Etiological drug treatment of human infection by Trypanosoma cruzi

Abstract

Forty-nine American Trypanosomiasis (Chagas' disease) patients, with xenodiagnosis proven parasitemia were treated by the authors. Forty-one of these patients were given benznidazole, at dosages ranging from 5mg/kg/day to 8mg/kg/day, during a pre-established period of 60 days. In this group, 17 patients had an undetermined form of the disease, whereas 22 had cardiologic disease and 4 had digestive disease (two patients had a mixed form of the disease). Side effects were frequent, and led to the discontinuation of treatment in 17 patients. The follow-up period ranged from 1 to 20 years (mean follow-up period of 6 yrs. 7 mo). 26 (63.4%) of the patients became parasitemia-negative. The other eight patients were treated with nifurtimox, during 120 days, following a variable dose regime of 5mg/kg/day (initial dose) to 17 mg/kg/day (final dose). Six of them had severe side effects, and only one patient remained parasitemia-negative throughout the observation period (ranging from 1 to 18 years). Benznidazole proved to be better tolerated and more effective in the management of parasitemia when compared to nifurtimox, although more effective and less toxic drugs are still desirable.

Tolerance and Safety of Nifurtimox in Patients with Chronic Chagas Disease

“…The most frequent AEs were digestive, neurologic, and psychiatric. Levi et al [16] administered nifurtimox at various doses (5-17 mg/kg/day) for up to 120 days in 8 patients and reported premature treatment termination in six (75%) patients because of severe AEs (nausea, vomiting, weight loss, neuropathy, and psychiatric disturbance).…”

Treatment of chronic Chagas' disease with itraconazole and allopurinol.

“…In acute Chagas' disease, the criterion for cure is clinical and parasitologic improvement detected by xenodiagnosis, hemoculture, and negative serologic test results. 6,9,13,25 However, in chronic Chagas' disease, there is no clear standard for cure. 6,25,30 There may be clinical and ECG improvement or negative xenodiagnosis results, but neither of these alone is a sure sign of cure.…”

“…6,8 In chronic cases, the same drugs have been used, as well as allopurinol, in various dosages and for different lengths of time with variable results. [9][10][11][12][13] Nifurtimox and benznidazole are now available on a limited basis; however, both have side effects, especially in adults, which limits their use. For these reasons it is important to have access to an efficient, safe, low-cost drug.…”

Benznidazole Use among Patients with Chronic Chagas' Cardiomyopathy in an Endemic Region of Brazil

“…A high dropout rate from BZN treatment was observed in previous studies [12,17–20]. Dropout rates from BZN treatment range from 13% [12] to 34% [18]. Adverse reactions were the main reason for the treatment dropout.…”