Chagas Disease: A Parasitic Infection in an Immunosuppressed Host

Shikanai‐Yasuda, Maria Aparecida; Almeida, Eros Antônio de; López, Manuel Carlos López; Delgado, María-Jesús Pinazo

doi:10.1007/978-3-030-44054-1_13

Cited by 6 publications

(28 citation statements)

References 91 publications

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“…The observed rate of CDR in the present study (26.1%) is greater than the previous reported values, that can be explained by the lack of uniformity in the notification of cases, from previous studies and some health centers. Data from reported retrospective studies are variable [ 5 , 21 ], and although CDR is a rare event, the data of patients from large prospective studies could lead to a more reliable rate of CDR [ 6 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Concerning CDR diagnosis, parasites search in the blood by microscope concentration methods is easily performed but the result could be negative in myocarditis or encephalitis, and the search for parasites in other fluids (pericardial and cerebrospinal) or even invasive procedure with biopsy could increase the CDR diagnosis rate [ 6 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…The risk of CDR is increased in chronically immunosuppressed CD patients suffering from HIV infection/AIDS, neoplasia, autoimmune diseases, immunosuppression treatment and organ transplants [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…cruzi -HIV co-infection in Brazil using the mortality database from AIDS (103,000 deaths) and CD (about 54,000 deaths), with both diagnoses recorded in death certificates, showed that AIDS was the basic cause of death in 77.9% and CD in 17.6% [ 28 ]. Chagas Disease reactivation rates ranged from 10 to 15% among HIV co-infected people in retrospective case series [ 5 , 21 ] and was estimated to be about 10% in patients followed in a prospective study [ 6 , 15 ], needing to be better established in larger studies.…”

Section: Introductionmentioning

confidence: 99%

“…The affected sites of CDR from these other forms of immunosuppression are the central nervous system and the heart, as occurs in T . cruzi /HIV co-infection in AIDS situations, with the same clinical outcomes [ 6 , 29 ]. Oligosymptomatic cases and/or panniculitis/erythema nodosum could occur frequently in solid organ transplants.…”

Section: Introductionmentioning

confidence: 99%

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Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the “Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions”

et al. 2021

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Objective Chagas disease (CD) globalization facilitated the co-infection with Human Immunodeficiency Virus (HIV) in endemic and non-endemic areas. Considering the underestimation of Trypanosoma cruzi (T. cruzi)-HIV co-infection and the risk of life-threatening Chagas Disease Reactivation (CDR), this study aimed to analyze the major co-infection clinical characteristics and its mortality rates. Methods This is a cross-sectional retrospective multicenter study of patients with CD confirmed by two serological or one parasitological tests, and HIV infection confirmed by immunoblot. CDR was diagnosed by direct microscopy with detection of trypomastigote forms in the blood or other biological fluids and/or amastigote forms in inflammatory lesions. Results Out of 241 patients with co-infection, 86.7% were from Brazil, 47.5% had <200 CD4+ T cells/μL and median viral load was 17,000 copies/μL. Sixty CDR cases were observed. Death was more frequent in patients with reactivation and was mainly caused by CDR. Other causes of death unrelated to CDR were the manifestation of opportunistic infections in those with Acquired Immunodeficiency Syndrome. The time between the co-infection diagnosis to death was shorter in patients with CDR. Lower CD4+ cells count at co-infection diagnosis was independently associated with reactivation. Similarly, lower CD4+ cells numbers at co-infection diagnosis and male sex were associated with higher lethality in CDR. Additionally, CD4+ cells were lower in meningoencephalitis than in myocarditis and milder forms. Conclusion This study showed major features on T. cruzi-HIV co-infection and highlighted the prognostic role of CD4+ cells for reactivation and mortality. Since lethality was high in meningoencephalitis and all untreated patients died shortly after the diagnosis, early diagnosis, immediate antiparasitic treatment, patient follow-up and epidemiological surveillance are essentials in T. cruzi/HIV co-infection and CDR managements.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the “Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions”

et al. 2021

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Sensitivity analysis for causality in observational studies for regulatory science

Díaz,

Lee,

Kıcıman

et al. 2023

J. Clin. Trans. Sci.

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Objective: The United States Congress passed the 21st Century Cures Act mandating the development of Food and Drug Administration guidance on regulatory use of real-world evidence. The Forum on the Integration of Observational and Randomized Data conducted a meeting with various stakeholder groups to build consensus around best practices for the use of real-world data (RWD) to support regulatory science. Our companion paper describes in detail the context and discussion of the meeting, which includes a recommendation to use a causal roadmap for study designs using RWD. This article discusses one step of the roadmap: the specification of a sensitivity analysis for testing robustness to violations of causal model assumptions. Methods: We present an example of a sensitivity analysis from a RWD study on the effectiveness of Nifurtimox in treating Chagas disease, and an overview of various methods, emphasizing practical considerations on their use for regulatory purposes. Results: Sensitivity analyses must be accompanied by careful design of other aspects of the causal roadmap. Their prespecification is crucial to avoid wrong conclusions due to researcher degrees of freedom. Sensitivity analysis methods require auxiliary information to produce meaningful conclusions; it is important that they have at least two properties: the validity of the conclusions does not rely on unverifiable assumptions, and the auxiliary information required by the method is learnable from the corpus of current scientific knowledge. Conclusions: Prespecified and assumption-lean sensitivity analyses are a crucial tool that can strengthen the validity and trustworthiness of effectiveness conclusions for regulatory science.

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Deaths related to Chagas disease and HIV/AIDS coinfection in Brazil: a nationwide population-based analysis

Martins-Melo

Castro

Werneck

et al. 2021

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background Trypanosoma cruzi/HIV coinfection has been described as a relevant clinical event and an emerging public health problem. Here, we describe the epidemiological patterns of deaths related to Chagas disease and HIV/AIDS coinfection in Brazil from 2000 to 2019. Methods We performed a nationwide population-based study using mortality data obtained from the Brazilian Mortality Information System. We included all deaths recorded in Brazil from 2000 to 2019 in which Chagas disease and HIV/AIDS were mentioned on the same death certificate, either as underlying or as associated causes of death. Results Chagas disease and HIV/AIDS were mentioned on 196/22 663 092 death certificates. HIV/AIDS was the underlying cause in 58.2% (114/196) of deaths and Chagas disease in 33.2% (65/196). The average annual mortality rate was 0.05 deaths/1 000 000 inhabitants (95% CI 0.03 to 0.09). The highest death rates were found among males, those aged 60–69 y, Afro-Brazilians, those with 1–3 y of schooling/study and residents in Chagas disease-endemic regions/states. Respiratory, infectious/parasitic and cardiovascular diseases/disorders were the associated causes of death most commonly mentioned. Conclusions Mortality due to Chagas disease and HIV/AIDS coinfection may be largely underestimated in Brazil. Our data further reinforce the importance of screening for T. cruzi infection in HIV-infected patients from Chagas disease-endemic areas. Appropriate clinical management should be ensured for Chagas disease and HIV coinfected patients.

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Chagas Disease: A Parasitic Infection in an Immunosuppressed Host

Cited by 6 publications

References 91 publications

Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the “Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions”

Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the “Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions”

Sensitivity analysis for causality in observational studies for regulatory science

Deaths related to Chagas disease and HIV/AIDS coinfection in Brazil: a nationwide population-based analysis

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