Resumen Chagas es una endemia que afecta a Latinoamérica con alto impacto biomédico y social. Es un caso único en la historia médica donde primero se descubre un microorganismo y luego la enfermedad que produce. El “redescubrimiento” de su importancia se origina en la Argentina, con los estudios de Salvador Mazza y colaboradores de diferentes provincias en la Misión de Estudios de Patología Regional Argentina (MEPRA). A pesar de su magnitud, es objeto de adjetivaciones como “endemia olvidada”, “enfermedad silenciosa”, “mal escondido” y está incluida entre las “enfermedades desatendidas”. Originalmente era una endemia rural, actualmente se ha urbanizado y globalizado por migraciones y propagación interhumana, principalmente por la transmisión madre-hijo. Además, la vía oral hace años adquirió importancia epidemiológica. El diagnóstico de laboratorio está protocolizado y es posible realizarlo incluso en laboratorios de baja complejidad. Para la prevención, interferir en la cadena epidemiológica que incluye reservorios domésticos es una estrategia que puede contribuir a disminuir la infección en zonas con transmisión vectorial. La vacunación con Trypanosoma rangeli, parásito inmunológicamente similar a Trypanosoma cruzi pero no patógeno, ha demostrado su eficacia para proteger perros y cobayos contra la infección por T. cruzi. Basso et al. han estudiado además mecanismos protectores, demostrando la importancia de la inmunidad innata, además de la clásica inmunidad adaptativa. Por último, este artículo aborda aspectos académicos, sociales y bioéticos, enfatizando la importancia de la enseñanza de Chagas en ciencias de la salud y la necesidad de garantizar los principios y valores bioéticos aplicables a poblaciones vulnerables.

Resumo Chagas é uma doença endêmica que afeta à América Latina com alto impacto biomédico e social. É um caso único na história da Medicina, onde primeiro se descobre um microrganismo e depois a doença que ele produz. A “redescoberta” de sua importância tem origem na Argentina, com os estudos de Salvador Mazza e colaboradores de diferentes províncias na Missão de Estudos de Patologia Regional Argentina (MEPRA). Apesar de sua importância, é objeto de adjetivos como “endemia esquecida”, “doença silenciosa”, “mal escondido” e está incluída entre as “doenças negligenciadas”. Originalmente endemia rural, agora é urbanizada e globalizada por migrações e disseminação inter-humana, principalmente a transmissão mãe-filho. Por outro lado, a transmissão oral faz anos adquiriu importância epidemiológica. O diagnóstico laboratorial é protocolizado e é possível realizá-lo mesmo em laboratórios de baixa complexidade. Quanto à prevenção, a interrupção da cadeia epidemiológica que inclui reservatórios domésticos, é uma estratégia que pode contribuir a reduzir a infecção em áreas com transmissão vetorial. A vacinação com Trypanosoma rangeli, parasita imunologicamente semelhante ao Trypanosoma cruzi, mas não patogênico, tem se mostrado eficaz na proteção de cães e cobaias contra a infecção por T. cruzi. Basso et al. estudaram os mecanismos protetores, demonstrando a importância da imunidade inata, além da imunidade adaptativa clássica. Finalmente, o artigo aborda aspectos acadêmicos, sociais e bioéticos, enfatizando a importância do ensino de Chagas em Ciências da Saúde, e a necessidade de garantir os princípios e valores bioéticos aplicáveis às populações vulneráveis.

Abstract Chagas disease is an endemic disease that affects Latin America with high biomedical and social impact. This work addresses aspects and particularities that characterise this disease. It is a unique case in medicine as the microorganism was discovered before the disease it causes. The re-discovery of its relevance had its origin in Argentina, due to studies conducted by Salvador Mazza and collaborators from various provinces, within the Mission of Regional Pathology Studies from Argentina (MEPRA). Notwithstanding its importance, it is often described as “forgotten endemic disease”, “silent disease”, “hidden illness”, and it is included among the “neglected diseases”. Originally considered as rural endemic, nowadays it is urbanised and globalised, due to migrations and inter-human propagation, mainly by mother-child transmission. On the other hand, oral transmission is considered now of epidemiological relevance. Laboratory diagnosis is protocolised and it is possible to carry it out even in low complexity laboratories. Concerning disease prevention, interrupting the epidemiological chain that includes domestic reservoirs is a strategy that can contribute to reducing the infection in areas where it is vector-borne. Vaccination with Trypanosoma rangeli, a parasite immunologically similar to Trypanosoma cruzi but which is nonpathogenic, has demonstrated its efficacy in protecting dogs and guinea pigs against T. cruzi infection. Basso et al. have studied the importance of innate immunity, in addition to the classic adaptive immunity. Finally, this article addresses academic, social and bioethical aspects, emphasizing the importance of an adequate education in the health science field, as well as the need to guarantee bioethical principles and values regarding vulnerable populations.

