African trypanosomiasis (sleeping sickness) can show transplacental transmission to a fetus.
Features:
(1) stillborn fetus or neonate with unexplained neurological disorder, reduced level of consciousness and seizures (clinical encephalitis, meningitis, etc)
(2) abnormal histologic exam of the placenta with inflammation (villitis, placentitis)
(3) evidence of trypanosomes in fetus/neonate or mother (blood smear, serologic evidence of anti-trypanosomal antibodies, PCR)
(4) mother has a history of living in or travel to an area endemic for African trypanosomiasis
(5) exclusion of vector-borne (tsetse fly) transmission
Limitations for diagnosis:
• If the neonate is born in an area endemic for African trypanosomiasis, then exclusion of vector-borne transmission can be difficult. The most convincing cases of congenital trypanosomiasis occur in neonates born in a non-African country.
• The mother may not have a history of clinical sleeping sickness and may have lived in a non-endemic area for some time.
• The diagnosis is easy to miss in a non-endemic region if a complete maternal history has not been taken and testing is not performed.
