Pregnant Mothers - Beware of Kissing Bug that Attacks from the Womb

Bug that Attacks from the Womb
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Government health sources estimate that chronic Chagas disease affects approximately 300,000 Americans in the U.S. While Chagas disease - also commonly referred to as “the kissing bug” disease (named so, because they bite the face and lips of humans) - is typically transmitted via insect bites, blood transfusion, organ transplantation, and consumption of contaminated food or drink.

However, its mode of transmission in the U.S. according to the CDC’s Morbidity and Mortality Weekly Report has recently expanded with an infected mother to her child while in the womb as authorities describe the first U.S. case of Chagas disease via transplacental infection in the U.S.

Chagas disease - named after the Brazilian physician Carlos Chagas, who discovered the disease in 1909— is caused by the parasite Trypanosoma cruzi. Trypanosoma cruzi is a protozoan parasite that is found in triatomine insects (kissing bugs) and several species of small, wild mammals. While endemic in South America, the incidence of Chagas disease has made its way northward to the southern and southwestern U.S. and has raised some alarm with reported incidences of Chagas disease transmission via donated blood in the U.S. Some experts proclaim that Chagas is the new HIV/AIDS of the U.S. While many infected are symptomless, Chagas disease is a lifelong parasitic infection that if left untreated can result in eventual cardiomyopathy or other serious and life-threatening disease manifestations.

According to a past study published in the journal Emerging Infectious Diseases, the rate of transplacental transmission from mothers with chronic T. cruzi infection to their newborns is 2-10%. The danger to newborn infants is that they are often asymptomatic or exhibit only subtle manifestations of the disease that can be easily missed by a healthcare provider. Infected newborns can show signs of low birth weight, low Apgar scores, hepatosplenomegaly, respiratory distress, anasarca, cardiac failure, and/or meningoencephalitis. In severe case of congenital Chagas disease there is a high risk for neonatal death.

According to the CDC, however, even in instances of severe disease a diagnosis may not be reached because of the lack of defining clinical features and because Chagas disease is an uncommon diagnosis consideration for many physicians.

The importance of raising awareness of Chagas disease in newborn infants is highlighted in a recent publication of the CDC’s Morbidity and Mortality Weekly Report that tells of a case of a newborn infant in the U.S who had contracted Chagas disease from his mother.

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According to the report, in 2010 a mother who had immigrated from Bolivia to the U.S, gave birth to a an infant boy whose health was subpar with the presence of ascites, pleural effusion, and pericardial effusion, and was thereby suspected of carrying an infection of some type. Initial tests failed to reveal common sources of infection.

By the second week, however, the infant’s physicians learned through interviewing the mother that she had been told by her previous physician during an earlier pregnancy that she had Chagas disease, of which she had never received anti-trypanosomal treatment. Serological and genetic tests afterward confirmed that the infant had Chagas disease and that it had been transmitted transplacentally from mother to fetus.

A 60-day course of benznidazole treatment resolved the infant’s ascites and effusions and a follow-up performed at age 10 months determined that the boy had been cured.

The CDC points out that it is currently unknown how many women are at risk of transmitting the kissing bug disease to their unborn children. Estimates of the annual incidence of congenital Chagas disease ranges from 65–315 cases in one study to166–638 cases in another study—primarily among women who have emigrated from Mexico, Central America, and South America. Treatment of congenital infection is highly effective, with cure rates >90% when instituted in the first few weeks of life and therefore necessitates a need for awareness by physicians and pregnant mothers-to-be in the U.S.

Image Source: Courtesy of Wikipedia

References:

“Congenital Transmission of Chagas Disease” CDC Morbidity and Mortality Weekly Report July 6, 2012; 61(26);477-479.

“Congenital Transmission of Trypanosoma cruzi Infection in Argentina”
Emerging Infectious Diseases Volume 9, Number 1 (January 2003); Ricardo E. Gürtler et al.

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