ABSTRACT
In the indeterminate chronic period of Chagas disease (ChD) the treatment has not been conclusive, because the serological negativization requires many years. This study aims to evaluate the efficacy of nifurtimox (NF) in the treatment of chronic ChD in prolonged follow-up by serological techniques of indirect immunofluorescence assay (IFA) and enzyme-linked immunosorbent assay (ELISA) IgG comparing 2 groups of patients, treated and non treated. Mann-Whitney test was performed for ELISA and IFA, with significant difference between the groups (P < 0.05). IgG levels were lower in individuals treated compared with untreated patients, indicating chemotherapeutic efficacy in prolonged follow-up.
Subject(s)
Humans , Chagas Disease , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique, Indirect , Follow-Up Studies , Immunoglobulin G , Immunoglobulins , Nifurtimox , Trypanosoma cruzi , TrypanosomaSubject(s)
Chagas Disease/history , Brazil , Chagas Disease/epidemiology , Global Health , History, 20th Century , History, 21st Century , HumansSubject(s)
History, 20th Century , History, 21st Century , Humans , Chagas Disease/history , Brazil , Chagas Disease/epidemiology , Global HealthABSTRACT
As expert consensus has been arisen about universal antiparasitic treatment for all patients infected with Trypanosoma cruzi, most important drugs licensed for Chagas disease treatment are reviewed: nifurtimox and benznidazol, their mechanisms of action, doses, treatment schedules, adverse effects and contraindications. Two other drugs used for Chagas disease treatment, for which a Chilean experience may be exhibited, are allopurinol and itraconazole. Indications for treatment of Chagas disease in immunocompetent patients and immunocompromised hosts are detailed. This chapter refers besides to the evaluation and monitoring of antiparasitic therapy in immunocompromised patients, the availability of drugs and includes various forms facsimiles suggested to perform clinical and laboratory follow up of patients that undergo treatment, indicating the prescribed drug, adverse effects and time of follow up.
Subject(s)
Chagas Disease/drug therapy , Trypanocidal Agents/therapeutic use , Allopurinol/therapeutic use , Animals , Chagas Disease/classification , Follow-Up Studies , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Nifurtimox/therapeutic use , Nitroimidazoles/therapeutic use , Trypanosoma cruzi/drug effectsABSTRACT
En el año 1999, se certificó en Chile la interrupción de la transmisión vectorial de la enfermedad de Chagas. Por otra parte, el desarrollo de políticas habitacionales, que incluyen zonas rurales endémicas, han logrado importantes avances en grupos humanos que presentaban graves deficiencias de habitabilidad. En esta situación epidemiológica, se estudió 10 años después de la terapia, a 37 chagásicos crónicos procedentes de zonas rurales de la IV Región, mediante encuesta epidemiológica (pre y post-terapia) y evaluación parasitológica (post-terapia). La encuesta incluyó: conocimiento del vector, triatominos en el domicilio actual, antecedentes de haber sido picado por triatominos y material de la construcción de la vivienda. La evaluación parasitológica se realizó mediante xenodiagnóstico (XD) (37 casos) y Reacción en Cadena de la Polimerasa (PCR) en sangre periférica (34 casos). Los resultados de la encuesta epidemiológica evidenciaron cambios importantes en la calidad de la vivienda rural de los chagásicos tratados, mientras que, en relación a la parasitemia, se detectó Trypanosoma cruzi circulante en el 89,2 por ciento de los casos (37,8 por ciento y 88,2 por ciento, mediante XD y PCR, respectivamente). Se concluye que la persistencia del parásito en condiciones post-terapia, no está relacionada con la presencia de Triatoma infestans intradomiciliario.
Subject(s)
Adult , Male , Humans , Female , Chagas Disease/diagnosis , Insect Vectors , Parasitemia/diagnosis , Triatoma/physiology , Trypanosoma cruzi/genetics , Chronic Disease , Chile/epidemiology , Enzyme-Linked Immunosorbent Assay , Chagas Disease/parasitology , Fluorescent Antibody Technique, Direct , Follow-Up Studies , Health Surveys , Polymerase Chain Reaction , Rural Areas , XenodiagnosisABSTRACT
In 1977 the authors launched a long-term investigation of the epidemiology of Chagas'disease and its cardiac implications in Chile. During this work, clinical examinations were performed, blood samples were drawn for serologic tests, and electrocardiograms were obtained using a study population of 2 938 subjects residing in rural settlements of northern Chile; and this was done again four years later with 481 study subjects remaining in the area. This article reports on the latter four-year followup study. To begin with, the study subjects were divided into three specific groups: those with no evidence of Chagas'disease but with cardiopathy (as indicated by abnormal ECGs) were disignated Group A; those with positive chagasic serology and cardiopathy were designated Group B; and 67 subjects randomly selected from those with positive chagasic serology and normal ECGs were designated Group C. At the time of the followup work, 216 subjects were retained in Group A and 198 in Group B. Comparison of the initial and final Group A and Grup B data yielded a number of results that seem significant. To beigin with, they indicated that mortality was four times higher among the infected subjects and that the disease tended to threaten a much younger population than was threatened by nonchagasic cardiopathy. Also, cardiopathy appeared to develop among the infected Group C subjects at a rate of about 9.7