Abstract The selected film, The man who knew infinity (2015), by Matt Brown, addresses issues which are fundamental to this article’s objectives. The film is about Srinivasa Ramanujan’s experience as an Indian mathematician at Trinity College (Cambridge) where he suffers racism, discrimination, poor housing conditions, malnutrition. Even so, he achieves recognition as a genius, and ultimately becomes an academic member of the College. During his stage in Cambridge, World War I begins, and he gets ill with tuberculosis. In this context, this article aims to explore affections that involve humanity as a whole, such as endemics, pandemics, war, discrimination, among others. It phocuses on phenomena that affect intensely entire populations’ health and wellbeing. In this sense, a critical vision given by the humanities can question the senses in which these three notions affect a whole population, and yet affect it in different ways and intensities. Thus, this work underlines the fact that some bodies are more vulnerable, more exposed to precarization, and have less conditions to overcome its effects. Scientific production of knowledge is not an exception to this distribution of precariousness, as the film shows. In this light, it is necessary to refocus on neglected diseases and precariousness diseases, in order to create egalitarian conditions for prevention and medical treatment.

Resumen El hombre que conocía el infinito / The man who knew infinity (2015) de Matt Brown, conjuga problemáticas de las que se ocupa este artículo. El filme se centra en la experiencia del matemático indio Srinavasa Ramanujan en Cambridge, donde sufre situaciones de racismo, discriminación, vivienda precaria, malnutrición. Aun así, logra que reconozcan su genio, siendo nombrado Miembro de la Royal Society of London. Durante su estadía, se desencadena la Primera Guerra Mundial y él enferma de tuberculosis. Sobre este contexto, el trabajo apunta a explorar afecciones que atañen a la humanidad toda: endemias, pandemias, guerra, discriminación. Se trata, de algún modo, de fenómenos, que afectan con intensidad a la salud y bienestar de poblaciones enteras. En ese marco, la visión crítica desde las humanidades permite preguntarse, si bien son eventos que afectan a toda una población, en qué sentido lo hacen diferencialmente respecto a ciertos sectores. Así, se considera el hecho de que hay cuerpos más expuestos, con mayor vulnerabilidad y menores condiciones para afrontar sus efectos. La producción de conocimiento científico no es ajena a esta distribución de la precariedad, como muestra el filme, y es preciso hacer foco en enfermedades desatendidas y de la precariedad en pos de generar condiciones sanitarias más igualitarias.

Na era hipertecnológica, somos assistidos pela Tecnologia ou assistentes da Tecnologia? A máquina inteligente, o robô ideal: pode realizar todas as tarefas de laboratório com igual ou maior eficiência do que o homem? Acreditamos que não, visto que a máquina só pode ter "pensamento calculador". Contudo, o homem possui "pensamento reflexivo" e juízo ético que lhe permitem um discernimento crítico fundamental. A máquina deve assistir-nos, porém, é o profissional quem deve tomar as decisões a respeito das pré e pós-análises, do controle do instrumental na fase analítica e do atendimento do paciente. A simplificação dos métodos analíticos conduz à realização das análises deslocadas, "ao lado do paciente". Os avanços técnicos como a miniaturização, a automação e a informática favorecem o processo de deslocação que pode ter lugar em unidades críticas, plantões, salas de cirurgia, ou até mesmo, fora do ambiente hospitalar. A velocidade de resposta em casos críticos pode justificar as análises deslocadas, porém existem claras limitações: segurança na Qualidade, Biossegurança e aspectos bioéticos; a respeito da confidencialidade e capacidade para fornecer ao paciente informação adequada. Nesse contexto, é imperativo repensar as Ciências da Saúde não só na importância da Tecnologia, mas também, e principalmente, no fator humano e no papel social do Bioquímico como integrante da equipe de saúde.

