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Clinical manifestations of congenital Chagas disease

Congenital T. cruzi infection, though an acute infection, is frequently asymptomatic at birth, as observed in 40—100% of cases.55,135,172—177

Clinical manifestations of congenital Chagas disease can appear within days or weeks after birth, depending on the transplacental transmission time (see section: Timing of maternal—fetal transmission of Trypanosoma cruzi). Signs and symptoms that can be observed are non-specific. They are generally similar to those reported in other common congenital infections, due, e.g., to cytomegalovirus and Herpes simplex virus (commonly identified in the acronym TORCH).178 This and the high frequency of asymptomatic cases highlight the mandatory need for sensitive diagnostic tools to detect such infection close to birth (see section: Laboratory diagnosis of congenital infection with Trypanosoma cruzi). T. cruzi-infected newborns can exhibit fever, low birth weight (<2500 g), prematurity (gestational age <37 weeks), hepato-splenomegaly, and pneumonitis and more rarely jaundice.24,49,51,55,62,135,173,175,179—181 The premature rupture of membranes frequently observed in congenital Chagas disease (see section: The hematogenous transplacental route: strengths and weaknesses of the trophoblastic barrier) can result in the birth of premature newborns with immature pulmonary function. Pneumonitis in such cases can be more severe and evolve into respiratory distress syndromes.55 Growth retardation can be associated with a multisystemic diffusion of parasites in fetus, in addition to being a consequence of placentitis (see section: The hematogenous transplacental route: strengths and weaknesses of the trophoblastic barrier).

More severe clinical manifestations can be also observed in congenital Chagas disease, such as meningoencephalitis (inducing a large range of signs from slight tremors of face or limbs to generalized convulsions) and/or acute myocarditis

(resulting in alterations of cardiac rhythm and cardiomegaly),55,135,179,182—184

particularly in case of maternal coinfection with HIV (see section: Other maternal factors involved in transmission of congenital infection85,180).

Purpura and edema (anasarca/fetal hydrops in severe forms) can be also observed.4955185 Anemia and thrombocytopeny have been reported as the main hematological alterations of congenital Chagas disease.194962173—175179183185 Megaesophagus or megacolon have been rarely reported in congenital cases.186—190 Ocular involvement has been also exceptionally mentioned though the possibility of coinfection with Toxoplasma has not been eliminated.179191 No malformations are detected in such infected newborns.

It is interestingly to note that the oldest clinical reports on congenital Chagas disease from Argentina, Brazil, and Chile indicate the highest morbidity rates, whereas, by contrast, the recent studies in endemic as well as nonendemic countries, more frequently report congenital cases, either asymptomatic or suffering from mild symptoms.

Except in women presenting severe cardiac or digestive forms of Chagas disease before pregnancy, 9 , 9 gestation generally does not enhance the development of disease in chronically infected women. This allows considering congenital infection and placentitis as being the main short-term consequences of T. cruzi infection during pregnancy.

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