Diagnóstico, manejo y tratamiento de la cardiopatía chagásica crónica en áreas donde la infección por Trypanosoma cruzi no es endémica

Gascón, Joaquím; Albajar, Pedro; Cañas, Elías; Flores, María; Prat, Jordi; Herrera, Ramón N.; LaFuente, Carlos; Luciardi, Héctor; Moncayo, Álvaro; Molina, Lluís; Muñóz, José; Puente, Sabino; Sanz, Ginés; Treviño, Begoña; Sergio-Salles, Xavier

doi:10.1157/13100280

Cited by 74 publications

(16 citation statements)

References 35 publications

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“…Summary estimates for commercial ELISA were a pooled sensitivity of 99.3% (97.9%–99.9%) and a pooled specificity of 97.5% (88.5%–99.5%). Despite these supposedly high sensitivity/specificity levels for tests, a number of groups recommend or advise the use of multiple tests for accurate diagnosis [6], [15] suggesting that many experts are still skeptical of the high accuracy of individual tests reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of High Quality Diagnostic Tests for Chagas Disease

2012

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BackgroundThere is significant heterogeneity in reported sensitivities and specificities of diagnostic serological assays for Chagas disease, as might be expected from studies that vary widely according to setting, research design, antigens employed, and reference standard. The purpose of this study is to summarize the reported accuracy of serological assays and to identify sources of heterogeneity including quality of research design. To avoid associated spectrum bias, our analysis was limited to cohort studies.MethodsWe completed a search of PubMed, a bibliographic review of potentially relevant articles, and a review of articles identified by a study author involved in this area of research. Studies were limited to prospective cohort studies of adults published since 1985. Measures of diagnostic accuracy were pooled using a Der Simonian Laird Random Effects Model. A subgroup analysis and meta regression were employed to identify sources of heterogeneity. The QUADAS tool was used to assess quality of included studies and Begg's funnel plot was used to assess publication bias.ResultsEighteen studies and 61 assays were included in the final analysis. Significant heterogeneity was found in all pre-determined subgroups. Overall sensitivity was 90% (95% CI: 89%–91%) and overall specificity was 98% (95% CI: 98%–98%).ConclusionSensitivity and specificity of serological assays for the diagnosis of Chagas disease appear less accurate than previously thought. Suggestions to improve the accuracy of reporting include the enrollment of patients in a prospective manner, double blinding, and providing an explicit method of addressing subjects that have an indeterminate diagnosis by either the reference standard or index test.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review of High Quality Diagnostic Tests for Chagas Disease

2012

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“…The amplification products were detected by 1.5% agarose gel electrophoresis following staining with ethidium bromide staining (5 mg/mL). For hemoculture, 200 µL of blood was added to 5 mL LIT medium and incubated at 28°C for 30 days, being weekly examined by light microscopy to detect epimastigote forms [24]. Only negative parasitaemia and hemocultive samples were further screened by PCR analysis [11], [15].…”

Section: Methodsmentioning

confidence: 99%

In Vitro and In Vivo Investigation of the Efficacy of Arylimidamide DB1831 and Its Mesylated Salt Form - DB1965 - against Trypanosoma cruzi Infection

et al. 2012

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Chagas disease is caused by infection with the intracellular protozoan parasite Trypanosoma cruzi. At present, nifurtimox and benznidazole, both compounds developed empirically over four decades ago, represent the chemotherapeutic arsenal for treating this highly neglected disease. However, both drugs present variable efficacy depending on the geographical area and the occurrence of natural resistance, and are poorly effective against the later chronic stage. As a part of a search for new therapeutic opportunities to treat chagasic patients, pre-clinical studies were performed to characterize the activity of a novel arylimidamide (AIA - DB1831 (hydrochloride salt) and DB1965 (mesylate salt)) against T.cruzi. These AIAs displayed a high trypanocidal effect in vitro against both relevant forms in mammalian hosts, exhibiting a high selectivity index and a very high efficacy (IC50 value/48 h of 5–40 nM) against intracellular parasites. DB1965 shows high activity in vivo in acute experimental models (mouse) of T.cruzi, showing a similar effect to benznidazole (Bz) when compared under a scheme of 10 daily consecutive doses with 12.5 mg/kg. Although no parasitological cure was observed after treating with 20 daily consecutive doses, a combined dosage of DB1965 (5 mg/kg) with Bz (50 mg/kg) resulted in parasitaemia clearance and 100% animal survival. In summary, our present data confirmed that aryimidamides represent promising new chemical entities against T.cruzi in therapeutic schemes using the AIA alone or in combination with other drugs, like benznidazole.

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“…The present article reviews the evidence and presents arguments for antiparasitic treatment of adult chronic patients, representing the opinion of clinical and biomedical scientists of the NHEPACHA network and coinciding with international guidelines that now recommend offering treatment to these patients (3,11,12).…”

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confidence: 99%

Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease

Viotti¹,

Noya

Araújo-Jorge

et al. 2014

Antimicrob Agents Chemother

189

140

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Treatment for Chagas disease with currently available medications is recommended universally only for acute cases (all ages) and for children up to 14 years old. The World Health Organization, however, also recommends specific antiparasite treatment for all chronic-phase Trypanosoma cruzi-infected individuals, even though in current medical practice this remains controversial, and most physicians only prescribe palliative treatment for adult Chagas patients with dilated cardiomyopathy. The present opinion, prepared by members of the NHEPACHA network (Nuevas Herramientas para el Diagnóstico y la Evaluación del Paciente con Enfermedad de Chagas/New Tools for the Diagnosis and Evaluation of Chagas Disease Patients), reviews the paradigm shift based on clinical and immunological evidence and argues in favor of antiparasitic treatment for all chronic patients. We review the tools needed to monitor therapeutic efficacy and the potential criteria for evaluation of treatment efficacy beyond parasitological cure. Etiological treatment should now be mandatory for all adult chronic Chagas disease patients.

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Diagnóstico, manejo y tratamiento de la cardiopatía chagásica crónica en áreas donde la infección por Trypanosoma cruzi no es endémica

Cited by 74 publications

References 35 publications

A Systematic Review of High Quality Diagnostic Tests for Chagas Disease

A Systematic Review of High Quality Diagnostic Tests for Chagas Disease

In Vitro and In Vivo Investigation of the Efficacy of Arylimidamide DB1831 and Its Mesylated Salt Form - DB1965 - against Trypanosoma cruzi Infection

Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease

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