Efficacy of benznidazol treatment for asymptomatic chagasic patients from state of Rio Grande do Sul evaluated during a three years follow-up

Fernandes, CD; Tiecher, FM; Balbinot, MM; Liarte, DB; Scholl, Daniele; Steindel, Mário; Romanha, Álvaro J.

doi:10.1590/s0074-02762009000100004

Cited by 54 publications

(40 citation statements)

References 32 publications

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“…Using these criteria, it was possible to verify negative results in 8.5% of the patients. This result corroborates the findings of several authors who found a cure index of 5% to 19.1% in posttreatment evaluations of patients etiologically treated in the chronic phase of Chagas' disease in Brazil and Argentina (5,12,49,50). Moreover, the eight TC patients were the same across the different combinations of conventional serological tests (two or three tests).…”

Section: Discussionsupporting

confidence: 91%

“…Caballero et al (4) showed that rec-ELISA is a test with high sensitivity and specificity that reduces false positives, inconclusive results, and cross-reactions with other pathogens. Currently, this test has been very useful in monitoring parasitological cure, with good results (11,12,38,54). In addition, several other serological tests, including conventional ELISA with purified antigens (17,20), ELISA with recombinant antigens (21,33,42), flow cytometry (31,32), and the complement-mediated lysis test (15), have been used for diagnosis and cure control of Chagas' disease.…”

Section: Discussionmentioning

confidence: 99%

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Posttherapeutic Cure Criteria in Chagas' Disease: Conventional Serology followed by Supplementary Serological, Parasitological, and Molecular Tests

Machado-de-Assis¹,

Silva²,

L.³

et al. 2012

Clin. Vaccine Immunol.

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ABSTRACTWe performed a critical study of conventional serology, followed by supplementary serological, parasitological, and molecular tests, to assess the response to etiologic treatment of Chagas' disease. A group of 94 Chagas' disease patients treated with benznidazole at least 10 years earlier were evaluated from the laboratory and clinical points of view. When conventional serology (enzyme-linked immunosorbent assay [ELISA], indirect immunofluorescence [IIF], and indirect hemagglutination [IHA]) and classic criteria (consistent results with any two of the three tests) or more rigorous criteria (consistent results from the three tests) were used, 10.6% and 8.5% of patients were considered treated and cured (TC) by classic and rigorous criteria, respectively. Patients were then evaluated using supplementary (recombinant ELISA andTrypanosoma cruziexcreted-secreted antigen blotting [TESA-blot]), parasitological (hemoculture), and molecular (PCR) tests. The results of recombinant ELISA were similar to those with the rigorous criterion (three consistent test results). The TESA-blot group showed a higher percentage (21.3%) of negative results than the groups defined by either cure criterion. Hemoculture and PCR gave negative results for all treated and cured (TC) patients, regardless of the criterion used. Recombinant ELISA and TESA-blot tests showed negative results for 70% and 87.5% of the patients categorized as TC by the classic and three-test criteria, respectively. For patients with discordant conventional serology, the supplementary serological and molecular tests were the decisive factor in determining therapeutic failure. Clinical evaluation showed that 62.5% of TC patients presented with the indeterminate form of the disease. Additionally, treated patients with negative TESA-blot results should be reevaluated later with all methodologies used here to verify whether TESA-blot is a reliable way to determine early parasitological cure of Chagas' disease.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Posttherapeutic Cure Criteria in Chagas' Disease: Conventional Serology followed by Supplementary Serological, Parasitological, and Molecular Tests

Machado-de-Assis¹,

Silva²,

L.³

et al. 2012

Clin. Vaccine Immunol.

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“…The use of RT-PCR allowed us to confirm treatment failure in 5 of 26 (19.2%) of patients. As shown by other studies, repeated PCR testing may indicate that the true treatment failure rate is higher (6).…”

mentioning

confidence: 64%

Tolerance of Benznidazole in Treatment of Chagas' Disease in Adults

Pinazo¹,

Muñóz²,

Posada³

et al. 2010

Antimicrob Agents Chemother

156

114

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Chagas’ disease is an emerging public health problem in areas where the disease is not endemic. Treatment with benznidazole has shown efficacy in the acute stage of the disease, but its efficacy in the chronic stage remains controversial, and unwanted side effects are more frequent and severe in adults than in children. This study describes the profile of side effects of benznidazole in a cohort of Trypanosoma cruzi-infected patients in a European country.

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“…However, efficacy declines markedly with the duration of infection. 21 Although several studies have shown that benznidazole is unable to induce parasitological cures in the majority of chronically infected adult patients, 22,23 there is an increasing trend to offer antitrypanosomal treatment to infected adults with asymptomatic disease or early cardiomyopathy, because it has been shown in some studies that this drug can slow down the progression of cardiac lesions. 24 This could be explained by a reduction of the patients' parasite load and the associated inflammatory response at the sites of infection.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment with Posaconazole of a Patient with Chronic Chagas Disease and Systemic Lupus Erythematosus

Pinazo¹,

Espinosa²,

Gállego³

et al. 2010

The American Journal of Tropical Medicine and Hygiene

123

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Abstract. American Trypanosomiasis or Chagas disease (CD) is a neglected disease that affects Latin American people worldwide. Two old antiparasitic drugs, benznidazole and nifurtimox, are currently used for specific CD treatment with limited efficacy in chronic infections and frequent side effects. New drugs are needed for patients with chronic CD as well as for immunosuppressed patients, for whom the risk of reactivation is life-threatening. We describe a case of chronic CD and systemic lupus erythematosus (SLE) that required immunosuppression to control the autoimmune process. It was found that benznidazole induced a reduction, but not an elimination, of circulating Trypanosoma cruzi levels, whereas subsequent treatment with posaconazole led to a successful resolution of the infection, despite the maintenance of immunosuppressive therapy.

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Efficacy of benznidazol treatment for asymptomatic chagasic patients from state of Rio Grande do Sul evaluated during a three years follow-up

Cited by 54 publications

References 32 publications

Posttherapeutic Cure Criteria in Chagas' Disease: Conventional Serology followed by Supplementary Serological, Parasitological, and Molecular Tests

Posttherapeutic Cure Criteria in Chagas' Disease: Conventional Serology followed by Supplementary Serological, Parasitological, and Molecular Tests

Tolerance of Benznidazole in Treatment of Chagas' Disease in Adults

Successful Treatment with Posaconazole of a Patient with Chronic Chagas Disease and Systemic Lupus Erythematosus

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