In the hyper technological era, are we assisted by technology or assistants of technology? The intelligent machine, the ideal robot can perform all tasks in the laboratory, with equal or greater efficacy than man? We think not, because the machine can only have "calculating thinking". Instead, man has "reflexive thinking" and ethical judgment, which allow a fundamental critical discernment. The machine must assist professionals, but is the professional who must decide about questions relative to pre and post analysis, control of instruments in the analytical phase, and patient care. Simplification of analytical methods leads to the realization of delocalized analysis, or "point of care". Technical advances such as miniaturization, automation and computing favour delocalized analysis, which can take place in critical units, emergencies, surgeries or even outside the hospital setting. The speed of response in critical cases can justify the delocalized analysis, but there are clear limitations: Quality Assurance, biosafety and bioethical aspects: confidentiality and ability to provide adequate information to the patient. In this context, in the Health Sciences, it is imperative to rethink the importance of technology, but also, and especially, the human factor and the social role of the Biochemist as health team member.

En la era hipertecnológica, ¿somos asistidos por la Tecnología o asistentes de la Tecnología? La máquina inteligente, el robot ideal, ¿puede realizar todas las tareas del laboratorio, con igual o mayor eficacia que el hombre? Creemos que no, ya que la máquina puede tener solamente "pensamiento calculador". En cambio, el hombre posee "pensamiento reflexivo" y juicio ético, que le permiten un discernimiento crítico fundamental. La máquina debe asistirnos, pero es el profesional quien debe decidir lo atinente al pre y post análisis, al control del instrumental en la fase analítica, y a la atención al paciente. La simplificación de los métodos analíticos conlleva a la realización de los análisis deslocalizados, "al lado del paciente". Los progresos técnicos como la miniaturización, la automatización y la informática favorecen el proceso de deslocalización, que puede tener lugar en unidades críticas, guardias, quirófanos o, incluso, fuera del ámbito hospitalario. La rapidez de respuesta en casos críticos puede justificar los análisis deslocalizados, pero existen claras limitaciones: Aseguramiento de la Calidad, Bioseguridad y aspectos bioéticos, respeto de la confidencialidad y capacidad para brindar información adecuada al paciente. En este contexto, es imperativo repensar las Ciencias de la Salud en la importancia de la tecnología pero, también, y sobre todo, en el factor humano y en el rol social del Bioquímico integrante del equipo de salud.

Many patients with Chagas disease live in remote communities that lack both equipment and trained personnel to perform a diagnosis by conventional serology (CS). Thus, reliable tests suitable for use under difficult conditions are required. In this study, we evaluated the ability of personnel with and without laboratory skills to perform immunochromatographic (IC) tests to detect Chagas disease at a primary health care centre (PHCC). We examined whole blood samples from 241 patients and serum samples from 238 patients. Then, we calculated the percentage of overall agreement (POA) between the two groups of operators for the sensitivity (S), specificity (Sp) and positive (PPV) and negative (NPV) predictive values of IC tests compared to CS tests. We also evaluated the level of agreement between ELISAs and indirect haemagglutination (IHA) tests. The readings of the IC test results showed 100% agreement (POA = 1). The IC test on whole blood showed the following values: S = 87.3%; Sp = 98.8%; PPV = 96.9% and NPV = 95.9%. Additionally, the IC test on serum displayed the following results: S = 95.7%; Sp = 100%; PPV = 100% and NPV = 98.2%. Using whole blood, the agreement with ELISA was 96.3% and the agreement with IHA was 94.1%. Using serum, the agreement with ELISA was 97.8% and the agreement with IHA was 96.6%. The IC test performance with serum samples was excellent and demonstrated its usefulness in a PHCC with minimal equipment. If the IC test S value and NPV with whole blood are improved, then this test could also be used in areas lacking laboratories or specialised personnel.

