New evidence of spontaneous cure in human Chagas' disease

Francolino, Sonia S.; Antunes, Antonio Fernandez; Talice, R. V.; Rosa, R. Gámez de la; Selanikio, Joel; Rezende, Joffre Marcondes de; Romanha, Álvaro J.; Dias, João Carlos Pinto

doi:10.1590/s0037-86822003000100014

Cited by 41 publications

(19 citation statements)

References 5 publications

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“…Because the standard for determining a diagnosis of T. cruzi infection is based on at least 2 tests out of 3 conventional serological tests performed, we considered the conversion to negative serology on 2 or 3 tests as a possible indicator of cure. Although, spontaneous cure is a rare event documented in long-term untreated T. cruzi -infected subjects [20], [21], in this short-term study we have not recorded any case.…”

Section: Discussionmentioning

confidence: 54%

Impact of Aetiological Treatment on Conventional and Multiplex Serology in Chronic Chagas Disease

Viotti¹,

Vigliano²,

Alvarez³

et al. 2011

PLoS Negl Trop Dis

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BackgroundThe main criterion for treatment effectiveness in Chagas Disease has been the seronegative conversion, achieved many years post-treatment. One of the main limitations in evaluating treatment for chronic Chagas disease is the lack of reliable tests to ensure parasite clearance and to examine the effects of treatment. However, declines in conventional serological titers and a new multiplex assay can be useful tools to monitor early the treatment impact.Methodology/Principal FindingsChanges in antibody levels, including seronegative conversion as well as declines in titers, were serially measured in 53 benznidazole-treated and 89 untreated chronic patients in Buenos Aires, Argentina with a median follow-up of 36 months. Decrease of titers (34/53 [64%] treated vs. 19/89 [21%] untreated, p<0.001) and seronegative conversion (21/53, [40%] treated vs. 6/89, [7%] untreated, p<0.001) in at least one conventional serological test were significantly higher in the benznidazole-treated group compare with the untreated group. When not only complete seronegative conversion but also seronegative conversion on 2 tests and the decreases of titers on 2 or 3 tests were considered, the impact of treatment on conventional serology increased from 21% (11/53 subjects) to 45% (24/53 subjects). A strong concordance was found between the combination of conventional serologic tests and multiplex assay (kappa index 0.60) to detect a decrease in antibody levels pos-treatment.Conclusions/SignificanceTreatment with benznidazole in subjects with chronic Chagas disease has a major impact on the serology specific for T. cruzi infection in a shorter follow-up period than previously considered, reflected either by a complete or partial seronegative conversion or by a significant decrease in the levels of T. cruzi antibodies, consistent with a possible elimination or reduction of parasite load.

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Section: Discussionmentioning

confidence: 54%

Impact of Aetiological Treatment on Conventional and Multiplex Serology in Chronic Chagas Disease

Viotti¹,

Vigliano²,

Alvarez³

et al. 2011

PLoS Negl Trop Dis

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“…�ike the cases described by Zeledón et al 15 and Francolino et al 7 , it was registered in an endemic area and presented a typical and well-established acute onset, which was diagnosed by the direct parasitological test. In all the previous reports, the basic argument for claiming that disease cure had occurred was the continuing, consistently negative conventional IgG serology findings, along with the lack of positive indirect parasitological test results (xenodiagnosis and blood culturing), a concept that is well established in the literature 1 .…”

Section: Discussionmentioning

confidence: 84%

Further evidence of spontaneous cure in human Chagas disease

Dias

Filho

et al. 2008

Rev. Soc. Bras. Med. Trop.

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An acute case of Chagas disease was studied in 1944, with clinical and laboratory follow-up until 2007, in Bambuí, Minas Gerais, Brazil. A five-year-old girl living in a rural hut that was highly infested with Triatoma infestans presented a febrile clinical condition compatible with the acute form of trypanosomiasis. She presented a positive thick blood smear, but never again showed serological and/or parasitological evidence of Trypanosoma cruzi infection, on several occasions. This patient never received any specific treatment and, to this day, she remains completely asymptomatic, with normal findings from clinical, electrocardiographic, X-ray and echocardiographic examinations.

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“…Longitudinal studies in endemic and non-endemic areas have shown that anti-T. cruzi antibodies persisted in infected individuals for many years (Coura et al 1996, Gomes et al 1999, Francolino et al 2003. On the other hand, serology became negative after successful parasitological treatment of both acute and chronic infection, indicating cure from the infection (Luquetti 1999).…”

Section: Resultsmentioning

confidence: 99%