Congenital Chagas disease
From IDWiki
Background
- Risk of vertical transmission
- 5% in chronic infection
- 50% in acute infection
- 100% with untreated HIV coinfection
Clinical Manifestations
- 60-90% are asymptomatic
- Spectrum of disease from oligosymptomatic to severe disease
- Manifestations include:
- Low birth weight
- Prematurity
- Low Apgar scores
- Hepatomegaly and splenomegaly
- Anemia and thrombocytopenia
- Meningoencephalitis
- Megaesophagus and other gastrointestinal mega-syndromes
- Cardiomyopathy
- Pneumonitis
- Anasarca
Diagnosis
- Direct microscopy of infant cord blood Buffy coat using a Wright Giemsa stain
- PCR is most sensitive, but can give a false positive with cord blood testing
- Serology can be used after 8 months of age
- Stepwise diagnostics for an infant <3 months old:
- Giemsa stain or PCR
- If negative, repeat microscopy on blood smear and PCR at 4 to 6 weeks of age
- If negative, send serology at 9 months
- If negative, then the diagnosis is excluded
- Stepwise diagnostics for a child ≥3 months old:
- Serology on infant
- If positive, repeat serology at 9 months
- If positive, then the diagnosis is confirmed
Management
- During acute phase, treated with benznidazol and nifurtimox for 60 days
- Effective if started in first year of life
- Adverse effects include rash, cytopenias, and neuropathy, but less common in children
Prevention
- Vector control strategies
- Screening at-risk pregnancy women
- Diagnosing and treating infants and children
- Unknown if it is transmitted via breastmilk
