Chronic American trypanosomiasis: parasite persistence in endomyocardial biopsies is associated with high-grade myocarditis

Abstract

Myocyte diameter, fractional area of collagen, intensity of myocarditis and parasite persistence (explored by immunohistochemistry and PCR) were evaluated in serial sections of endomyocardial biopsies from 29 outpatients with chronic chagasic cardiopathy. The patients, 25 males and four females with a mean (S.D.) age of 43 (9) years, were subsequently followed up for 3-2861 days (median=369 days). During this follow-up, 16 (55%) of the patients died. The biopsies revealed myocarditis in 25 (86%) of the patients and high-grade myocarditis in 14 (56%). Although immunohistochemistry failed to demonstrate Trypanosoma cruzi antigens in any of the samples, five (33%) of the 15 biopsies successfully tested in the PCR-based assay for T. cruzi DNA were found positive, indicating parasite persistence. There was a significant positive association between myocardial parasite persistence and high-grade myocarditis (P=0.014); five (71%) of the seven endomyocardial biopsies with high-grade myocarditis that were successfully tested in the PCR assays showed persistent T. cruzi DNA. The survival time of the patients was not, however, found to be significantly associated with myocardial parasite persistence, any of the morphometric measurements taken, or the presence or intensity of myocarditis.

Trypanosoma cruzi: parasite persistence in tissues in chronic chagasic Brazilian patients

“…Significant positive association between parasite persistence in heart tissue and myocarditis was demonstrated by PCR in endomyocardial biopsies (Benvenuti et al 2008). Knowledge of the exact role of the parasite in the pathogenesis of Chagas disease appears extremely important to guide therapeutic strategies (Higuchi et al 2003).…”

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

“…[5][6][7][8] Third, in chronic infections, the levels of circulating parasites are often at or below the limit of the most sensitive direct parasitological methods, such as PCR. [9][10][11][12][13] Moreover, many patients with chronic CD have other health conditions, including immunosuppression, which can severely complicate the prognosis. Concomitant infections of T. cruzi and human immunodeficiency virus (HIV) are serious and have been well-described.…”

Prevalence of Trypanosoma cruzi antibodies and inflammatory markers in uncompensated heart failure

“…Bellotti et al 17 and Benvenutti et al 18 also showed a significant correlation between the presence of Trypanosoma cruzi antigens and the presence of a moderate or severe myocarditis. Additionally, Schijman et al 19 reported a positive correlation between mononuclear cell infiltration, fibrosis grade, and clinical HF evolution, and the detection of Trypanosoma cruzi by PCR.…”