Ethiological treatment of acute and chronic Chagas' heart disease

Abstract

The uncertainties in the ethiological treatment of Chagas' Disease are consequence of the lack of entire knowledge of its pathogeny and the no existence of a healing criterium. There is a consensus that antiparasite drugs should be in the acute phase of the infection, regardless of the infection route, in new crisis, in patients under immunosuppression and in organs transplantation. There is still controversy regarding subacute, chronic or indetermined phase or cases with mild cardia/digestive forms, not included in the situations listed above neither in a research protocol. The treatment includes oral benzonidazol 5 mg/kg/dat, bid or tid for 60 days. In 71 patients monitored in this fashion, the authors have found 60% of negative xenodiagnostic at the end of treatment It is still necessary, however, to continue to investigate and accomplishing more randomized trials to confirm the efficacy of such method, and also to try to obtain effective and less toxic agents. It is also fundamental to standardize a more reliable healing criterium.

Enzyme-Linked Immunoassay Using Recombinant trans -Sialidase of Trypanosoma cruzi Can Be Employed for Monitoring of Patients with Chagas' Disease after Drug Treatment

“…Patients were treated for 60 days with 5 mg of benznidazole per kg of body weight per day (9). After treatment, they were evaluated for several years by clinical examination and parasitological and serological tests at 1-year intervals.…”

“…Treatment and clinical evaluation were performed by one of us (Abilio Augusto Fragata-Filho). This protocol for the treatment of patients with Chagas' disease is traditionally used at the Instituto Dante Pazzanese de Cardiologia, São Paulo, which focuses mainly on the cardiac involvement and evolution of Chagas' disease (9).…”

Chagas' heart disease

“…There is only very incipient evidence regarding the possible favorable impact of etiological treatment in the clinical outcome in the chronic phase of disease 122 . In particular, some results have been reported on a nonrandomized, open label, placebo controlled trials of benznidazole in the clinical outcome of 131 treated and 70 nontreated chronic chagasic patients followed for eight years on average 123 .…”

Immunopathological Aspects of ExperimentalTrypanosoma cruziReinfections

“…This phase is followed by the development of acquired immunity, leading to the control of parasitaemia and tissue parasitism. On the other hand, the chronic phase of the disease is usually marked by low parasitaemia and tissue parasitism but high levels of antibodies [4, 5]. The presence of Th1 cytokines in this phase appears to be connected with the severe forms of the disease [6, 7], whereas IL-10 seems to protect the host by promoting less tissue damage [8–10].…”