An eight-year old boy from Posadas (27º 23' S, 55º 54' W)

Summary:The efficacy of preemptive therapy was evaluated in bone marrow transplantation (BMT) recipients associated with Chagas disease (CD). The criterion to include patients in the protocol was the serological reactivity for CD in recipients and/or donors before transplant. After BMT, the monitoring was performed using the direct Strout method (SM), which detects clinical levels of Trypanosome cruzi parasitemia, and CD conventional serological tests. Monitoring took place during 60 days in ABMT and throughout the immunosuppressive period in allogeneic BMT. Reactivation of CD was diagnosed by detecting T. cruzi parasites in blood or tissues. In primary T. cruzi infection, an additional diagnostic criterion was the serological conversion. A total of 25 CD-BMT patients were included. Two ABMT and four allogeneic BMT recipients showed CD recurrences diagnosed by SM. One patient also showed skin lesions with T. cruzi amastigotes. Benznidazole treatment (Roche Lab), an antiparasitic drug, was prescribed at a dose of 5 mg/kg/day during 4-8 weeks with recovery of patients. Primary T. cruzi infection was not observed. This report proves the relevance of monitoring CD in BMT patients and demonstrates that preemptive therapy was able to abrogate the development of clinical and systemic disease.

Chagas' disease is an endemic zoonosis of South America caused by a protozoan parasite Trypanosoma cruzi. About 30% of infected people develop the disease. This disease is known to reactivate in immunocompromised hosts, such as patients with acquired immunodeficiency syndrome, leukemia, and transplantation. There is some experience with transplantation of infected renal grafts into negative recipients, resulting in an index of transmission of 35%. No cases have been reported involving other organ transplants up to 2002, when the Centers for Disease Control and Prevention reported 3 cases of Chagas' disease transmission to 3 recipients (liver, kidney, and pancreas‐kidney) from a single chagas infected donor. Here we report on a case of orthotopic liver transplant from a chagas infected donor into a negative recipient in clinical emergency status. The recipient was monitored by direct parasitological Strout method and serological tests with detection of transmission on the 84th day by both studies, without clinical signs. The patient was put on benznidazole with rapid clearance of the parasitemia. However, we propose that chagas infected donors may be accepted for liver transplant recipients only in emergency status. (Liver Transpl 2005;11:1112–1116.)

Summary:and systemic tissue spread are also features of this stage. After the acute phase, patients enter an asymptomatic or indeterminate period, a long-lasting period of up to 10-30 We report the clinical course of five adult patients with chronic Chagas' disease (Cd) who underwent BMT.years in which patients persist with serological reactivity and subclinical parasitemia.3 Trypanosoma cruzi, the etioTwo patients with non-Hodgkin's lymphoma and one with ALL received an ABMT. Allogeneic BMT was perlogic protozoan agent, is transmitted to human beings in the endemic areas by sucking insects. 1 In urban areas of formed in two patients with AML and CML respectively. One donor had chronic Cd. Samples of peripheral developed and underdeveloped non-endemic countries, transmission through blood transfusions has acquired relblood for parasite investigation by the Strout method, blood culture, and immunological studies by indirect evance because infected people migrate to populated cities and are potential blood, bone marrow or organ donors. 4,5immunofluorescent assay, ELISA and indirect hemagglutination tests were performed weekly from the start Detection of high level of parasitemia has not been described during the course of chronic Cd in immunocomof chemotherapy until day +60 for ABMT and during the period of immunosuppression for allogeneic BMT.petent individuals. However, in immunosuppressed patients reactivation of chronic Cd associated with leukemia, 6 lymNo prophylaxis was given to any of these patients. In only one ABMT patient were trypomastigotes detected phoma, 7 heart, 8 BM 9 and kidney transplantation 10 and HIV infection, 11 has been reported. early by blood culture without symptoms of reactivation. Benznidazole as preemptive treatment wasWe report the course of chronic Cd in five patients undergoing BMT and define control measures for early administered at 5-8 mg/kg/daily for 30 days. Parasitemia was rapidly cleared and at the end of therapy detection of parasitemia and/or reactivation using a preemptive approach to avoid the development of clinical disease. xenodiagnosis was negative. The other Cd patients showed no evidence of relapse of parasitemia or signs and symptoms of reactivation. In brief, evidence of Cd should be sought in all BMT patients coming from Materials and methods endemic areas because parasitemia and reactivation are potential complications during the period of neutroBetween January 1989 and December 1996 we performed 28 allogeneic and 206 ABMT. In allogeneic patients penia and immunosuppression. The strategy used for early detection and treatment of parasitemia and reactiimmunosuppressive therapy to prevent acute GVHD included CsA and MTX. Selection criteria for including vation was safe and effective.

This report shows the early detection of reactivation of chronic Chagas' disease (CCd) in a 27-year-old man with chronic myelogenous leukemia undergoing allogeneic bone marrow transplantation (ABMT). Pre-emptive therapy with benznidazole during a period of 7 weeks led to a rapid recovery of the patient, who remains free of parasitemia 2 years after the bone marrow transplantation.