Benznidazole therapy for Chagas disease in asymptomatic Trypanosoma cruzi -seropositive former blood donors: evaluation of the efficacy of different treatment regimens

Abstract

Introduction: Chagas disease currently affects 5.7 million people in Latin America and is emerging in non-endemic countries. There is no consensus concerning the effi cacy of trypanocidal therapy for patients with the chronic form of the disease. We evaluated cardiac function and sociodemographic, clinical, and serologic characteristics of a group of asymptomatic Trypanosoma cruzi-seropositive former blood donors, and compared the effects of benznidazole treatment applied for different lengths of time. Methods: Blood donors who screened positive for T. cruzi between 1998 and 2002 were recruited 10 years later for follow-up (n = 244); 46 individuals had received treatment. Three subjects had terminated treatment prematurely. The remaining 43 individuals were divided into two groups: individuals who had received benznidazole therapy for 50-60 days (n = 28; BT ≤60 group) or more than 60 days (n = 15; BT >60). Serologic assays, biochemical tests, electrocardiographic, echocardiographic, and clinical examinations were performed on all participants. Parasite loads were determined by qualitative and quantitative polymerase chain reaction. Results: Parasitemia was signifi cantly reduced in the BT ≤60 and BT >60 groups compared with the untreated group. There were no differences in epidemiologic profi les or clinical, biochemical, electrocardiographic, or echocardiographic data between any of the groups. Conclusions: Despite elimination or signifi cant reduction in parasitemia in patients with chronic Chagas disease who received benznidazole, there was no clinical difference between those who were treated for >60 days and those treated for a shorter duration. Furthermore, the adverse effects of benznidazole appear to be less severe than previous reports would suggest.

Production of recombinant TSA-1 and evaluation of its potential for the immuno-therapeutic control ofTrypanosoma cruziinfection in mice

“…5 Drug treatments are effective during the acute phase of the infection as well as in children, but efficacy appears questionable for patients in the chronic phase, with a very high variability in treatment outcomes. [6][7][8][9][10] Thus, complementary or alternative tools are urgently needed for a better care of infected patients, and vaccines may represent an attractive strategy for the treatment, prevention, or control of T. cruzi infections.…”

Ideal benznidazole dose regimen in chronic chagasic patients: a systematic review

“…Of the included studies, 43.5% (n = 10) had a sample size smaller than or equal to 50 individuals 6,[11][12][13][14][15][16][17][18][19] and 56.5% (n = 13) greater than 50 individuals [20][21][22][23][24][25][26][27][28][29][30][31][32] . Five articles (21.7%) [11][12][13]19,21 had a higher risk of methodological bias, with scores lower than 15 in the quality assessment according to Downs and Black 10 , who claimed that the factors related to the potential confounders are the most affected.…”

“…Finally, cases of seronegativation were observed in 80% (n = 8) of the studies evaluating this parameter, being observed from 4.6 to 73.0% of participants with negative serology after benznidazole use 12,13,17,23,24,[30][31][32] . In 60.9% (n = 14) of the studies, adverse effects were reported, such as: gastrointestinal symptoms, dermatitis, cutaneous reactions, among others 6,11,14,15,17,18,20,22,23,[25][26][27][28]30 (Table 2). Vallejo et al 33 5 mg/kg twice daily/ 60 days 100.0 ---Maculopapular rash, facial rash, fever, rash.…”

“…Regarding the outcomes observed by the authors, 56.5% (n = 13) of the studies used the PCR assay 6 , 11 , 14 , 16 , 19 - 21 , 25 - 27 , 29 , 30 , 33 , and 43.5% (n = 10) evaluated the cardiac conditions of the participants 12 - 14 , 16 , 20 , 22 , 23 , 26 , 31 , 32 . A total of 43.5% (n = 10) used serological parameters 12 - 14 , 17 , 22 - 24 , 30 - 32 and 17.4% (n = 4) used parasitological parameters to evaluate the benznidazole treatment 14 , 15 , 22 , 23 ( Table 1 ).…”

“…The main limitations observed in the studies were difficulties during the follow-up period, such as loss or short follow-up time, 30.4% (n = 7) 6 , 13 , 16 , 18 , 27 , 29 , 31 , in addition to the small sample size, 21.7% (n = 5) 14 , 16 , 18 , 20 , 29 ( Table 1 ).…”