Lost opportunities in Congenital Chagas disease: retrospective study in a high complexity hospital of La Plata city

Abstract

Background: Congenital Chagas disease causes high morbimortality in new-borns. Timely diagnosis is of upmost importance, since treatment is highly effective in curing the disease. Methods & Materials: Retrospective, observational study. Clinical records were collected from pregnant patients with positive serology for Chagas disease, and from their children born at the maternity of the General Hospital “General San Martín” between 2011 and 2016. A diagnosis of Chagas disease was considered in the pregnant woman when two methods resulted reactive (being one of them ELISA or IIF). A diagnosis of congenital Chagas disease was considered after the direct detection of the parasite in blood of an infant under 10 months of age, using a parasitological micromethod. In negative cases, and those older than 10 months, it was considered congenital Chagas disease when two serological methods resulted positive (one of them being ELISA or IIF). Results: 55 mother–son binomials were analysed. 54.3% of the mothers were born in Bolivia (30/55), 30.9% were born in Argentina (17/55) and 14.5% were born in Paraguay (8/55). 3.6% (2/55) of the mothers recounted a history of transfusion of blood products. Serological diagnosis in the mother was attained before pregnancy in 47.3% (26/55), during the first trimester in 5.5% (3/55), in the second trimester in 38.2% (21/55) and in the third trimester in 9.1% (5/55%). 96.4% of the new-borns from women with Chagas disease were asymptomatic at birth (53/55) and 3.6% were symptomatic (2/55). The symptom identified was low birth weight. A microstrout assay was performed in 65.5% (36/55) of newborns, with 2.7% (1/36) of positive results. Follow-up with serological tests was performed in merely 18.2% (10/55) of the children, with negative results. Conclusion: With the data analysed we infer that follow-up of children under the year of age is deficient, with lost opportunities in early diagnosis and prompt treatment and thus cure of the disease. Given the small number of patients and lost data from clinical charts, the incidence of congenital Chagas disease could not be estimated.