Fatal Congenital Chagas' Disease In a Non-Endemic Area: a Case Report

Cases Journal
Case Report

BioMed Central

Open Access

Fatal congenital Chagas' disease in a non-endemic area: a case report
María Flores-Chávez1, Yamile Faez2, José M Olalla2, Israel Cruz1, Teresa Gárate1, Mercedes Rodríguez1, Pilar Blanc2 and Carmen Cañavate*1
Address: 1Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra.Pozuelo-Majadahonda Km 2, 28220 Majadahonda, Madrid, Spain and 2Hospital Carlos Haya, Av. Carlos Haya s/n, 29010 Málaga, Spain Email: María Flores-Chávez - mflores@isciii.es; Yamile Faez - yamilefh@hotmail.com; José M Olalla - jomaolalla@yahoo.es; Israel Cruz - cruzi@isciii.es; Teresa Gárate - tgarate@isciii.es; Mercedes Rodríguez - mero@isciii.es; Pilar Blanc - pblanci@telefonica.net; Carmen Cañavate* -ccanave@isciii.es * Corresponding author

Published: 7 November 2008 Cases Journal 2008, 1:302 doi:10.1186/1757-1626-1-302

Received: 7 August 2008 Accepted: 7 November 2008

This article is available from: http://www.casesjournal.com/content/1/1/302 © 2008 Flores-Chávez et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons AttributionLicense (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
The early diagnosis of congenital Chagas' disease is very important if infected newborns, whether symptomatic or not, are to receive adequate treatment. This paper describes the complications arising in thediagnosis of a newborn with fatal congenital Chagas' disease in Spain, a non-endemic area where visceral leishmaniasis is present.

Introduction
Chagas' disease is endemic from the south of the United States to southern Argentina and Chile, where it is mainly transmitted by reduvid insects. The protozoan that causes the disease – which has a wide range of clinical manifestations – is T. cruzi, aparasite that shows great genetic variation. Large numbers of protozoa are detected during the acute phase of the disease, while numbers are much lower during the chronic phase. However, it is during this latter phase when the humoral immune response is patent. Vertical or congenital transmission of T. cruzi is also possible. This route is associated with an infection rate of 0– 10%, depending onthe geographical area in question. Recent studies indicate the majority of children born to infected mothers to be asymptomatic, although some 2– 10% present with severe respiratory distress, hepatosplenomegaly, myocarditis and meningoencephalitis [1]. Without specific treatment, the mortality rate among such children is high. Since the transmission of T. cruzi

during pregnancy cannot beprevented, early diagnosis in newborns is essential so that appropriate etiological treatment can be administered; such treatment can be 100% effective. Since maternal IgG antibodies and excretionsecretion antigens that stimulate IgM or IgA production can cross the placenta [2], serological tests cannot discriminate between infected and non-infected newborns. However, the presence of anti-T. cruziantibodies in maternal serum identifies mothers whose newborns are at risk of having been infected [2]. Accordingly, to confirm the parasite infection, mobile T. cruzi trypomastigotes should be sought microscopically in the cord blood or peripheral blood of newborns after a concentration procedure (the microhaematocrit test) [3].

Case presentation
A 37 year-old Argentine woman with a background ofbipolar disease attended an appointment for a fetal ultrasound scan during the third trimester of pregnancy at a teaching hospital. The results revealed her unborn child to

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be suffering a 3–4 weeks delay in growth, unilateral ventriculomegaly, and signs of...