High-dose benznidazole in a 62-year-old Bolivian kidney transplant recipient with Chagas central nervous system involvement

Montero, M. Gomez; Mir, Marisa; Sulleiro, Elena; Esquivel, J.L. Avalos; López, Enrique García; Molina-Morant, Daniel; López-Montesinos, Inmaculada; Sorlí, Luisa; Espinosa, Gerard; Oliva, E. Mounteis; Crespo, Marta; Monge, Ixchel Flores; Horcajada, Juan Pablo; Grau, S; Pascual, Jordi

doi:10.1016/j.ijid.2018.10.014

Cited by 10 publications

(16 citation statements)

References 7 publications

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“…The drug reaches CNS concentrations close to 70% of those observed in plasma, which has allowed successful treatment of Chagas CNS infections (e.g. meningoencephalitis) in immunosuppressed patients [69][70][71][72] . Plasma protein binding of BZN is approximately 50% and is thus not expected to lead to significant interactions with other drugs 54 .…”

Section: Bnz Pharmacologymentioning

confidence: 99%

“…meningoencephalitis) in immunosuppressed patients. [80][81][82][83] Plasma protein binding of BZN is approximately 50% and is thus not expected to lead to significant interactions with other drugs. 65 Clearance of BZN is mainly by biotransformation (>80%), 79,84 believed to take place mostly in the liver, probably by members of the cytochrome P450 (CYP) family and/or tissue nitroreductases.…”

Section: Bnz Pharmacologymentioning

confidence: 99%

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Review of pharmacological options for the treatment of Chagas disease

Lascano

Bournissen

Altcheh

2021

Brit J Clinical Pharma

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Introduction: Chagas disease (CD) is a worldwide problem, with over 8 million people infected in both rural and urban areas. CD was first described over a century ago, but only two drugs are currently available for CD treatment, benznidazole (BZN) and nifurtimox (NF). Treating CD infected patients, especially children and women of reproductive age, is vital in order to prevent long term sequelae, such as heart and gastrointestinal dysfunction, but this aim is still far from being accomplished. Currently, the strongest data to support benefit-risk considerations come from trials in children. Finally, treatment response biomarkers need further development as serology is being questioned as the best method to assess treatment response.Areas covered: This article is a narrative review on the pharmacology of drugs for CD, particularly BZN and NF. Data on drug biopharmaceutical characteristics, safety and efficacy of both drugs are summarized from a clinical perspective. Current data on alternative compounds under evaluation for CD treatment, and new possible treatment response biomarkers are also discussed. Conclusion:Early diagnosis and treatment of CD, especially in pediatric patients, is vital for an effective and safe use of the available drugs (i.e. BZN and NF). New biomarkers for CD are urgently needed for the diagnosis and evaluation of treatment efficacy, and to guide efforts from academia and pharmaceutical companies to accelerate the process of new drugs development.

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Section: Bnz Pharmacologymentioning

confidence: 99%

Section: Bnz Pharmacologymentioning

confidence: 99%

Review of pharmacological options for the treatment of Chagas disease

Lascano

Bournissen

Altcheh

2021

Brit J Clinical Pharma

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“…12 Severe clinical manifestations are infrequent and usually correlate with a delayed diagnosis and high parasitic load in blood. Isolated blood hypotension (personal observation), Chagas meningoencephalitis, 13 and tumor-like brain lesions (Chagomas) 14 may be unfrequently observed. Focal lung involvement with T cruzi observed in bronchoalveolar lavage has been described.…”

Section: Clini C Al Manife S Tati On Of Chag a S Infec Ti On In Solmentioning

confidence: 99%

“…Mortality related to Chagas disease reactivation in heart transplantation has been reported to be 0.7%‐0.9% 35,36 . Higher benznidazole doses (15 mg/kg/day) may be considered in cases with central nervous system involvement when disease is refractory to usual doses 14 …”

Section: Different Scenarios Of Chagas Disease In Solid Organ Transplmentioning

confidence: 99%

American trypanosomiasis (Chagas disease) in solid organ transplantation

Radisic¹,

Repetto

2020

Transplant Infectious Dis

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Chagas disease is caused by Trypanosoma cruzi, a protozoan parasite which is transmitted by triatomine bugs. These insect vectors naturally occur only in the American continent, where the endemic area extends from southern United States of America (US) to northern Argentina. Approximately 7 million people worldwide (but mostly within the endemic area) are estimated to be infected. 1 Parasite transmission is vector-borne in 80% of the cases. Metacyclic trypomastigotes are eliminated in the stools of the vector, when it defecates while feeding from humans. After biting, metacyclic trypomastigotes enter human host through the bite, skin lesions, or intact mucous membranes. Transmission may also occur orally after the ingestion of food or fluids contaminated with infected triatomine feces, vertically from an infected mother to infant, in laboratory accidents, and-uncommonly-via unscreened blood transfusion or organ transplantation. 2 Chagas disease may occasionally be observed in non-endemic areas. International immigration from endemic to non-endemic areas led to the presence of an estimate of ~300 000 infected immigrants living in the US, 3 48 000-87 000 in Spain, and several thousands in other European countries, Australia, and Canada. 4 Chagas may be observed in patients born in non-endemic areas who received blood or organs from infected immigrants 4, or in children born in non-endemic areas from an infected mother

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“…The drug acts in different ways, able to induce parasite direct modification, improve phagocytosis, and increase trypanosomal death through interferon-gamma induction and inhibition of NADH-fumarate reductase [119]. Higher doses of benznidazole have been used for transplant recipients with CNS ChD involvement [46,124].…”

Section: Benznidazolementioning

confidence: 99%

Chagas Disease: Coming to a Transplanted Patient Near You

Pierrotti

Ibrahim

2020

Emerging Transplant Infections

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Chagas disease is a vector-borne infection caused by the protozoan Trypanosoma cruzi that is endemic in Latin America. More recently, the geographic distribution of the disease has changed due to immigration of asymptomatic infected individuals from endemic to non-endemic regions. Therefore, Chagas disease involving acute infection among negative recipients receiving a transplant graft from positive donors and reactivation episodes among positive recipients due to posttransplant immunosuppression is a problem that has been recognized worldwide. This chapter aims to highlight the epidemiology, clinical manifestations, diagnosis, management, and outcomes of Chagas disease among transplant recipients.

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High-dose benznidazole in a 62-year-old Bolivian kidney transplant recipient with Chagas central nervous system involvement

Cited by 10 publications

References 7 publications

Review of pharmacological options for the treatment of Chagas disease

Review of pharmacological options for the treatment of Chagas disease

American trypanosomiasis (Chagas disease) in solid organ transplantation

Chagas Disease: Coming to a Transplanted Patient Near You

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