O antígeno carcinoembrionário (CEA) é uma glicoproteína amplamente usada como complemento do diagnóstico, monitoração de tratamento e evolução do câncer colorretal. O objetivo deste trabalho foi realizar uma análise comparativa entre dois métodos para a detecção do CEA: eletroquimioluminescência e quimio-luminescência em amostras de soro de 57 pacientes com diagnóstico de câncer, principalmente colorretal. Quando analisados os dados totais, houve uma correlação elevada (r=0,9135, p<0,00001). Quando realizado um corte dos resultados tomando como valor limite 4 ng/mL, observou-se que as maiores diferenças entre ambos os métodos estiveram nos valores considerados dentro da faixa dos valores normais (r=0,5716, p<0,0014, n=29). No entanto, nas concentrações superiores respeito do limite de corte, a correlação foi elevada (r=0,9453, p<0,00001, n=28). Estes resultados sugerem que, comparado com o descrito pelos fabricantes, os valores de CEA obtidos por ambos os métodos são comparáveis. A menor correlação observada nas concentrações inferiores a 4 ng/mL não seria tão relevante devido a que estes níveis consideram-se dentro da faixa de normalidade e, portanto, sua importância, do ponto de vista clínico, é relativa. Contudo, devido a que podem ser detectados com baixa frequência diferenças individuais (atribuídas provavelmente a diferenças nos epitopos detectados por cada método), para os casos com forte suspeita clínica e um valor de CEA incongruente, sugere-se repetir a determinação através de outra metodologia.

The carcinoembryonic antigen (CEA) is a glycoprotein widely employed in colorectal cancer, mainly as evolutive marker and as measure of therapy's ef-ficacy. The goal of this work was to perform a comparative study between two analytical methods to measure serum CEA levels: electrochemiluminescence (ECL) and chemilumines-cence (CL) in serum samples of 57 patients with diagnosis of cancer, mainly colorectal. On the whole, an elevated correlation between ECL and CL (r=0.9135; p<0.00001) was obtained. When data was analyzed with a cut-off value of 4 ng/mL, the main discrepancy between methods occurred in the range of normal values (r=0.5716; p<0.0014; n=29). On the contrary, in concentrations higher than the cut-off, the cor-relation was very high (r=0.9453; p<0.00001; n=28). These results suggest that, in spite of the reports of manufacturers, the CEA values obtained by both methods are comparable. The lower correlation observed in values below 4 ng/mL would not be significant because those values are in the normal range and, for that reason, their clinical importance is minor. However, due to the individual differences that could be detected in some patients (probably resulting from the differences in epitopes detected by each method), in cases with strong clinical evidence without concordance with the CEA result, it could be necessary to repeat the determination using another methodology.

El antígeno carcinoembrionario (CEA) es una glicoproteína ampliamente utilizada como complemento del diagnóstico, monitoreo de tratamiento y evolución del cáncer colorrectal. El objetivo del presente trabajo fue realizar un análisis comparativo entre dos métodos para la determinación de CEA: electroquimioluminiscencia y quimioluminiscencia, en muestras de suero de 57 pacientes con diagnóstico de cáncer, principalmente colorrectal. Cuando se analizaron los datos totales se obtuvo una elevada correlación (r=0,9135, p<0,00001). Al realizar un corte de los resultados tomando como límite el valor de 4 ng/mL se observó que las mayores discrepancias entre métodos estuvieron en los valores considerados dentro del rango normal (r=0,5716, p<0,0014, n=29). Por el contrario, en concentraciones mayores al límite de corte, la correlación fue elevada (r=0,9453, p<0,00001, n=28). Estos resultados sugieren que, a diferencia de lo descripto por los fabricantes, los valores de CEA obtenidos por ambos métodos son comparables. La menor correlación observada en concentraciones inferiores a 4 ng/mL no sería tan relevante debido a que estos niveles se consideran dentro del rango de normalidad y, por lo tanto, su importancia desde el punto de vista clínico es relativa. Sin embargo, debido a que pueden detectarse con baja frecuencia diferencias individuales (atribuidas probablemente a diferencias en los epitopes detectados por cada método), para los casos con fuerte presunción clínica y un valor de CEA incongruente, se sugiere repetir la determinación por medio de otra metodología.

In America, there are two species of Trypanosoma that can infect humans: Trypanosoma cruzi, which is responsible for Chagas disease and Trypanosoma rangeli, which is not pathogenic. We have developed a model of vaccination in mice with T. rangeli epimastigotes that protects against T. cruzi infection. The goal of this work was to study the pattern of specific immunoglobulins in the peritoneum (the site of infection) and in the sera of mice immunized with T. rangeli before and after challenge with T. cruzi. Additionally, we studied the effects triggered by antigen-antibodies binding and the levels of key cytokines involved in the humoral response, such as IL-4, IL-5 and IL-6. The immunization triggered the production of antibodies reactive with T. cruzi in peritoneal fluid (PF) and in serum, mainly IgG1 and, to a lesser magnitude, IgG2. Only immunized mice developed specific IgG3 antibodies in their peritoneal cavities. Antibodies were able to bind to the surface of the parasites and agglutinate them. Among the cytokines studied, IL-6 was elevated in PF during early infection, with higher levels in non-immunized-infected mice. The results indicate that T. rangeli vaccination against T. cruzi infection triggers a high production of specific IgG isotypes in PF and sera before infection and modulates the levels of IL-6 in PF in the early periods of infection.

