Case Reports
Case 1, a 3.56 kilogram (kg) infant, was born at full-term to a Bolivian
woman who had arrived in Ireland at 31 weeks gestation. She was
diagnosed serologically with CD in Bolivia by routine antenatal
screening at 23 weeks. Repeat maternal serology was tested at The
Hospital for Tropical Diseases, London UK and was strongly positive.T. cruzi polymerase chain reaction (PCR) tested in the Diagnostic
Parasitology Laboratory at The London School of Hygiene and Tropical
Medicine, was also positive. As per World Health Organisation (WHO)
recommendations, maternal trypanocidal treatment was delayed until after
delivery. Newborn clinical examination was normal and microscopy of cord
blood was negative for blood forms of T. cruzi . PCR of infant
cord and venous blood (day 2) for T. cruzi were inconclusive
(positive in 1 of 8 replicates and 2 of 12 replicates, respectively).
Repeat PCR and microscopy of blood were negative at 4 weeks. Blood PCR
for T. cruzi was strongly positive at 3 months of age and the
infant was commenced on a 2-month course of oral Benznidazole 10
milligram/kg/day. The infant experienced mild self-limiting
gastrointestinal upset and macular rash at the onset of treatment.T. cruzi PCR was negative after one month of treatment and at
treatment completion. Monitoring full blood count and liver function
tests remained normal throughout treatment. T. cruzi PCR was also
negative at 9 months of age.
The mother discontinued her Benznidazole treatment after 3 weeks due to
concerns that it might interfere with breast-feeding and she disengaged
from follow-up. Further maternal follow up is planned following
cessation of breast feeding at one-year post-partum to recommence
treatment and she has been advised to avoid pregnancy until treatment
completion.
Case 2 was an infant born 4 months after case 1. Routine placental
examination for intrauterine growth restriction (IUGR) in a 2.4 kg
infant delivered by caesarean section at 39 weeks gestation,
demonstrated numerous T. cruzi blood forms within the placental
membranes and umbilical cord (Figure 1a). The infant, then aged 4 weeks,
was recalled. Examination was normal save for symmetrical growth
retardation. Presence of T. cruzi trypomastigotes in blood films
(Figures 1b and 1c) and positive blood PCR confirmed the diagnosis of
cCD. The infant was commenced on a 2-month course of oral Benznidazole.
Trypanocidal therapy was well tolerated. Iron supplementation was
started at age 6 weeks for mild microcytic anaemia. PCR for T.
cruzi and microscopy of venous blood were negative after 1 month of
treatment and at treatment completion. The infant’s mother was born in
Bolivia and moved to Brazil at age 2 years. She migrated to Ireland 2
years prior to pregnancy. Twenty years earlier she was diagnosed
serologically with CD in Brazil when family members had tested positive.
She had attended annual cardiology review there but had not received
trypanocidal treatment as her CD was asymptomatic. She chose to
discontinue breast-feeding due to concerns of ongoing T. cruzitransmission. She was commenced on oral Benznidazole treatment and was
referred for cardiology review.
Both infants are thriving, developing normally and will be monitored
clinically and serologically up to age 1 year. Echocardiograms were
normal and cardiology follow up is scheduled for both infants.