Chagas cardiomyopathy associated with serological cure after trypanocidal treatment during childhood

Abstract

Chagas disease is a chronic parasitological disease, which could cause cardiac manifestations in approximately one-third of affected individuals. Benznidazole and nifurtimox are used to treat this parasitological infection caused by Trypanosoma cruzi. Conventionally, the criterion for cure is consistently negative serological tests after treatment. We report a case of a patient who was treated when she was 13 years old and achieved T. cruzi negative seroconversion but developed Chagas disease cardiomyopathy as an adult.

Serological response to nifurtimox in adult patients with chronic Chagas disease: An observational comparative study in Argentina

“…Seropositivity can persist long after clearance of the parasite, so negative seroconversion in Chagas disease is the best evidence currently available that the parasite infection may have been overcome, even though it is not directly indicative of cure. Indeed, cardiac complications associated with chronic Chagas disease have been reported in patients shown to have undergone negative seroconversion after benznidazole treatment [ 32 ]. Notwithstanding the uncertainty of the relationship between negative seroconversion and parasitological cure, achieving negative seroconversion with antiparasitic treatment is intrinsically desirable in certain scenarios, for example among chronically infected women of childbearing potential in whom it can reduce or even ablate vertical transmission of parasite to the unborn child [ 33 ].…”

Declining antibody levels to Trypanosoma cruzi correlate with polymerase chain reaction positivity and electrocardiographic changes in a retrospective cohort of untreated Brazilian blood donors

“…There are case reports of complete spontaneous seroreversion with clearly documented evidence of initial infection in patients with no apparent clinical disease [12,14]. However, in contrast to these lines of argument, rare case reports exist (for example [31]) of typical Chagasic ECG changes in patients with complete treatment-induced seroreversion, implying Chagas cardiomyopathy can develop following apparent treatment success. The significance of these findings is unclear as conduction abnormalities can develop during acute infection and may have preceded treatment initiation.…”