Immunosuppression and Chagas disease; experience from a non-endemic country

Abstract

Reactivation of Chagas disease in the chronic phase may occur when immunosuppression is established, sometimes resulting in high parasitaemia and severe clinical manifestations such as meningitis and meningoencephalitis. Although this situation is being increasingly described, there is still scarce information. This retrospective observational study was performed in three Tropical Medicine Units of Barcelona (Spain) included in the International Health Programme of the Catalan Health Institute (PROSICS). The objective of the study was to describe epidemiological, clinical, microbiological, prognostic and therapeutic data from patients with Chagas disease and any kind of immunosuppressive condition attended in these three institutions from January 2007 to October 2014. From 1823 patients with Chagas disease attending these three centres during the study period, 38 (2%) had some kind of immunosuppressive condition: 12 patients had human immunodeficiency virus infection, 8 patients had neoplasia, 4 patients underwent organ transplantation and 14 patients had an autoimmune disease. Eight (21.1%) patients had cardiac involvement, and six (15.8%) patients had gastrointestinal involvement. Acute Trypanosoma cruzi infection was detected in two Spanish patients. Thirty-one (81.6%) patients received treatment with benznidazole, of whom 17 (54.8%) had some kind of adverse event. No patient had a severe manifestation or reactivation of Chagas disease. Patients with Chagas disease under immunosuppressive conditions are being increasingly described, especially in non-endemic countries. More information about this topic is required and international consensus in the diagnosis, treatment and follow up of these patients must be established to reduce the morbidity and mortality.

Trypanosoma cruzi seroprevalence and associated risk factors in cancer patients from Southern Brazil

“…The coexistence of CD and immune disorders has been reported worldwide, and may lead to an acute reactivation with parasitemia and severe clinical manifestations such as meningitis and meningoencephalitis (4) (5) .…”

“…However, when they were clinically assessed by their doctors (both patients and doctors were aware of test positivity), they did not show any clinical sign that could be attributed to disease reactivation, and cancer remained a treatment priority. It must be noted that immunocompromised individuals with CD were observed for possible disorders related to the presence of the parasite, aiming to provide faster and more effi cient treatment in case of reactivation, since CD can present unusually severe clinical manifestations in immunocompromised patients, such as meningitis and meningoencephalitis (5) .…”

Efficacy of the Benznidazole+Posaconazole combination therapy in parasitemia reduction: An experimental murine model of acute Chagas

“…Anti-parasitic treatment during acute phase CD is the central pillar of disease management, partially because of the higher parasite load in comparison with the chronic phase [27][28][29] , in which the etiological treatment has not shown beneficial against cardiopathological progression 30 . Currently, BZL and NFX are the treatment of choice for CD, with BZL being more widely used, owing to its excellent pharmacological efficacy and less adverse effects [31][32][33] . Cancado et al 34 found differences in the proportion of recovered patients treated with BZL for extended periods according to the CD phase; 76% in the acute phase compared with just 8% in the chronic phase.…”

The immunosuppressed traveler: infection risks with autoimmunity and immunosuppression, vaccinations, and general travel advice

“…One case series looked at immunosuppressed patients with chronic CD and included three patients with autoimmune disorders treated with regimens that included biologics. None of these patients suffered a reactivation or severe manifestation of their CD [57]. Although the effect of biological therapies on the course of CD remains unknown, expert opinion favors screening patients with serological testing prior to treatment if their mothers were born in endemic areas, they have lived in endemic areas for prolonged periods, or they have received a blood transfusion in an endemic country [58].…”