Chagas disease, which is caused by Trypanosoma cruzi, affects nearly 16 million people in Latin America and causes 75-90 million people to be at risk of infection. The disease is urbanizing and globalizing due to frequent migrations. There are regions of high prevalence of infection, including the north-eastern provinces of Argentina and the entire phytogeographic region known as the Gran Chaco. In the province of Chaco, Argentina, there are places inhabited by native populations such as the Wichi and Toba communities, among others. Many Creole populations resulting from miscegenation with European colonists and immigrants coexist within these communities. It has been widely accepted that in the chronic phase of the disease, between 25-30% of individuals develop some form of cardiac disease, with the right bundle-branch block being the most typical condition described so far. The aim of this work was to study the prevalence of Chagas infection and its electrocardiographic profile in the Wichi and Creole populations of Misión Nueva Pompeya, in the area known as Monte Impenetrable in Chaco, to determine the prevalence and the pattern of heart diseases produced by Chagas disease in this region.

INTRODUÇÃO: A doença de Chagas é causada pelo Trypanosoma cruzi e os mamíferos periantrópicos e silvestres mantêm o ciclo de infecção/transmissão, tanto no ambiente natural, como no peridomicílio. O objetivo deste trabalho foi mostrar os resultados de um estudo de roedores silvestres do centro e norte da Província de San Luis, Argentina, para avaliar a prevalência da infecção. MÉTODOS: Estabeleceram-se lugares de caça com armadilhas tipo Sherman entre os 32º - 33º de latitude S e 65º - 66º de longitude W. Identificou-se taxonomicamente os roedores, isolou-se os hemoflagelados e fizeram-se estudos morfológicos, biométricos, moleculares, cultivo in vitro, infecção a animais de laboratório, histologia de músculo cardíaco e de zona de inoculação. Observou-se parasitas em sangue circulante: Calomys musculinus, Graomys griseoflavus, Phyllotis darwini e Akodon molinae. A identificação dos parasitas foi feita utilizando critérios biológicos e, em alguns, realizou estudos moleculares por PCR que confirmaram a caracterização desses hemoflagelados como Trypanosoma cruzi. RESULTADOS E CONCLUSÕES: Dos 25 isolados, 44% foram identificados como Trypanosoma cruzi e 56% como Trypanosoma cruzi like. Este achado nos induz a considerar a importância dos ratos do mato infectados com Trypanosoma cruzi y Trypanosoma cruzi like, em área de baixa endemicidade.

INTRODUCTION: Chagas disease is caused by Trypanosoma cruzi. Wild and perianthropic mammals maintain the infection/transmission cycle, both in their natural habitat and in the peridomestic area. The aim of this paper was to present the results from a study on wild rodents in the central and northern regions of San Luis province, Argentina, in order to evaluate the prevalence of this infection. METHODS: Sherman traps were set up in capture areas located between latitudes 32º and 33º S, and longitudes 65º and 66º W. The captured rodents were taxonomically identified and hemoflagellates were isolated. Morphological, biometric and molecular studies and in vitro cultures were performed. Infection of laboratory animals and histological examination of the cardiac muscle and inoculation area were also carried out. Parasites were detected in circulating blood in Calomys musculinus, Graomys griseoflavus, Phyllotis darwini and Akodon molinae. The parasites were identified using biological criteria. Molecular PCR studies were performed on some isolates, which confirmed the characterization of these hemoflagellates as Trypanosoma cruzi. RESULTS AND CONCLUSIONS: Forty-four percent of the 25 isolates were identified as Trypanosoma cruzi, and the remaining 56% as Trypanosoma cruzi-like. These findings provide evidence that wild rats infected with Trypanosoma cruzi and Trypanosoma cruzi-like organisms are important in areas of low endemicity.

