Trypanocide treatment among adults with chronic Chagas disease living in Santa Fe city (Argentina), over a mean follow-up of 21 years: parasitological, serological and clinical evolution

Rev Soc Bras Med Trop. Jan-Feb 2007;40(1):1-10. doi: 10.1590/s0037-86822007000100001.

Abstract

The efficacy of treatment with nifurtimox and/or benznidazole among adults with chronic Chagas disease with no previous electrocardiographic disturbances was evaluated over a mean follow-up of 21 years, by means of conventional serology, xenodiagnosis, clinical examination, electrocardiograms and chest X-ray. One hundred and eleven patients, between 17 and 46 years old, were studied: 54 underwent treatment (nifurtimox 27, benznidazole 27) and 57 remained untreated (control group). Xenodiagnosis was performed on 65% of them: 36/38 of the treated and 9/34 of the untreated patients had previous positive xenodiagnosis. Post-treatment, 133 xenodiagnoses were performed on 41 patients, all resulting negative. In the control group, 29 xenodiagnoses were performed on 14 patients; 2 resulted positive. Sera stored during the follow-up were simultaneously analyzed through conventional serology tests (IHA; DA-2ME; IIF). The serological evolution in the treated group was: a) 37% underwent negative seroconversion (nifurtimox 11, benznidazole 9); b) 27.8% decreased titers (nifurtimox 9, benznidazole 6), 9 showed inconclusive final serology (nifurtimox 7, benznidazole 2); c) 35.2% remained positive with constant titers (nifurtimox 7; benznidazole 12). The control group conserved the initial antibody levels during the follow-up. In the clinical evolution, 2/54 (3.7%) of the treated and 9/57 (15.8%) of the untreated patients showed electrocardiographic disturbances attributable to Chagas myocardiopathy, with a statistically relevant difference (p<0.05). Treatment caused deparasitation in at least 37% of the chronically infected adults and a protective effect on their clinical evolution.

MeSH terms

  • Adolescent
  • Adult
  • Chagas Disease / blood
  • Chagas Disease / drug therapy*
  • Chagas Disease / physiopathology
  • Chronic Disease
  • Drug Therapy, Combination
  • Electrocardiography
  • Epidemiologic Methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nifurtimox / adverse effects
  • Nifurtimox / therapeutic use*
  • Nitroimidazoles / adverse effects
  • Nitroimidazoles / therapeutic use*
  • Serologic Tests
  • Time Factors
  • Treatment Outcome
  • Trypanocidal Agents / adverse effects
  • Trypanocidal Agents / therapeutic use*
  • Xenodiagnosis

Substances

  • Nitroimidazoles
  • Trypanocidal Agents
  • Nifurtimox
  • benzonidazole