Clinical Considerations for Congenital Chagas Disease

Key points

  • In the U.S., about 40,000 women of childbearing age have Chagas disease.
  • Test at-risk infants and pregnant women from endemic areas—Mexico and Central and South America—for Chagas disease.
  • Treat all congenital Chagas cases in infants to achieve a high cure rate.

Care and treatment considerations

The risk of transmission from mother-to-child is thought to be low, with an estimated 1 – 5% of infants born in the United States to mothers with Chagas disease infected with T. cruzi. This translates to between 63 – 315 infected infants born every year.

Most babies born with congenital Chagas disease show mild or no symptoms. However, if untreated, the infection will last a lifetime, and these infants risk developing symptoms of chronic Chagas disease later in life. Identification and testing of infants at risk of infection is critical to prevent Chagas disease in the United States.

Signs in infants

Infants with congenital Chagas disease may present with

  • Low birth weight
  • Prematurity
  • Low Apgar scores
  • Hepatosplenomegaly
  • Anemia
  • Thrombocytopenia

Though rare, severe disease in infected infants can include

  • Meningoencephalitis,
  • Pneumonitis,
  • Anasarca, and
  • Death

Healthcare providers should screen women at risk for Chagas disease before or during pregnancy. Women who have lived in Mexico, Central America, and South America are at greatest risk for Chagas disease.

Routine testing of pregnant women in the U.S., is not generally necessary unless there is a concern for exposure to triatomine bugs.

An infant should be evaluated for congenital Chagas disease if

  • The mother has been diagnosed with Chagas disease.
  • The infant shows signs suggestive of Chagas disease.
  • The mother is from an endemic area and has not been screened.

Diagnosing infants involves detecting the Trypanosoma cruzi parasite in blood smears and/or PCR tests for T. cruzi DNA in the blood.

Because the infected mother's antibody to T. cruzi can persist in her infant for up to 9 – 12 months, serologic testing is not useful for detecting congenital infection in newborn infants. Over time, the mother's antibody will disappear and children who are uninfected should be antibody negative by 9 – 12 months of age.

Treatment

All congenital Chagas disease cases in infants should be treated. The cure rate among infants treated in the first year of infection is >90%.

Under 18 years of age

  • Benznidazole is approved by FDA for use in children 2–12 years of age and is commercially available at http://www.benznidazoletablets.com/en/ .
  • Lampit® (nifurtimox) is FDA approved for treatment of children from birth to younger than 18 years and is commercially available for pharmacies to purchase from several drug wholesalers.

Siblings of an infant diagnosed with congenital Chagas disease should also be tested for the disease.

Resources

Use of trade names is for identification only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Services.

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)