Mother-to-child transmission of Chagas disease in preterm triplets: treatment monitoring

CRUZ CINTIA; SATOSTEGUI MARGARITA; PEREZ MONTILLA CARLOS; LASCANO FERNANDA; RAMIREZ JUAN CARLOS; MANGONE FRANCO; ALTCHEH JAIME

Lisboa

Congreso; 41° Annual Meeting of the ESPID; 2023

Title of Case: Mother-to-child transmission of Chagas disease in preterm triplets: treatment monitoring. Background: Chagas disease is a worldwide disease. Mother-to-child transmission of T.Cruzi parasite is the main route of infection in non-endemic areas. Previous studies report lower Benznidazole (BZN) plasma concentrations in children than adults. This has not been studied in preterm infants. Case Presentation Summary: Preterm triplets (27 weeks) with congenital Chagas disease diagnosed by positive parasitemia by T.Cruzi DNA qPCR. The first newborn showed myocarditis, hyaline membrane disease (HMD) and died at 6 days of life. The second suffered HMD, and the third one showed anasarca, anemia and hepatomegaly at birth. Treatment: BZN 5 mg/kg/day for 30 days was administered by nasogastric tube diluted in milk due to patient´s critical condition. BNZ dosages at steady state in blood were performed 5 times by mass spectrometry. Therapeutic response was monitored by qPCR. In the 2nd newborn, clinical condition improved, qPCR was negative at the end of treatment. BZN concentrations were between 0.3-0.7mg/L. At 4th month of follow up, qPCR turned into positive result. A second course of BNZ was prescribed and one concentration was tested resulting 3.6mg/L. qPCR remained negative during 3 months follow-up. Regarding 3rd newborn, first 3 BZN dosages were between 2.1-2.5mg/L and in 2 were 0.1 and 04mg/L. Persistent positive qPCR was observed. A second course of BZN was prescribed. BZN concentrations were taken 4 times and resulted between 0.2-1.8 mg/L. qPCR remained negative during 7 months follow-up. No related adverse events of BNZ were reported. Learning Points/Discussion: This is the first report of therapeutic evaluation by BNZ dosing in extreme preterm infants. Close therapeutic drug monitoring and qPCR parasitemia allowed early detection treatment failure related to low concentration of BNZ.