Early antiparasitic treatment prevents progression of Chagas disease: Results of a long-term cardiological follow-up study in a pediatric population

Abstract

<jats:p>Abstract Background Chagas disease (CD), a parasitic disease caused by Trypanosoma cruzi. Parasite persistence is crucial in the development and progression of Chagas cardiomyopathy that occurs in 30% of untreated patients. Methods and findings A cohort of 95 CD treated children, with at least 6 years post-treatment follow up, was evaluated. Median after treatmeant follow-up was 10 years. At the time of the last visit a group of non infected subjects were also included as a control for cardiological studies. During follow-up, the majority of treated subjects 59/61 (96%) achieved negative parasitemia by qPCR at the end of treatment. A decrease in T. cruzi antibodies titers were observed and seroconversion by two conventional serology tests (IHA, ELISA) occurred in 53/95 (56%). Holter showed alterations in 3/95 (3%) of treated patients: isolated ventricular extrasystoles and nocturnal sinus bradycardia (one patient); asymptomatic and vagal related 1st and 2nd degree AV block (one patient); and complete right bundle branch block (cRBBB) (one patient). Only the last one is probably related to CD involvement. 2D speckle tracking echocardiography was conducted in 79/95 (83%) patients and no alterations in myocardial contractility were observed. In the non infected group Holter evaluations showed similar non pathological results in 3/28 (10%) of subjects: isolated ventricular premature beats (2 patients); asymptomatic 2nd degree AV block with Wenckebach sequences during night time (one patient). 2D speckle tracking echocardiography was conducted in 25/28 (89%) with no alterations. Conclusions After long term follow-up of a cohort of treated children for CD, a good parasiticidal treatment effect and a low incidence of cardiological lesions, related to Chagas disease, were observed. These results suggest a protective effect of treatment on the development of cardiological lesions and strengthen the recommendation of early diagnosis and treatment of infected children. Trial registration ClinicalTrials.gov <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" xlink:href="NCT04090489">NCT04090489</jats:ext-link>.</jats:p>

Effectiveness of Nifurtimox in the Treatment of Chagas Disease: a Long-Term Retrospective Cohort Study in Children and Adults

“…Notably, our group observed a low incidence of cardiac lesions related to ChD in treated patients ( 23 ). However, the retrospective characteristics of our study in a real-world setting do not allow a conclusive result regarding this matter.…”

Elevated Pediatric Chagas Disease Burden Complicated by Concomitant Intestinal Parasites and Malnutrition in El Salvador

“…are important zoonotic nematodes with expansive geographic distribution, and the significant finding of dog ownership in this study further highlights the potential for this nematode to co-occur in Chagas disease patients. [ 47 , 48 , 49 , 50 , 51 , 52 , 53 ] Pediatric populations in particular should be investigated because of their high antiparasitic treatment response [ 54 , 55 ] and any potential interruption in this therapeutic effect would be of important clinical consequence.…”

Review of pharmacological options for the treatment of Chagas disease

“…would yield positive antibody results with lower titers), with no correlation with clinical outcomes such as organ impact, but this still requires more research to confirm. In order to study the correlation between serologic response and organ damage, a recent study of a pediatric cohort performed a median after treatment follow-up of 10 years of treated children with electrocardiograms (ECG), 24 hours ECG (Holter) and Speckletracking strain echocardiography and observed no CD untoward impact on heart function in this population years after treatment, supporting the low correlation between serological tests and clinical response 117 . Also, T. cruzi detection tests currently in use in some countries for long term follow up of patients such as polymerase chain reaction against T.cruzi-DNA (PCR) or different serology techniques, were initially developed for diagnostic purposes.…”