[Congenital Chagas disease: from the laboratory to public health]

Trypanosoma cruzi, the protozoan agent of Chagas disease can be transmitted from mother to foetus. The incidence of congenital infection is estimated to be at least 15,000 cases per year in Latin-America. Its incidence in the non endemic countries (U.S.A., Europe, Japan) is not known. Thanks to multidisciplinary studies performed in Bolivia, it has been possible to specify the epidemiologic and clinical features of congenital Chagas disease. The transplacental route, as well as the role of some parasitic (genotype and parasitic charge) or host factors (capacity of maternal and fetal/neonatal immune responses, particularly the generation of CD8T cells with cytotoxic and IFN-gamma-producing capacities) in mother-to-fetus transmission of infection and/or development of congenital Chagas disease, have been also studied. Altogether, these data have allowed the development of a strategy to control T. cruzi congenital infection, which has been validated by WHO and is applied in various Latin American countries.