Recomendaciones para el diagnóstico, seguimiento y tratamiento de la embarazada y del niño con enfermedad de Chagas

2 nd Brazilian Consensus on Chagas Disease, 2015

“…The evidence of T. cruzi infection does not justify the abdominal delivery indication (Cesarean), (115) since the congenital T. cruzi infection may result in delayed uterine growth, detected in ultrasound, and premature delivery (102) (115) (116) (123) . The importance of carrying out all the recommended evaluations during prenatal care, including anti-HIV testing is emphasized.…”

“…Studies point to the possible benefit of antiparasitic treatment, with better evolution of Chagas disease (116) (119) (120) (121) (122) and reduction of the risk of vertical transmission in future gestations (109) (116) . High maternal parasitemia is associated with an increased risk of vertical transmission and abortion (103) (115) . Pregnant women who are in the acute phase of Chagas disease should be evaluated case by case, preferably with the participation of experts, to define the risk-benefit of indicating the antiparasitic treatment.…”

“…However, given the evidence of teratogenicity demonstrated in animals, the specific antiparasitic treatment of infection by T. cruzi is contraindicated during pregnancy and not recommended during breastfeeding (20) (115) , and should be given only after these periods (112) . Accidental exposure to antiparasitic drug during pregnancy is not a criterion for interrupting the gestation (115) .…”

“…However, given the evidence of teratogenicity demonstrated in animals, the specific antiparasitic treatment of infection by T. cruzi is contraindicated during pregnancy and not recommended during breastfeeding (20) (115) , and should be given only after these periods (112) . Accidental exposure to antiparasitic drug during pregnancy is not a criterion for interrupting the gestation (115) . Studies point to the possible benefit of antiparasitic treatment, with better evolution of Chagas disease (116) (119) (120) (121) (122) and reduction of the risk of vertical transmission in future gestations (109) (116) .…”

“…Signs of meningoencephalitis and myocarditis were observed in coinfection with HIV (102) (104) (113) (114) (115) (123) . Therefore, they have been recommended as routine assessments in children with clinical signs of congenital Chagas disease: complete blood count, serum biochemistry, urinalysis, chest X-ray, electrocardiogram (ECG), echocardiogram, and cerebral and abdominal ultrasonography (115) . The strategy employed for the diagnosis of T. cruzi infection depends essentially on the child's age.…”