Estimation of the morbidity and mortality of congenital Chagas disease: A systematic review and meta-analysis

Abstract

Chagas disease is caused by the parasite Trypanosoma cruzi which can be transmitted from mother to baby during pregnancy. There is no consensus on the proportion of infected infants with clinical signs of congenital Chagas disease (cCD). The objective of this systematic review is to determine the burden of cCD. Articles from journal inception to 2020 reporting morbidity and mortality associated with cCD were retrieved from academic search databases. Observational studies, randomized-control trials, and studies of babies diagnosed with cCD were included. Studies were excluded if they were case reports or series, without original data, case-control without cCD incidence estimates, and/or did not report number of participants. Two reviewers screened articles for inclusion. To determine pooled proportion of infants with cCD with clinical signs, individual clinical signs, and case-fatality, random effects meta-analysis was performed. We identified 4,531 records and reviewed 4,301, including 47 articles in the narrative summary and analysis. Twenty-eight percent of cCD infants showed clinical signs (95% confidence interval (CI) = 19.0%, 38.5%) and 2.2% of infants died (95% CI = 1.3%, 3.5%). The proportion of infected infants with hepatosplenomegaly was 12.5%, preterm birth 6.0%, low birth weight 5.8%, anemia 4.9%, and jaundice 4.7%. Although most studies did not include a comparison group of non-infected infants, the proportion of infants with cCD with clinical signs at birth are comparable to those with congenital toxoplasmosis (10.0%-30.0%) and congenital cytomegalovirus (10.0%-15.0%). We conclude that cCD burden appears significant, but more studies comparing infected mother-infant dyads to non-infected ones are needed to determine an association of this burden to cCD.

Chagas Disease in Europe

“…Symptomatic congenital CD occurs in nearly 30% of cases and is associated with a mortality of around 2% [ 36 ]. Mother-to-child infection can occur at any stage of the disease, acute or chronic, and appears to depend on interactions between the mother, placenta, fetus, and parasite [ 33 ].…”

Mother‐to‐child Chagas disease transmission: The challenge of detection and prevention in areas without the risk of vectorial transmission

“…12 Other characteristic manifestations including meningoencephalitis, neurological alterations, or myocarditis, may appear less frequently but with higher mortality risk. 18 In countries where CD is not endemic, mortality is very low or anecdotally associated with previously undiagnosed cases. 12 As a result, even if physical examination is normal, it is recommended that all newborns with CD undergo additional tests, including blood cell count, blood and urine biochemistry, chest x-ray, brain and abdominal ultrasonography, fundoscopy, echocardiography, and electrocardiography.…”

“…Clinical manifestations, such as nonspecific symptoms that may be difficult to distinguish from other infections, including fever, splenomegaly, edema, anasarca, skin lesions, purpura, jaundice, anemia, or thrombocytopenia, may not develop until weeks after delivery 12 . Other characteristic manifestations including meningoencephalitis, neurological alterations, or myocarditis, may appear less frequently but with higher mortality risk 18 …”

Chagas Disease Maternal Seroprevalence and Maternal–Fetal Health Outcomes in a Parturition Cohort in Western El Salvador

“…Most infected individuals acquire infection in childhood and experience subclinical chronic disease, in which 30% will insidiously progress to dilated cardiomyopathy and heart failure years to decades after initial infection [3]. An estimated 1 million infected women of child-bearing age are unknowingly infected, posing a considerable risk for both their health and the health of their neonates [4]. Vertical transmission of T. cruzi occurs in approximately 5% of infected pregnant women, and up to 60% of these vertically infected infants are asymptomatic at the time of delivery [5,6].…”