Stress has a high prevalence in the world; one of its causes is sepsis. During this syndrome, cytokines are released, which activate the hypothalamic - pituitary - adrenal (HPA) axis. This raises cortisol levels and acute phase proteins. The goal of this work was to analize the effects of sepsis on the HPA axis, through cortisol measurements, and to associate it with interleukin 1 beta (IL1-beta) and C reactive protein (CRP). Cortisol was measured by electrochemoluminiscence, CRP by immunoturbidimetric method and IL1-beta by ELISA in sera of septic (S, n=40) and non septic (NS, n=21) patients. Cortisol was significantly higher than its cut-off (CO), established by ROC curves, in 63% of S patients, and only in 14% of NS (OR: 10,0; CI: 2.5 - 39.7; p<0.05). CRP was elevated in 55% of S, and in 43% of NS (p>0.05). In some S patients, very high levels of IL1-beta were observed on the day of admission. The joint elevation of CRP and cortisol was of 40% in S and 5% in NS, while rises in all parameters were only seen in S (8%). It can be concluded that in the group of patients studied sepsis acted as an activator of the HPA axis, as evidenced by the elevated cortisol levels.

El estrés tiene alta prevalencia en el mundo; una de sus causas es la sepsis. Durante la misma, se liberan citoquinas que activan el eje hipotálamo-hipofiso suprarrenal (HHS) elevándose el cortisol y proteínas de fase aguda. El objetivo de este trabajo fue analizar el efecto de la sepsis sobre el eje HHS a través del cortisol, y asociarlo con interleuquina 1 beta (IL1-beta) y proteína C reactiva (PCR). Se dosó cortisol por electroquimioluminscencia, PCR por inmunoturbidimetría e IL1-beta por ELISA en sueros de pacientes sépticos (S, n=40) y no sépticos (NS, n=21). El cortisol fue significativamente mayor al valor de corte (VC), establecido mediante curva ROC, en el 63% de pacientes S, y sólo en el 14% de NS (OR: 10,0; IC: 2,5 - 39,7; p<0,05). La PCR estuvo elevada en el 55% de S, y en el 43% de NS (p>0,05). En algunos pacientes S se evidenciaron niveles muy aumentados de IL1-beta en el día de admisión. La elevación conjunta de PCR y cortisol fue del 40% en S y del 5% en NS, mientras que el aumento de los tres parámetros sólo se vio en S (8%). En conclusión, en el grupo de pacientes estudiado la sepsis actuó como activador del eje HHS, evidenciado por el incremento en el cortisol.

In our laboratory, we have developed a model of vaccination in mice with Trypanosoma rangeli, a non-pathogenic parasite that shares many antigens with Trypanosoma cruzi. The vaccinated mice were protected against infection with virulent T. cruzi. The goal of the present work was to study the protective activity of strains of T. rangeli of different origin, with the aim of analysing whether this protective capacity is a common feature of T. rangeli. BALB/c mice were vaccinated with live or fixed epimastigotes of two T. rangeli strains, Choachi and SC-58. Vaccinated (VM) and control mice (CM) were infected with virulent T. cruzi, Tulahuen strain. The results showed that the levels of parasitemia of VM, vaccinated with the two strains of T. rangeli were significantly lower than those developed in CM. The survival rate of VM was higher than that CM. Histological studies revealed many amastigote nests and severe inflammatory infiltrates in the heart and skeletal muscles of CM, whereas in the VM only moderate lymphomonocytic infiltrates were detected. Altogether, the results of the present work as well as previous studies show that the antigens involved in the protection induced by T. rangeli are expressed in different strains of this parasite. These findings could prove useful in vaccine preparation.

Se descrevem 3 gestantes com a doença de Chagas aguda. Duas gestantes infetadas no 3º trimestre de gestação não tiveram crianças infetadas. O 3º filho, doquella madre foi infetada no 1º trimestre, nasceu com doença de Chagas congénita. Estes resultados inducem a investigação sobre os fatores de riscos da transmição e sobre as desições médicas na conducção dos casos de gestantes com a doença de Chagas aguda.

We studied three pregnant women with acute chagasic infection. Two patients, infected in the third trimester of pregnancy, had uninfected children. The third patient, infected earlier, had an infected newborn. These results encourage research on risk factors of transmission and on medical decisions concerning pregnant women with acute Chagas' disease.