Chagas disease

Vertical transmission. A description of clinical cases

Abstract

Chagas disease is a disease caused by Trypanosoma cruzi. In 1997 a certification was issued declaring the interruption of the vectorial transmission of T.cruzi in Uruguay. Within this context, non-vectorial transmission mechanisms became more important. Congenital infection is the only transmission mechanism in the country. This risk (4%) results in specific serologic testing for Chagas being mandatory in obstetric follow up visits of the 13 endemic departments of Uruguay and the maternity of the Pereira Rossell Hospital Center in Montevideo (Decree of the Executive Power N° 49085/95). The objective of the study is to describe five clinical cases of children to mothers with positive serology for Chagas, who were seen at Médica Uruguaya from 2011 through 2014. The mothers of all these children live in Montevideo, three of them used to live in endemic departments during their childhood (Rivera, Artigas, Tacuarembó) and the grandmothers on the mother’s side live in the endemic departments. Xenodiagnosis was negative in four children. Infection was confirmed in one four-year old asymptomatic boy who lived in Montevideo through serological testing.
Conclusions: parasitological treatment must be avoided during pregnancy. Diagnosis prior to 9 months of age requires xenodiagnosis (Instituto de Higiene. School of Medicine, University of the Republic), since serological tests may provide biological false-positive test due to placenta transmission of IgG type maternal antibodies. In this small series, infection was confirmed in one of the five cases. Disease controls requires detection during pregnancy and timely referral, as well as follow up of children until they are one year old to discard the disease.