CDC: Chagas disease may be overlooked in newborns

CDC: Chagas disease may be overlooked in newborns
CDC: Chagas disease may be overlooked in newborns

HealthDay News -- Chagas disease, a parasitic infection that can lead to cardiomyopathy, is usually transmitted by contact with triatomine insects, but it can be passed congenitally, according to a case report published in the CDC's Morbidity & Mortality Weekly Report.

The first congenital case of Chagas disease reported in the United States has been identified in a baby boy from Virginia, who was delivered at 29 weeks of gestation via cesarean section after clinicians found fetal hydrops. The CDC added that "additional, but unrecognized, cases likely exist."

Trypanosoma cruzi -- the parasite that causes Chagas disease -- is typically transmitted to humans via blood-feeding triatomine insects, also known as "kissing bugs" because of their proclivity to bite people on the lips.

After undergoing a battery of tests to determine the cause of the infant's ascites, pleural effusion and pericardial effusion, clinicians performed blood tests for T. cruzi, when the mother -- a 31-year old immigrant from Bolivia -- reported she had been previously diagnosed with Chagas disease but had not been treated for it.

The case report "illustrates that congenital Chagas disease, even when severe, might not be recognized or diagnosis might be delayed because of the lack of defining clinical features or because the diagnosis is not considered," the CDC wrote.

In this case, health-care providers first performed blood tests for Toxoplasma gondii, rubella virus and cytomegalovirus, all of which were negative, as were genetic tests for cytomegalovirus and enterovirus, a malaria smear and a hepatitis panel. Clinicians identified antibodies to herpes simplex virus, but cultures and genetic testing for viral nucleic acid were negative. 

After the mother's history revealed a previous diagnosis of Chagas disease, doctors performed a blood smear and serologic tests on the infant, which revealed the presence of T. cruzi antibodies. Polymerase chain reaction testing for T. cruzi was also positive, indicating Chagas disease.

The child was treated with a 60-day course of benznidazole, an antiparasitic drug used to treat Chagas disease that is not currently approved in the United States. The drug is only available through the CDC for use in investigational protocols. Laboratory tests performed at 10 months confirmed the infant was cured.

Increased awareness of Chagas disease is needed among clinicians treating pregnant women who have emigrated from countries where the disease is endemic, the CDC concluded, adding that cure rates are higher than 90% among those who receive treatment within the first few weeks of life.

Centers for Disease Control and Prevention. MMWR. 2012;61: 477-479.

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