Acute Chagas' disease in postrenal transplant and treatment with benzonidazole

Abstract

Transplanted organs may act as a route of transmission of infectious diseases, such as Chagas' disease. The aim of this study was to describe the transmission of the Trypanosoma cruzi through a renal transplant and the anatomo-clinical evolution of the patient after treatment with benzonidazole. The patient was a 31-year-old white male from the State of Minas Gerais in Brazil. He had renal failure secondary to diabetes and later received a kidney from a cadaveric donor. The patient was undergoing immunosuppression therapy with azathioprine, cyclosporine A, and prednisone. After the transplant, he developed an acute phase of Chagas' disease and complications from diabetes and died 2 months later. In the autopsy, T cruzi amastigotes were found in the transplanted kidney, heart, bladder, liver, and pancreas. An important reduction in the parasitemia was obtained through the treatment of the infection with benzonidazole; however, the patient died due to complications from diabetes associated with tissue lesions caused by T cruzi.

Modulation of Biotransformation Systems and ABC Transporters by Benznidazole in Rats

“…Thus, an inducer effect of BZL in patients cannot be ruled out because the time of treatment is more extended than in our experimental approach. Drug-drug interactions could be particularly important in chagasic patients under immunosuppressant treatment with cyclosporine, corticosteroids, and azathioprine for heart or kidney transplantation (42,43) or in HIV patients infected with T. cruzi and receiving antiretrovirals (44,45).…”

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

“…Acute CD has been diagnosed following kidney, heart, liver, and lung transplantation from T. cruzi seropositive donors; the clinical picture ranges from asymptomatic parasitaemia detected only by polymerase chain reaction (PCR) performed on peripheral blood samples to an acute disease presenting with daily high fever or with involvement and dysfunction of the kidney, heart, and brain [19,20,22,23,50,51]. Besides fever in patients experiencing post-transplant acute infection several clinical pictures have been reported: acute chagasic myocarditis, cerebral trypanosomiasis with space-occupying brain lesions or kidney failure [18,20,51,52]. In the above cited cases, trypomastigotes were identified in the bloodstream, peritoneal fluid, and cerebrospinal fluid, and T. cruzi amastigotes were found in endomyocardial biopsies [20,51,52].…”

“…Besides fever in patients experiencing post-transplant acute infection several clinical pictures have been reported: acute chagasic myocarditis, cerebral trypanosomiasis with space-occupying brain lesions or kidney failure [18,20,51,52]. In the above cited cases, trypomastigotes were identified in the bloodstream, peritoneal fluid, and cerebrospinal fluid, and T. cruzi amastigotes were found in endomyocardial biopsies [20,51,52]. In an autopsied kidney transplant recipient, disseminated CD was demonstrated with intense T. cruzi parasitism involving the heart, liver, spleen, kidney, bladder, and pancreas [51].…”

“…In the above cited cases, trypomastigotes were identified in the bloodstream, peritoneal fluid, and cerebrospinal fluid, and T. cruzi amastigotes were found in endomyocardial biopsies [20,51,52]. In an autopsied kidney transplant recipient, disseminated CD was demonstrated with intense T. cruzi parasitism involving the heart, liver, spleen, kidney, bladder, and pancreas [51]. The median interval from transplantation to diagnosis of acute infection in a US study was 8 weeks, with a range of 3-29 weeks [21].…”

“…Quantitative real-time PCR monitoring during the first 6 to 24 months post-transplant is actually recommended and employed in the centers transplanting the organs of Chagas disease patients [1,5,9,31,45]. Direct parasitological examination (Strout method or blood smear) on peripheral blood, cerebrospinal fluid, or pericardial fluid as well as histopathology are less sensitive, although usually employed [20,51,52]. Blood culture and xenodiagnosis are also less sensitive and time-consuming methods.…”