In 2001, a 31-year-old woman from Santa Cruz, Bolivia, delivered a 2,860-g, full-term, apparently healthy baby at the Geneva University Hospitals after an uncomplicated pregnancy. Like most undocumented immigrants recently arrived in Switzerland, she had received no medical supervision during her pregnancy. She stated that a blood test for T. cruzi, conducted in Bolivia, had been negative. Macroscopic examination of the fetal side of the placenta showed a 3.5-cm, subchorial, liquid-filled cyst (). Histopathologic examination showed disseminated chorioamnionitis and associated funiculitis with large numbers of nonflagellated parasites. A recent infection with Toxoplasma gondii was ruled out by serologic testing. Congenital T. cruzi infection was confirmed by a positive blood microscopic examination for the infant, a positive serologic test result for the mother (immunofluorescence assay using killed T. cruzi parasites, Swiss Tropical Institute, Basel, Switzerland), and a positive blood PCR with TCZ1/TCZ2 primers for both the mother and the newborn. Electrocardiogram and echocardiogram of the newborn showed no abnormalities. The newborn received nifurtimox (10 mg/kg/d for 60 days) without notable adverse effects. Parasitemia became undetectable at the end of treatment, and serologic test result at 1 year of age was negative. The mother refused to be treated, claiming that she was feeling fine.
Fetal side of the placenta from Latin American pregnant woman who delivered her baby at Geneva University Hospitals, Geneva, Switzerland. A macroscopic subchorial liquid-filled cyst can be seen near the umbilical cord insertion.
In 2006, a 25-year-old woman arrived in Switzerland from Santa Cruz, Bolivia, when she was 5 months pregnant. She delivered a 2,480-g, premature but healthy baby at 34 weeks’ gestation at the Geneva University Hospitals. After discharge, histopathologic examination of the placenta showed funiculitis and chorioamnionitis with clusters of nonflagellated parasites. The mother had not been previously tested for T. cruzi but related that her father had died of Chagas disease–related heart complications. T. cruzi serologic testing by immunofluorescence was positive for the mother, and blood microscopic examination and PCR were positive for the newborn, confirming vertical transmission. Electrocardiogram and echocardiogram of the baby showed no abnormalities. The newborn began a 60-day course of nifurtimox (10 mg/kg/d) at 20 weeks of age and had no adverse effects. Blood PCR and serologic testing at 5 and 26 weeks after treatment was started, respectively, produced negative results. The mother was treated with nifurtimox after completion of breast-feeding and showed good tolerance to the drug.