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Home arrow Economics arrow American Trypanosomiasis Chagas Disease, Second Edition: One Hundred Years of Research

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Recommendations

A reliable biological diagnosis of congenital infection is essential to take the decision to initiate a treatment (see section: Treatment of congenital infection with Trypanosoma cruzi). So, the criteria defining a “successful” T. cruzi congenital infection (to be treated) have to be carefully and clearly specified for public health programs aiming to control such infection (see section: Prevention and control of congenital Trypanosoma cruzi infection).7

The 2011 conclusions of the WHO technical group on congenital Chagas disease were based on a consensus considering the detection of blood parasites at any time after birth, and/or a positive serology after 8 months of age, as both gold standards for the diagnosis of such infection.105 An early diagnosis allows a rapid initiation of the treatment and an easier follow-up of the newborns, avoiding their escape from the health system.229 However, different recent studies have clearly shown a detrimental lack of sensitivity of the parasitological detection.72,103 Examination of other biological samples of the same neonate week(s) after birth should increase the sensitivity of parasitological detection since neonatal parasitic loads can increase up to 1—3 months after delivery.72,103,229

In such a context, what might be the place of PCR for such a diagnosis? Practically, if a PCR is positive in neonates of infected mothers close to birth, it can be considered as alerting the health system to search congenital infection on subsequent samples of these neonates, by using parasitological and/or serological later tests while repeating PCR. This might allow maintaining a more straight contact with the family in order to limit patient escape (see above), and generate a greater efficiency in the management of congenital cases.230

 
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