Congenital Chagas disease

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