In the Journals

Congenital Chagas disease affects up to 5% of infants born to infected mothers in US

Morven Edwards (2019)
Morven S. Edwards

Up to 5% of infants born in the United States to mothers infected with Chagas disease become congenitally infected, according to a review published in The Journal of the Pediatric Infectious Diseases Society. If left untreated, these infants can develop chronic infection at a young age, which puts them at risk for serious heart and gastrointestinal complications.

Morven S. Edwards, MD, a professor of pediatrics at Baylor College of Medicine, and colleagues wrote that approximately 300,000 people the U.S. have Trypanosoma cruzi infection. Cases can be found in all 50 states and Washington, D.C. — all acquired in Latin America, where Chagas disease is endemic.

Of the 300,000 infections identified in the U.S., approximately 40,000 are estimated to occur among women of childbearing age. Most were not aware that they were infected or that Chagas disease could be transmitted congenitally.

Edwards and colleagues wrote that an estimated 63 to 315 infants are born annually with congenital Chagas disease, although previous research suggested that at least 2,000 children were infected. The rate of mother-to-infant transmission of T. cruzi was estimated to be between 1% and 5% in the U.S.

When infected, people may have mild influenza-like illness that persists for 2 to 3 months, known as the acute phase. If left untreated, these cases may become chronic, and the infection will persist for life. Infants congenitally infected with the disease experience the acute phase for the first few months of life and will develop chronic disease if not treated.

Edwards and colleagues stressed that if left untreated, 20% to 40% of infected individuals may develop Chagas cardiomyopathy or gastrointestinal disease.

Although congenital Chagas disease can be identified before birth through maternal antenatal screening, no serologic test is sensitive or specific enough to establish a diagnosis. The researchers recommended that positive screening results should be confirmed with two or more tests using different techniques and antigen preparations at a reference lab.

“Improved knowledge of the locales in the U.S. in which women of childbearing age with chronic T. cruzi infection reside could enhance identification of infants with congenital infection,” the researchers wrote. “Improved performance of existing tests is needed, as is validation of rapid screening tests for use in infants. Development of effective and well-tolerated drugs for treatment should be a priority.” – by Katherine Bortz

Disclosures: Edwards is the recipient of a research grant from Pfizer, Inc. All other authors report no relevant financial disclosures.

Editors’ Note: This story was updated to show that 5% of children born to mothers with Chagas disease are congenitally infected. The editors regret the error.

Morven Edwards (2019)
Morven S. Edwards

Up to 5% of infants born in the United States to mothers infected with Chagas disease become congenitally infected, according to a review published in The Journal of the Pediatric Infectious Diseases Society. If left untreated, these infants can develop chronic infection at a young age, which puts them at risk for serious heart and gastrointestinal complications.

Morven S. Edwards, MD, a professor of pediatrics at Baylor College of Medicine, and colleagues wrote that approximately 300,000 people the U.S. have Trypanosoma cruzi infection. Cases can be found in all 50 states and Washington, D.C. — all acquired in Latin America, where Chagas disease is endemic.

Of the 300,000 infections identified in the U.S., approximately 40,000 are estimated to occur among women of childbearing age. Most were not aware that they were infected or that Chagas disease could be transmitted congenitally.

Edwards and colleagues wrote that an estimated 63 to 315 infants are born annually with congenital Chagas disease, although previous research suggested that at least 2,000 children were infected. The rate of mother-to-infant transmission of T. cruzi was estimated to be between 1% and 5% in the U.S.

When infected, people may have mild influenza-like illness that persists for 2 to 3 months, known as the acute phase. If left untreated, these cases may become chronic, and the infection will persist for life. Infants congenitally infected with the disease experience the acute phase for the first few months of life and will develop chronic disease if not treated.

Edwards and colleagues stressed that if left untreated, 20% to 40% of infected individuals may develop Chagas cardiomyopathy or gastrointestinal disease.

Although congenital Chagas disease can be identified before birth through maternal antenatal screening, no serologic test is sensitive or specific enough to establish a diagnosis. The researchers recommended that positive screening results should be confirmed with two or more tests using different techniques and antigen preparations at a reference lab.

“Improved knowledge of the locales in the U.S. in which women of childbearing age with chronic T. cruzi infection reside could enhance identification of infants with congenital infection,” the researchers wrote. “Improved performance of existing tests is needed, as is validation of rapid screening tests for use in infants. Development of effective and well-tolerated drugs for treatment should be a priority.” – by Katherine Bortz

Disclosures: Edwards is the recipient of a research grant from Pfizer, Inc. All other authors report no relevant financial disclosures.

Editors’ Note: This story was updated to show that 5% of children born to mothers with Chagas disease are congenitally infected. The editors regret the error.