Estudo longitudinal e quimioterapia específica em crianças, com doença de Chagas crônica, residentes em área de baixa endemicidade da República Argentina

Abstract

Clinical and epidemiological results of 95 treated and untreated chronic chagasic children, with an up to 24 years follow-up period are presented. This population studied in the 1/14 age bracket, residing in Santa Fe city, Argentina, was diagnosed through Chagas-specific conventional serologic reactions. Clinical examination was supplemented with electrocardiogram, chest X-rays, and blood and urine tests for evaluating hepatic function. The drugs employed were nifurtimox or benznidazole. In post treatment period xenodiagnosis was made in 33 patients. Regarding Trypanosoma cruzi transmission, the studied individuals presented multi-risk antecedents: vectorial, congenital and/or blood transfusion. Among 24 untreated children 14 were controlled during 8/24 years: all this patients maintained the initial antibody concentration and clinical status. From 71 treated patients 49 were followed-up 4/24 years: 14 remained positive, 6 presented dubious results, and 29 showed final non-reactive results. 9 of this presented sometimes oscilating results. In 1/6 age bracket children, the serology turned negative after 3.5 years (median) once the treatment was finished, while patients treated in the 7/14 age bracket, the median of negativization was 8 years. 3.8% did not tolerate the drug. None of the groups changed their clinical condition. The untreated children did not change the serology. The percentage of treated children presenting negative serological results decrease according to the age when treatment was given: 75% became negative when treated at < or =4 years old and 43% when treated at > or =9 years old.

Evaluation of the ELISA-F29 test as an early marker of therapeutic efficacy in adults with chronic Chagas disease

“…These findings are different to those observed in children with chronic infection, since the lower the age of the treated patients, the higher the probability of negativization 22 .…”

“…Our group performed a longitudinal study in chronic chagasic children younger than 14 years of age treated with nifurtimox or benznidazole. Although it is difficult to compare the results from different methods, we observed a similar percentage of negativization according to CS, but after a follow-up period of 14 years 22 .…”

Trypanocide treatment among adults with chronic Chagas disease living in Santa Fe city (Argentina), over a mean follow-up of 21 years: parasitological, serological and clinical evolution

“…In follow-ups on children with chronic Chagas disease who received treatment with Nx or Bz up to the age of 14, we observed a significant percentage of negative seroconversion of CS (59%) 30 . Such a significant negative seroconversion had not been observed in adults with chronic infection.…”

Serological Evaluation of Specific-Antibody Levels in Patients Treated for Chronic Chagas' Disease

“…Several research groups have used serological tests to monitor patients with Chagas' disease for treatment success. After the treatment of children younger than 14 years old, four groups (Britto et al [5], da Silveira et al [7], Sosa Estani and Segura [22], and Streiger et al [23]) detected significant titer reductions or regression to negative results for Ͼ50% of the patients, particularly when treatment was given during the acute phase. Other authors (Fabbro de Suasnábar et al [8], Pereira-Chioccola et al [16], and Viotti et al [26]) attempted to treat adults during the unapparent or chronic phase of infection.…”