Terapêutica da forma crônica da doença de Chagas. Tratamento específico da infecção pelo Trypanosoma cruzi

Neto, Vicente Amato

doi:10.1590/s0066-782x1998000100013

Cited by 5 publications

(4 citation statements)

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“…However, other studies are contradictory and indicate that when treatment is administered during the chronic phase of the disease, the parasite is not completely eliminated, and the progress of the disease is not interrupted; therefore, the complications of the infection are not prevented [23,24,25,26,27]. Controversies still exist regarding the real effects of the drugs used in human treatment on the clinical progression of CD, particularly in adults during the chronic phase of the infection.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal follow up of serological response in children treated for Chagas disease

et al. 2019

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Background Evaluation of therapeutic response in chronic Chagas disease is a major challenge, due to prolonged persistence of Trypanosoma cruzi -specific antibodies, lack of sensitivity of parasitological tests, and need for long-term follow-up to observe negative seroconversion of conventional serological tests (CS). The objective of this study was to evaluate F2/3-ELISA serology, a promising early biomarker of therapeutic response, and T . cruzi Polymerase chain reaction (PCR) for T . cruzi Deoxyribonucleic acid (DNA), for neonatal diagnosis and evaluation of parasitemia after treatment. Methods Prospective cohort study, with three-year clinical, serological and parasitological follow-up of pediatric Chagas disease patients treated with benznidazole. Serology was evaluated by Enzyme-Linked ImmunoSorbent Assay (ELISA), Indirect hemagglutination (IHA) and F2/3-ELISA; Parasitemia by microhematocrit (MH) and PCR. Results A cohort of 107 pediatric patients treated with benznidazole was enrolled in the study. ELISA and IHA were initially reactive in 100% of patients, F2/3-ELISA serology was reactive in 80% (86/107) and 91% (97/107) had detectable parasitemia. Seventy-six (71%) patients completed at least 36 months of serological follow up after treatment. Although a similar decreasing linear trend was observed for all serological tests, F2/3-ELISA presented earlier, age dependent, negative seroconversion compared to CS. All patients reaching undetectable CS titers had previously seroreverted by F2/3-ELISA. All patients with persistently decreasing antibody titers had negative PCRs throughout the follow up period. No new cardiological lesions were observed during the 3 years follow-up period. Conclusions The data reported here, using CS, F2/3 ELISA and PCR provide support for the efficacy of benznidazole in congenital Chagas diseases. These results provide support for scaling up of screening, diagnosis and access to benznidazole treatment. Trial registration ClinicalTrials.gov 0028/04 in the Research Council, Secretary of Health Buenos Aires city Goberment.

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Section: Discussionmentioning

confidence: 99%

Longitudinal follow up of serological response in children treated for Chagas disease

et al. 2019

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“…However, other studies are contradictory and indicate that when treatment is administered during the chronic phase of the disease, the parasite is not eliminated, the progress of the disease is not interrupted; therefore, the complications of the infection are not prevented (Ianni et al . 1993, Amato Neto 1998, Ianni & Mady 1998, Braga et al . 2000, Lauria-Pires et al .…”

Section: Discussionmentioning

confidence: 99%

A serological, parasitological and clinical evaluation of untreated Chagas disease patients and those treated with benznidazole before and thirteen years after intervention

Machado-de-Assis

Diniz

Montoya

et al. 2013

Mem. Inst. Oswaldo Cruz

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The etiological treatment of Chagas disease is recommended for all patients with acute or recent chronic infection, but controversies remain regarding the benefit of chemotherapy and interpretations of the parasitological cure after etiological treatment. This study compares the laboratory and clinical evaluations of Chagas disease patients who were diagnosed 13 years earlier. Fifty-eight Chagas disease patients (29 treated with benznidazole and 29 untreated) were matched at the time of treatment based on several variables. Conventional serology revealed the absence of seroconversion in all patients. However, lower serological titres were verified in the treated group, primarily among patients who had the indeterminate form of the disease. Haemoculture performed 13 years after the intervention was positive for 6.9% and 27.6% of the treated and untreated patients, respectively. Polymerase chain reaction tests were positive for 44.8% and 13.8% of the treated and untreated patients, respectively. Patients who presented with the indeterminate form of the disease at the beginning of the study exhibited less clinical progression (17.4%) compared with the untreated group (56.5%). Therefore, this global analysis revealed that etiological treatment with benznidazole may benefit patients with respect to the clinical progression of Chagas disease and the prognosis, particularly when administered to patients with the indeterminate form of the disease.

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“…However, up to 40% may progress over the years to cardiac or digestive forms [7,8]. The predictors for progression are still poorly understood, and the beneficial impact of specific anti-parasitic therapy with Benznidazole is not supported by robust evidence [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Predictors of development of cardiac and digestive disorders among patients with indeterminate chronic Chagas Disease

2021

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American trypanosomiasis (Chagas disease, CD) affects circa 7 million persons worldwide. While of those persons present the asymptomatic, indeterminate chronic form (ICF), many will eventually progress to cardiac or digestive disorders. We studied a nonconcurrent (retrospective) cohort of patients attending an outpatient CD clinic in Southeastern Brazil, who were admitted while presenting the ICF in the period from 1998 through 2018 and followed until 2019. The outcomes of interest were the progression to cardiac or digestive CD forms. We were also interested in analyzing the impact of Benznidazole therapy on the progression of the disease. Extensive review of medical charts and laboratory files was conducted, collecting data up to year 2019. Demographics (upon inclusion), body mass index, comorbidities (including the Charlson index) and use of Benznidazole were recorded. The outcomes were defined by abnormalities in those test that could not be attributed to other causes. Statistical analysis included univariate and multivariable Cox regression models. Among 379 subjects included in the study, 87 (22.9%) and 100 (26.4%) progressed to cardiac and digestive forms, respectively. In the final multivariable model, cardiac disorders were positively associated with previous coronary syndrome (Hazzard Ratio [HR], 2.42; 95% Confidence Interval [CI], 1.53–3.81) and negatively associated with Benznidazole therapy (HR, 0.26; 95%CI, 0.11–0.60). On the other hand, female gender was the only independent predictor of progression to digestive forms (HR, 1.56; 95%CI, 1.03–2.38). Our results point to the impact of comorbidities on progression do cardiac CD, with possible benefit of the use of Benznidazole.

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Terapêutica da forma crônica da doença de Chagas. Tratamento específico da infecção pelo Trypanosoma cruzi

Cited by 5 publications

References 0 publications

Longitudinal follow up of serological response in children treated for Chagas disease

Longitudinal follow up of serological response in children treated for Chagas disease

A serological, parasitological and clinical evaluation of untreated Chagas disease patients and those treated with benznidazole before and thirteen years after intervention

Predictors of development of cardiac and digestive disorders among patients with indeterminate chronic Chagas Disease

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