Congenital Chagas disease of second generation in Santiago, Chile. Report of two cases

Abstract

Congenital Chagas disease (CChD) has been reported in different countries, mostly in Latin America. In 1987 a fatal case of CChD of second generation (CChDSG) was published. Within a period of six months--1989-1990--two cases of CChDSG were diagnosed and studied in the city of Santiago. Two premature newborns, sons of two sisters, with moderate liver and spleen enlargement, were found to have positive serology for Chagas disease and xenodiagnoses. The mothers, urban residents all their lives, without antecedents of triatomine bugs contact or blood transfusions, showed positive serology and xenodiagnoses. Their mother (grandmother of the infants), lived 20 years in a Northern rural Chagas disease endemic locality, in a triatomine infested house. Afterwards, she moved to Santiago, where she married and has resided up to now. Serology and xenodiagnoses were also positive. All the Trypanosoma cruzi infected individuals were successfully treated with nifurtimox.

Congenital Trypanosoma cruzi Infection. Efficacy of Its Monitoring in an Urban Reference Health Center in a Non-Endemic Area of Argentina

“…27 According to our data, it is not possible to determine if those children born in the City of Buenos Aires or Greater Buenos Aires, whose mothers are also native of non-endemic areas, constitute second generation congenital CHD children, a piece of information that is clearly reported in studies from Chile and the province of Salta, Argentina. 28,29 In other countries of the Southern Cone, CT rate figures are as follows: 5.1% in Yacuiba and 5.2% in Bermejo, both from Bolivia, 20, 21 5.4% in Paraguay, 17 0.7% in Brazil, 30,31 and 21.2% in Chile. 32 The variability expressed in CT rates in countries and areas of Latin America could be related to the degree of success or difficulty in the application of the strategy, recording of cases, the impact of vectorial control and policies on surveillance and poverty.…”

Comparison of Trypanosoma cruzi Lineages and Levels of Parasitic DNA in Infected Mothers and Their Newborns

“…12 However, qPCR remains a sophisticated and expensive technique useful as an investigation tool to improve our understanding of the maternal-fetal transmission of T. cruzi but is hardly applicable in the control strategies for congenital Chagas disease. 2,3 Agreement between parasite levels obtained by qPCR and parasite counts in capillary tubes highlights the reliability of detecting parasitic DNA levels to estimate parasitemia. The high parasitemia observed in > 76% of congenitally infected neonates confirms the intense parasite multiplication occurring in fetal tissues in this particular form of acute chagasic infection.…”

“…1 In endemic countries where national programs of vectorial control and selection of blood donors have been developed, maternal-fetal transmission of parasites has evolved as the most important route of T. cruzi infection, making possible transmission from one generation to another. 2,3 Such transmission occurs in 1-12% of infected mothers, and morbidity and mortality of congenital infection vary from asymptomatic to severe and mortal clinical forms of disease. 3,4 Host as well as parasitic factors might be involved in such variations.…”

Trypanosoma cruzi and Chagas' Disease in the United States

“…Between 1 and 10% of infants of T. cruzi-infected mothers are born with congenital Chagas' disease (14,24,289). Congenital transmission can occur from women themselves infected congenitally, perpetuating the disease in the absence of the vector (263). Factors reported to increase risk include higher maternal parasitemia level, less robust anti-T. cruzi immune responses, younger maternal age, HIV and, in an animal model, parasite strain (9,32,34,107,289).…”