Congenital Chagas disease: Updated recommendations for prevention, diagnosis, treatment, and follow-up of newborns and siblings, girls, women of childbearing age, and pregnant women

• Published in: PLoS neglected tropical diseases 2019-10, Vol.13 (10), p.e0007694-e0007694
• Main Authors: Carlier, Yves, Altcheh, Jaime, Angheben, Andrea, Freilij, Hector, Luquetti, Alejandro O, Schijman, Alejandro G, Segovia, Manuel, Wagner, Noemie, Albajar Vinas, Pedro
• Format: Article
• Language: English
• Subjects: Biology and Life Sciences; Birth; Blood; Blood coagulation; Chagas disease; Chagas Disease - congenital; Chagas Disease - diagnosis; Chagas Disease - prevention & control; Chagas Disease - therapy; Childbirth & labor; Chronic Disease; Clinical trials; Congenital diseases; Congenital infection; Control equipment; Cytomegalovirus; Delivery of Health Care - standards; Deoxyribonucleic acid; Detection; Diagnostic software; Diagnostic systems; Disease; DNA; Edetic acid; EDTA; Equipment costs; Ethylenediaminetetraacetic acids; Female; Filter paper; Gene expression; Guanidine; Herpes simplex; HIV; Hospitals; Human immunodeficiency virus; Humans; Infant, Newborn; Infection; Infections; Infectious Disease Transmission, Vertical - prevention & control; Medical treatment; Medicine and Health Sciences; Neonates; Newborn infants; Nucleotide sequence; Parturition; Parvoviruses; PCR; People and Places; Planning; Polymerase chain reaction; Pregnancy; Pregnancy Complications, Parasitic - diagnosis; Pregnancy Complications, Parasitic - prevention & control; Pregnancy Complications, Parasitic - therapy; Pregnant Women; Prevention; Protozoa; Public health; Public Health - standards; Public Health Administration; Quality assurance; Quality control; Real time; Research and Analysis Methods; Satellite DNA; Siblings; Signs and symptoms; Sustainable development; Symptoms; Tests; Transmission; Transplants & implants; Tropical diseases; Trypanosoma cruzi; Vector-borne diseases; Viewpoints; Viruses; Women; Womens health
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0007694

Some cCD cases can present nonspecific symptoms, if any, as seen in other intrauterine or perinatal infections (like Toxoplasma gondii, Treponema pallidum, rubella virus, cytomegalovirus, HIV, herpes simplex virus, and parvovirus infections). [...]detection of T. cruzi congenital infection should rely on easy-to-use and point-of-care diagnostic tools [17]. [...]more sensitive and automated tests are needed for early detection of very low levels of T. cruzi, particularly when transmission occurs in the last period of pregnancy, close to or even at birth. Thereby, the following factors should be taken into account: the best timing of blood sampling (1 to 3 month[s] after birth rather than at birth, unless in presence of a clinically ill newborn), the number of samples to be taken, the sample collection process (EDTA, guanidine EDTA, filter paper, blood clot), the DNA extraction procedure, the DNA target (satellite DNA and/or kinetoplast DNA), the type of method (standard PCR or real-time PCR, requiring slightly more complex equipment and higher cost), the quality control, and the biological standards [28–34]. [...]currently, molecular tests can be considered as uptaking tests in order to prevent losing the patient during the follow-up, when parasitological techniques are not available/reliable for logistical/organizational constraints or lack of skilled personnel. First external quality assurance program for bloodstream Real-Time PCR monitoring of treatment response in clinical trials of Chagas disease.