of human milk to prevent transmission of Chagas disease. Rev Inst Med Trop Sao Paulo. 2003;45:41–2. DOIPubMedGoogle Scholar
  25. Calvo-Méndez  ML, Nogueda-Torres  B, Alejandre-Aguilar  R, Cortés-Jiménez  M. Experimental Trypanosoma cruzi infection via contaminated water and food. Rev Latinoam Microbiol. 1994;36:67–9 .PubMedGoogle Scholar
  26. Araujo  RGM, Nery  ACS, Bueno  LM, Turolo da Silva  O, Silva de Gusmão  A. Infecçao experimental do Trypanosoma cruzi utilizando a via oral. Rev Soc Bras Med Trop. 1998;31(Suppl III):50–1.
  27. Lima  CMP, Camandaroba  ELP, Andrade  SG. Influencia da cepa do Trypanosoma cruzi na infecçao experimental de camundongos pela via digestiva. Rev Soc Bras Med Trop. 2000;33(Suppl II):110–1.
  28. Medina-Lopes  MD, Macedo  V. Trypanossoma cruzi no colostro humano. Rev Soc Bras Med Trop. 1983;16:170. DOIGoogle Scholar
  29. Jörg  ME. Transmission of Trypansoma cruzi via human milk [in Spanish]. Rev Soc Bras Med Trop. 1992;25:83 .PubMedGoogle Scholar
  30. Shikanai-Yasuda  MA, Lopes  MH, Tolezano  JE, Umezawa  E, Amato Neto  V, Barreto  AC, Acute Chagas´ disease: transmission routes, clinical aspects and response to specific therapy in diagnosed cases in an urban centre [in Portuguese]. Rev Inst Med Trop Sao Paulo. 1990;32:16–27. DOIPubMedGoogle Scholar
  31. Amato Neto  V, Matsubara  L, Campos  R, Moreira  AA, Pinto  PL, Faccioli  R, Trypanosoma cruzi in the milk of women with chronic Chagas disease [in Portuguese]. Rev Hosp Clin Fac Med Sao Paulo. 1992;47:10–1 .PubMedGoogle Scholar
  32. Rassi  A, Amato Neto  V, Rassi  GG, Amato  VS, Rassi Júnior  A, Luquetti  AO, A retrospective search for maternal transmission of Chagas infection from patients in the chronic phase [in Portuguese]. Rev Soc Bras Med Trop. 2004;37:485–9. DOIPubMedGoogle Scholar
  33. Nóbrega  AA, Garcia  MH, Tatto  E, Obara  MT, Costa  E, Sobel  J, Oral transmission of Chagas disease by consumption of Açaí palm fruit, Brazil. Emerg Infect Dis. 2009;15:653–5. DOIPubMedGoogle Scholar
  34. Alarcón de Noya  B, Díaz-Bello  Z, Colmenares  C, Ruiz-Guevara  R, Mauriello  L, Zavala-Jaspe  R, Large urban outbreak of orally acquired acute Chagas disease at a school in Caracas, Venezuela. J Infect Dis. 2010;201:1308–15. DOIPubMedGoogle Scholar
  35. Shikanai-Yasuda  MA, Barbosa Carvalho  N. Oral transmission of Chagas disease. Clin Infect Dis. 2012;54:845–52. DOIPubMedGoogle Scholar
  36. Miles  MA. Orally acquired Chagas disease: lessons from an urban school outbreak. J Infect Dis. 2010;201:1282–4. DOIPubMedGoogle Scholar
  37. Yoshida  N. Molecular basis of mammalian cell invasion by Trypanosoma cruzi. An Acad Bras Cienc. 2006;78:87–111.
  38. Yoshida  N. Molecular mechanisms of Trypanosoma cruzi infection by oral route. Mem Inst Oswaldo Cruz. 2009;104(Suppl 1):101–7. DOIPubMedGoogle Scholar
  39. Hoft  DF. Differential mucosal infectivity of different life stages of Trypanosoma cruzi. Am J Trop Med Hyg. 1996;55:360–4 .PubMedGoogle Scholar
  40. Cortez  C, Yoshida  N, Bahia  D, Sobreira  TJP. Structural basis of the interaction of a Trypanosoma cruzi surface molecule implicated in oral infection with host cells and gastric mucin. PLoS ONE. 2012;7:e4215. DOIPubMedGoogle Scholar

Main Article

Page created: September 16, 2013
Page updated: September 16, 2013
Page reviewed: September 16, 2013
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external