Screening of congenital Chagas disease in Florence, Italy

Objectives: Chagas disease causes high morbidity in many Latin American countries. Maternal-fetal transmission of Trypanosoma cruzi occurs in 2–12% of pregnant infected mothers. Early treatment of infected infants attains a nearly 100% eradication rate. In August 2008, the Tuscany Reference Centre for Tropical Diseases implemented a protocol for the screening of congenital Chagas disease at the main public maternity hospital (Careggi Hospital) of Florence, Italy.Methods: The programme consists of: 1) screening of pregnant women coming from endemic areas for seroreactivity to T. cruzi, by using an immunochromatographic assay (ICT)(Chagas Quick Test, Cypress Diagnostics, Belgium) and conventional T. cruzi IgG ELISA test (CHAGAS IgG ELISA, DRG Diagnostics, Germany), 2) serological (ICT plus ELISA) and parasitological (microscopic examination and nested polymerase chain reaction-PCR with primers TCZ1/TCZ2 and TCZ3/TCZ4, followed by sequencing) evaluation of infants born to T. cruzi-infected women, 3) treatment of infected infants. Infants are considered infected in case of microscopic detection of T. cruzi, or PCR positivity in at least two different samples, or seropositivity at 8 months of age. Results: From 1/8/2008 to 10/06/2009, 70 pregnant women were screened (mean age 32 years, limits 14–42). The countries of origin were: Peru (40), Brazil (9), Argentina (5), Honduras (3), Bolivia (2), Colombia (2), Ecuador (2), El Salvador (2), Mexico (2), Chile (1), Costa Rica (1) and Venezuela (1). 47 patients (67%) lived exclusively in urban areas while 18 (25%) spent also several years in rural areas. In 5 (7%) patients the characteristics of the living place were unknown. Fourteen patients (20%) lived for several years in houses where the reproduction of triatomine bugs was possible None patient has been investigated for Chagas disease previously. All except one mother tested negative. The seroreactive mother, aged 29 years, came from Bolivia. The further evaluation of her infant is ongoing. The parasitological evaluation at 1 month of age was negative.Conclusions: In Europe, the presence of immigrants from endemic areas makes possible the appearance of congenital infection in newborns of mothers living with chronic Chagas disease. To increase the early detection of congenitally infected infants and thus facilitate their early treatment, surveillance of pregnant women from endemic areas is recommended. Furthermore, the detection of a maternal Chagas infection should lead to extend the screening to other family members.