Benznidazol na quimioprofilaxia primária da reativação de doença de Chagas em chagásicos crônicos em uso de corticosteróides em doses imunodepressoras: há evidência suficiente para a recomendação do seu uso?

Nishioka, Sérgio de Andrade

doi:10.1590/s0037-86822000000100013

Cited by 10 publications

(9 citation statements)

References 7 publications

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“…Two studies have provided valuable information about the use of corticosteroids at immunosuppressive doses in patients with T. cruzi [64], [65]. Rassi et al [65] described the effectiveness of benznidazole in reducing reactivation rates in patients with T. cruzi infection treated with corticosteroids, but they also described higher rates of parasitemia that appeared to be related to higher doses of corticosteroids.…”

Section: Resultsmentioning

confidence: 99%

“…There has just been one case reported of reactivation of Chagas disease in which corticosteroids were the only immunosuppressive factor: that of a child receiving dexamethasone for a cranial traumatism [66]. Currently, there is no firm evidence of an association between immunosuppressive doses of corticosteroids alone and higher rates of T. cruzi reactivation [64].…”

Section: Resultsmentioning

confidence: 99%

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Immunosuppression and Chagas Disease: A Management Challenge

et al. 2013

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Immunosuppression, which has become an increasingly relevant clinical condition in the last 50 years, modifies the natural history of Trypanosoma cruzi infection in most patients with Chagas disease. The main goal in this setting is to prevent the consequences of reactivation of T. cruzi infection by close monitoring. We analyze the relationship between Chagas disease and three immunosuppressant conditions, including a description of clinical cases seen at our center, a brief review of the literature, and recommendations for the management of these patients based on our experience and on the data in the literature. T. cruzi infection is considered an opportunistic parasitic infection indicative of AIDS, and clinical manifestations of reactivation are more severe than in acute Chagas disease. Parasitemia is the most important defining feature of reactivation. Treatment with benznidazole and/or nifurtimox is strongly recommended in such cases. It seems reasonable to administer trypanocidal treatment only to asymptomatic immunosuppressed patients with detectable parasitemia, and/or patients with clinically defined reactivation. Specific treatment for Chagas disease does not appear to be related to a higher incidence of neoplasms, and a direct role of T. cruzi in the etiology of neoplastic disease has not been confirmed. Systemic immunosuppressive diseases or immunosuppressants can modify the natural course of T. cruzi infection. Immunosuppressive doses of corticosteroids have not been associated with higher rates of reactivation of Chagas disease. Despite a lack of evidence-based data, treatment with benznidazole or nifurtimox should be initiated before immunosuppression where possible to reduce the risk of reactivation. Timely antiparasitic treatment with benznidazole and nifurtimox (or with posaconazole in cases of therapeutic failure) has proven to be highly effective in preventing Chagas disease reactivation, even if such treatment has not been formally incorporated into management protocols for immunosuppressed patients. International consensus guidelines based on expert opinion would greatly contribute to standardizing the management of immunosuppressed patients with Chagas disease.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Immunosuppression and Chagas Disease: A Management Challenge

et al. 2013

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“…Immunosuppression due to immunosuppressive therapies [36] or HIV/AIDS [52] increases the risk of reactivation in patients with chronic infection. Although the effectiveness of etiological treatment for the clinical control of episodes of reactivation has been proven, it is necessary to gather evidence as to whether preventive treatment is effective in patients with no signs of clinical reactivation and with abnormal immunological parameters [66]. In this regard, some protocols recommend the treatment of organ donors infected with T. cruzi in order to reduce risk of transmission by transplant [67].…”

Section: Resultsmentioning

confidence: 99%

Therapy of Chagas Disease: Implications for Levels of Prevention

Sosa-Estáni

Colantonio

Segura

2012

Journal of Tropical Medicine

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This paper reviews the evidence supporting the use of etiological treatment for Chagas disease that has changed the standard of care for patients withTrypanosoma cruziinfection in the last decades. Implications of this evidence on different levels of prevention as well as gaps in current knowledge are also discussed. In this regard, etiological treatment has shown to be beneficial as an intervention for secondary prevention to successfully cure the infection or to delay, reduce, or prevent the progression to disease, and as primary disease prevention by breaking the chain of transmission. Timely diagnosis during initial stages would allow for the prescription of appropriate therapies mainly in the primary health care system thus improving chances for a better quality of life. Based on current evidence, etiological treatment has to be considered as an essential public health strategy useful to reduce disease burden and to eliminate Chagas disease altogether.

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“…Primary prophylaxis with benznidazole or nifurtimox is controversial and more studies are necessary to determine if they really are beneficial, since these drugs have considerable side effects [10,30]. On the other hand, AIDS treatment with antiretroviral drugs improves cellular immunity and therefore reduces the possibility of disease reactivation [3,24].…”

Section: Discussionmentioning

confidence: 99%

Reactivation of Chagas' disease leading to the diagnosis of acquired immunodeficiency syndrome

Santos¹,

Canela²,

Monção³

et al. 2002

Braz J Infect Dis

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Reactivation of chronic Chagas' disease is a rare condition and occurs only in immunosuppressed patients. We report a case of a patient with a rapid and fatal reactivation of Chagas' disease, manifested by meningoencephalitis, which lead to a diagnosis of acquired immunodeficiency syndrome (AIDS). We believe there is sufficient evidence to include the reactivation of Chagas' disease among the diagnostic criteria of AIDS in Human Immunodeficiency Virus (HIV) infection.

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Benznidazol na quimioprofilaxia primária da reativação de doença de Chagas em chagásicos crônicos em uso de corticosteróides em doses imunodepressoras: há evidência suficiente para a recomendação do seu uso?

Cited by 10 publications

References 7 publications

Immunosuppression and Chagas Disease: A Management Challenge

Immunosuppression and Chagas Disease: A Management Challenge

Therapy of Chagas Disease: Implications for Levels of Prevention

Reactivation of Chagas' disease leading to the diagnosis of acquired immunodeficiency syndrome

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