A newborn male was being seen in the newborn nursery after an uneventful pregnancy and delivery. The intern reported that in addition to routine screening and monitoring the mother had also been tested for Chagas disease and had been negative. She had checked with the mother, who reported that her sister in Guatemala had been positive for Chagas disease and had been treated. The Guatemalan doctors had recommended that the mother be tested. “I’ve been doing more reading and because the exposure can be years ago, if there is someone with it, they often recommend to test the family especially women of child-bearing age. The baby looks great and moms testing is normal so his risk is really, really low,” she noted.
Discussion
Chagas disease is named for Dr. Carlos Chagas who in 1909 identified that the disease was caused by the parasite Trypanosoma cruzi, and that it was transmitted by a bite and subsequent defecation into the bite by a triatomine insect known as a kissing bug. It is also called American or South American trypanosomiasis. Blood transfusion, organ transplantation and congenital infections are also potential transmission modes.
Chagas disease is common in Latin America. About 300,000 individuals in the US are believed to be infected and most are believed to have been infected in Latin America and then the patients came to the US. It is estimated that 63-315 “…infants born in the United States are born with congenital Chagas disease each year.” Their mothers having acquired it while living in an endemic area and were unaware they were infected. Maternal child transmission is thought to be 1-5%.
Acute illness is usually similar to an influenza-like illness that is self-limited. Acute phase lasts 2-3 months and then can enter the chronic phase that is life-long without treatment. The disease can be dormant for years but if untreated cardiomyopathy and gastrointestinal problems can occur in 20-40% of infected individuals. This includes congenitally infected infants who may not have any disease until years later when they are diagnosed with cardiomyopathy or a gastrointestinal problem. The parasite can cross the placenta during the second or third trimester and therefore a congenitally infected infant can be in the acute phase for 4-8 weeks after birth, and then if untreated also enter the chronic phase.
Untreated Chagas disease can cause significant cardiomyopathy and other cardiac problems related to this such as arrhythmias and heart failure. If a child or mother is identified with Chagas disease, then screening of material relatives should be considered because family clusters do occur. Although routine prenatal screening is not widely used in the US, certain areas who have populations at higher risk may do targeted maternal screening. Testing for disease can be difficult and requires two different serological tests to be positive. Treatment for congenital Chagas in the US includes benznidazole and nifurtimox. Cure rate for congenital Chagas disease is about 90% if treated in first year of life.
Learning Point
Signs and symptoms of congenital Chagas disease can be detected at birth or in days to weeks after birth.
They can include:
- Neonatal
- ***Low birth weight
- Prematurity
- Hydrops fetalis
- Anasarca
- +++Myocarditis
- ***Respiratory distress/failure
- Arrhythmias
- Effusions – pleural or pericardial
- ***Hepatomegaly with or without splenomegaly
- Progressive dilation and dysfunction of gastrointestinal tract
- Ascites
- Hematological
- Anemia
- Thrombocytopenia
- Petechiae
- Neurological
- +++Meningoencephalitis
- Ophthalmological
- Retinitis
- Vitreitis
Questions for Further Discussion
1. What does TORCH stand for? A review can be found here
2. What causes hepatomegaly? A review can be found here
3. What are other parasitic infections found in Latin America?
Related Cases
- Disease: Chagas Disease
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Specialty: Infectious Diseases | Neonatology
- Age: Newborn
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews. Information prescriptions for patients can be found at MedlinePlus for this topic: Chagas Disease
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
To view videos related to this topic check YouTube Videos.
Edwards MS, Stimpert KK, Bialek SR, Montgomery SP. Evaluation and Management of Congenital Chagas Disease in the United States. J Pediatric Infect Dis Soc. 2019;8(5):461-469. doi:10.1093/jpids/piz018
Edwards MS, Montgomery SP. Implementation of Screening to Benefit Mother and Infant. Clin Perinatol. 2021;48(2):331-342. doi:10.1016/j.clp.2021.03.013
Pascual-Vazquez G, Alonso-Saron M, Rodriguez-Alonso B, et al. Molecular diagnosis of Chagas disease: a systematic review and meta-analysis. Infect Dis Poverty. 2023;12:95. doi:10.1186/s40249-023-01143-7
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa