The diagnostic and clinical aspects of congenital Chagas' disease were studied in 71 children in Buenos Aires. The children's ages ranged from 2 days to 10 years. In infants or = 6 months of age. Forty-six (64.8%) of the 71 children had no clinical signs of infection. The clinical sign most frequently documented was hepatomegaly (18.3%). Three children were coinfected with human immunodeficiency virus; the latter infection was severe in two instances. Nifurtimox (10-15 mg/[kg.d] for 2 months) was used for parasiticidal treatment, and use of this drug resulted in mild adverse effects.

Congenital Chagas' Disease: Diagnostic and Clinical Aspects

• Two different histological types of congenital Chagas disease are defined. In one type, parasites were seen within the skeletal and cardiac fibers, and in the other, they are found mostly within the cells of the reticuloendothelial system. The latter was often associated with parasitized giant-cells with a single, lobulated, hyperchromatic nucleus. In 24 placentas, the most consistent findings were villous and intervillous inflammatory infiltrates. Amastigotes ofTrypanosoma cruziwere found mostly in the chorionic villi and in the chorionic plate, and less frequently in the fetal membranes. (Am J Dis Child130:97-103, 1976)

https://jamanetwork.com/journals/PEDS/articlepdf/506329/archpedi_130_1_020.pdf

Congenital Chagas disease.

We designed a set of procedures for first-line local health services to detect and treat the congenital transmission of Trypanosoma cruzi at a province-wide scale, and field-tested the programme in the province of Tucuman, northwestern Argentina, from 1992 to 1994. The programme consists of routine screening of pregnant women for seroreactivity to T. cruzi, serological and parasitological follow-up of the newborn at least twice during the first year of age, treatment of the infected infants, and evaluation of the outcome. 927 (5.5%) of 16 842 pregnant women were seroreactive to T. cruzi by indirect haemagglutination assay and ELISA. Twenty-one (6.7%) of 315 newborns to seroreactive mothers were diagnosed as infected with T. cruzi parasites microhaematocrit concentration before 30 days of age. Five newborns who initially tested negative had a T. cruzi infection detected by microhaematocrit and/or serological techniques at 3 or 6 months of age. Thus, congenital infection was diagnosed in 26 (7.1%) infants born to seroreactive women and residing in houses free of triatomine bugs. Four of 6 infants born to seroreactive mothers died during the first year of age and had some evidence of T. cruzi infection; one of the deaths was attributed to T. cruzi based on clinical evidence. After specific treatment with nifurtimox or benznidazole, 30 of 32 infants remained parasitologically and serologically negative. This study shows the feasibility of controlling the incidence of congenitally acquired T. cruzi infections at a province-wide scale by means of a specific screening programme at first-line health services level.

Congenital transmission of Trypanosoma cruzi: an operational outline for detecting and treating infected infants in north-western Argentina.

After defining some concepts, this chapter specifies the epidemiological features of this peculiar transmission mode of Trypanosoma cruzi. The possible maternal–fetal routes, the placental responses to parasite infection and the timing of transmission are reviewed in depth. The factors susceptible to be involved in parasite transmission and development of congenital Chagas disease, such as parasite genotypes and maternal and fetal immune responses, are discussed in detail. Information obtained from vertical transmission in other mammals is also examined. T. cruzi congenital infection is frequently asymptomatic, whereas reported symptoms are nonspecific, and severe and mortal clinical forms are mainly observed in case of maternal coinfection with HIV. The long-term consequences of congenital infection, such as the transgenerational transmission and the imprinting of neonatal immune system are also mentioned. The diagnosis of infection in pregnant women requires standard serological investigations. The laboratory diagnosis in newborns of positive mothers includes the use of parasitological techniques at birth or in the first months of life (though of limited sensitivity, these tests indisputably confirm the presence of live parasites) and/or standard serological investigations 8 months after birth, when maternal transmitted antibodies have disappeared. The conditions of using polymerase chain reaction (detecting parasitic DNA and not live parasites) are discussed in depth. All diagnosed congenital cases have to be treated before 1 year of age in order to cure them without side effects. Since the treatment of infected pregnant women is not recommended, the control strategy of congenital infection refers to its systematic detection in newborns of infected mothers by the means mentioned above.

Maternal–Fetal Transmission of Trypanosoma cruzi

A study was carried out on T. cruzi infection in pregnant women in the Guemes area in Salta province; the rate of infection was 12.3%. Of newborn children studied by the microhematocrit technique, 8.8% were diagnosed with Chagas' disease. All of them were treated with benznidazol (5mg/kg/day) for one month; all of them presented anemia, which was interpreted to be an adverse drug reaction. The microhematocrit technique is believed to represent the best option for diagnosis of this disease in newborn children. A diagnostic methodology to follow the course of the infection is proposed.

/pdf/enfermedad-de-chagas-mazza-congenita-en-salta-3xi3ezfja6.pdf

Enfermedad de Chagas-Mazza congenita en Salta

[Congenital Chagas-Mazza disease in Tucuman. Concerning 8 doubtful and 2 probable cases diagnosed in the Dept. of Pediatrics of the S. M. Institute of Maternity during the period October 1967--September 1968].

Saleme Ae

Papers

[Congenital Chagas-Mazza disease in Tucuman. Concerning 8 doubtful and 2 probable cases diagnosed in the Dept. of Pediatrics of the S. M. Institute of Maternity during the period October 1967--September 1968].