Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas.
Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Curr Opin Infect Dis. 2021 Oct 1;34(5):538-545. doi: 10.1097/QCO.0000000000000769.
Lack of recognition of congenital Chagas disease in infants of mothers from endemic regions who are living in countries nonendemic for Trypanosoma cruzi infection suggests a high rate of underdiagnosis. Pregnancy is the optimal access point for identifying Chagas disease in at-risk mothers and their infants. In this review, we update progress toward implementation of pregnancy-based screening for congenital Chagas disease in nonendemic settings.
International organizations have updated recommendations for diagnosis, treatment and prevention of congenital Chagas disease. Reports of successful implementation of pregnancy-based screening at some centers provide a model for optimizing diagnosis of congenital Chagas disease. Screening family members of index patients may identify additional T. cruzi-infected persons. Promising tests to augment current diagnostic modalities for maternal and congenital Chagas disease are in development. Universal or risk-based screening would be cost-effective. More healthcare providers are now aware that treatment of congenital Chagas disease is curative and are promoting efforts to make pregnancy-based screening for congenital Chagas disease a standard of care.
Ongoing efforts to implement routine pregnancy-based screening for congenital Chagas disease in nonendemic regions will mutually benefit infants, their mothers and family members and can prevent potentially fatal Chagas cardiomyopathy.
在非锥虫病流行地区，来自流行地区的母亲所生婴儿若患有先天性 Chagas 病而未被识别，这表明漏诊率很高。妊娠是识别高危母亲及其婴儿中 Chagas 病的最佳切入点。在这篇综述中，我们更新了在非流行环境中基于妊娠的先天性 Chagas 病筛查实施进展。
国际组织已更新了先天性 Chagas 病的诊断、治疗和预防建议。一些中心成功实施基于妊娠筛查的报告为优化先天性 Chagas 病的诊断提供了模式。筛查指数患者的家庭成员可能会发现其他感染 T. cruzi 的人。正在开发有前途的测试来增强目前用于母体和先天性 Chagas 病的诊断方式。普遍或基于风险的筛查具有成本效益。现在有更多的医疗保健提供者意识到先天性 Chagas 病的治疗是可以治愈的，并正在努力使基于妊娠的先天性 Chagas 病筛查成为护理标准。
在非流行地区实施常规基于妊娠的先天性 Chagas 病筛查的持续努力将使婴儿、母亲及其家庭成员受益，并可预防潜在致命的 Chagas 心肌病。
