Myopericarditis, Hepatitis and Meningitis in a patient with Congenital Chagas Disease (CCD)

Abstract

Purpose: Describe a patient with myopericarditis, hepatitis and meningeal involvement due to congenital Chagas disease (CCD). Methods & Materials: case report. Results: A 26-day-old patient was derived to our hospital due to severe pericardial effusion. He had a maternal history of untreated Chagas disease. At physical examination he presented with generalized jaundice, mild respiratory distress and hepatomegaly. He required oxygen therapy for two days through a low-flow nasal cannula. Echocardiographic evaluation reported normal connection of chambers and vessels, moderate to severe pericardial effusion -without signs of hemodynamic compromise- and left ventricular hypertrophy with septal predominance and preserved ventricular motility.Lumbar puncture showed hypercellularity with a predominance of polymorphonuclear cells. Filmarray® and cultures of cerebrospinal fluid were negative, without the presence of protozoa. Direct parasitological examinations of blood -microhematocrit- were positive and CCD was diagnosed. The patient was treated with benznidazole 5 mg/k/d for two months. There were no adverse effects to the medication. Due to the initial symptoms of hepatitis, the antiparasitic was indicated at the minimum recommended dose. However, the response was satisfactory, negativization of the parasitological study of blood at 20 days after starting treatment and with complete resolution of the symptoms, including cardiac and liver involvement. Conclusion: We present a clinical case of symptomatic CCD with myopericarditis, hepatitis, and meningoencephalitis with a good response to antiparasitic treatment. CCD presents asymptomatic in 95% of cases. When it is symptomatic, the most frequent clinical manifestations are low birth weight, prematurity, muscular hypotonia, fever, hepatomegaly, splenomegaly, CNS alterations (seizures, cerebral calcifications, microcephaly), and skin signs. Among the cardiac manifestations, we find persistent tachycardia, congestive heart failure with ST-segment abnormalities, flattening of the T wave, lengthening of the A-V conduction time and low voltage, acute myopericarditis, and chronic fibrosing cardiomyopathy. The anti-trypanosomiasis treatment approach should be indicated promptly in all patients with acute or congenital infection. Benznidazole and Nifurtimox are the first line drugs. Treatment reduces the severity of symptoms, shortens the clinical course, and reduces the duration of detectable parasitemia. Control of the disease requires detection and treatment in people with the possibility of pregnancy and detection during pregnancy.