Clinical and laboratory status of patients with chronic Chagas disease living in a vector-controlled area in Minas Gerais, Brazil, before and nine years after aetiological treatment

Lana, Marta de; Martins, Helen Rodrigues; Bahia, Maria Terezinha; Machado-de-Assis, Girley Francisco; Wendling, Ana Paula Barbosa; Martins‐Filho, Olindo Assis; Montoya, Roberto Araújo; Dias, João Carlos Pinto; Albajar-Viñas, Pedro; Coura, José Rodrigues

doi:10.1590/s0074-02762009000800011

Cited by 37 publications

(37 citation statements)

References 28 publications

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“…However, the high percentage of patients with the indeterminate form of Chagas' disease, the lower percentage with the cardiac form, and the absence of the digestive form of Chagas' disease in the TC group suggest a beneficial effect of benznidazole on the prognosis of the disease, although other factors, such as the age and stage of the infection when the patient was treated and the host immune response of the patient, must be taken into account. Moreover, in a previous study using some of these methods, we verified a better clinical evolution of Chagas' disease morbidity in patients (21/22) who received treatment while having the indeterminate form of the disease (24).…”

Section: Discussionsupporting

confidence: 53%

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: 53%

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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“…These findings are also lower than what was observed by Lana et al. (2009), who demonstrated an incidence of 1.5%/year (three times higher than that observed in this study) for Chagas’ disease cardiomyopathy among untreated indeterminate patients in a 10‐year follow‐up study performed in Berilo‐MG, Brazil, the same region (Lana et al. 2009).…”

Section: Benefit Of Antiparasitical Treatment To Prevent Chagasic Chrcontrasting

confidence: 86%

“…This is lower than what has been observed by other authors in epidemiological and clinical studies of untreated patients that showed the indeterminate form of the disease in Brazil, from which rates ranging from 2% to 4%/year were recorded (Prata 2001; Dias 2006). These findings are also lower than what was observed by Lana et al. (2009), who demonstrated an incidence of 1.5%/year (three times higher than that observed in this study) for Chagas’ disease cardiomyopathy among untreated indeterminate patients in a 10‐year follow‐up study performed in Berilo‐MG, Brazil, the same region (Lana et al.…”

Section: Benefit Of Antiparasitical Treatment To Prevent Chagasic Chrcontrasting

confidence: 82%

“…The clinical evolution rate was 2%/year and was especially low in indeterminate patients (0.5%/year) relative to cardiac or digestive patients (7.4%/year). Although a control group of untreated Chagas’ patients was not included in this study, the data analysis indicates that indeterminate patients present a clinical evolution rate of only 0.5%/year (Lana et al. 2009).…”

Section: Benefit Of Antiparasitical Treatment To Prevent Chagasic Chrmentioning

confidence: 99%

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Antiparasitical chemotherapy in Chagas’ disease cardiomyopathy: current evidence

Guedes

Gutierrez

Nascimento

et al. 2012

Tropical Med Int Health

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Chronic chagasic cardiomyopathy affects 20% of Chagas' disease patients. At present, Chagas' disease chemotherapy uses nitrofurans, benznidazole (RochaganÒ, RodanilÒ, Roche) or nifurtimox (LampitÒ, Bayer). Treatment during acute and recent chronic phases in childhood effects 71.5% and 57.6%, respectively, of parasitological cure. However, in clinical trials during the late chronic phase, only 5.9% of parasitological cure were achieved. This review focuses on the benefit from aetiological treatment to avoid, stop or revert myocarditis. Divergent data gathered from clinical practice are not convincing to support prescription of aetiological treatment as routine for indeterminate and cardiac chronic patients.

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“…The best results in chemotherapy have been achieved for acute or recent chronic infections, with a lower rate of parasitological cure among more established chronic infections (Viotti et al 1994, Andrade et al 1996, Cançado 2002). Other studies have demonstrated that etiological treatment leads to a significant reduction in the development of electrocardiographic alterations, a slower clinical progression and the prevention of severe chronic cardiopathy (Segura et al 1994, Suasnabar et al 2000, Sosa-Estani & Segura 2006, Viotti et al 2006, de Lana et al 2009). The indication of etiological treatment during the chronic phase of Chagas disease is controversial, as demonstrated by the operational difficulties with the post-treatment follow-up of chronic Chagas disease patients and the diversity of criteria and methodologies used in evaluating therapeutic efficacy (Coura & de Castro 2002, Coura & Borges-Pereira 2011).…”

mentioning

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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Clinical and laboratory status of patients with chronic Chagas disease living in a vector-controlled area in Minas Gerais, Brazil, before and nine years after aetiological treatment

Cited by 37 publications

References 28 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

Antiparasitical chemotherapy in Chagas’ disease cardiomyopathy: current evidence

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

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