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Congenital Chagas disease: current diagnostics, limitations and future perspectives

Messenger, Louisa A.a; Bern, Carynb

Current Opinion in Infectious Diseases: October 2018 - Volume 31 - Issue 5 - p 415–421
doi: 10.1097/QCO.0000000000000478
TROPICAL AND TRAVEL-ASSOCIATED DISEASES: Edited by Christina Coyle

Purpose of review Congenital transmission is an important route of Trypanosoma cruzi infection, both in Latin America and internationally, with considerable populations of infected women of child-bearing age residing in the United States and Europe. This review examines recent literature on congenital Chagas disease, with a focus on the changing clinical spectrum and potential new diagnostic tools.

Recent findings Vertical transmission occurs in approximately 5–10% of births from T. cruzi-infected mothers. Historically, congenital Chagas disease was associated with high levels of neonatal morbidity and mortality. Bolivian birth cohort data from the early 1990s to the present indicate that the incidence of symptomatic neonatal disease has declined. Treatment with trypanocides is greater than 90% effective and well tolerated in infants. Current programs face challenges from the multistep screening algorithm, low sensitivity of microscopy and high loss to follow-up.

Summary Congenital Chagas disease remains an important contributor to the global disease burden because of T. cruzi. PCR and related molecular techniques represent the most sensitive diagnostic modalities for early detection but require further optimization for resource-limited settings. Several novel diagnostic tests show promise for the future but further validation and adaptation to field settings are needed.

aFaculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

bDepartment of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA

Correspondence to Caryn Bern, MD, MPH, Professor, Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, 94158 CA, USA. Tel: +1 415 476 2300; e-mail: Caryn.Bern2@ucsf.edu

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