Congenital Chagas Disease

Abstract

Abstract Chagas disease, a antropozoonosis caused by the protozoan Trypanosoma cruzi, is one of the main parasitic diseases to threaten public health in the world. More than any other parasitic disease, Chagas disease is closely related to social and economic development. T. cruzi infection may be acquired through the triatomid insect vector, blood transfusion, and the transplacental route causing congenital Chagas disease. The success in the control of vector-transmitted Chagas’disease and screening programs in blood banks has uncovered the public health relevance of congenital transmission, which has been gradually emerging in vector-free suburban areas and non-endemic cities, contributing to the urbanization of the infection. It has been estimated that congenital transmission is responsible for 8000–16,000 annual cases in the endemic countries of America. It is a consensus that congenital Chagas disease will be a pressing public health concern until the pool of infected women of childbearing age decreases to insignificant levels, which may happen only 30 years onwards, at least in the Southern Cone countries. Congenital transmission may occur at any time of pregnancy, in successive gestations and may affect twins. The infection may produce pathology in the growing foetus. The consequences on the newborn are variable, ranging from asymptomatic to severe clinical manifestations. The prevalence of T. cruzi infection in women of childbearing age, congenital transmission rates, clinical forms of disease, and mortality vary largely according to the geographical areas under study. Host conditions, such as the immunological, genetic, and nutritional status of the mothers, age, obstetrical history, and maternal stage of the disease, as well as parasite strains, histotropism and maternal parasitaemia may account as risk factors for pregnancy outcome and incidence of congenital Chagas disease. Congenital transmission cannot be prevented, but early diagnosis of the newborn enables prompt treatment, achieving cure rates close to 100% and thus avoiding progression to chronic Chagas disease. In this chapter, epidemiological, clinical, and inmunological aspects as well as mechanisms of transmission, host and parasitic risk factors are described and discussed. Finally, consensus recommendations of strategies for diagnosis and treatment of congenital Chagas disease are presented in detail.