A case report of long treatment with Itraconazole in a patient with chronic Chagas disease

Pau Bosch-Nicolau,Adrián Sánchez-Montalvá,Fernando Salvador,Elena Sulleiro,Israel Molina,Joaquín Burgos

doi:10.1186/s12879-019-4608-9

Pau Bosch-Nicolau, Adrián Sánchez-Montalvá + Show 4 more

Open Access

https://doi.org/10.1186/s12879-019-4608-9

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Abstract

BackgroundCurrent available treatments (benznidazole and nifurtimox) for Chagas disease (CD) show limited efficacy in chronic phase and frequent undesirable effects. Ergosterol synthesis inhibitors (ESI) had been considered as promising drugs for CD treatment and despite its recent poor results in several clinical trials, different strategies have been proposed to optimize its role in this infection.Case presentationWe present a case of chronic Chagas disease in patient diagnosed with HIV who received treatment for histoplasmosis with itraconazol during twelve months. Even though T. cruzi rt-PCR was persistently negative during treatment, when itraconazol was stopped she presented with a positive blood rt-PCR.ConclusionSeveral studies using different ESI had been published for CD treatment. Either in vitro or in vivo assays demonstrated activity against T. cruzi of the different triazole derivatives so different clinical trials had been carried out to evaluate its efficacy and safety. Despite contradictory evidence in the animal model, longer treatments along with other treatment strategies previously proposed suggests that ESI failure rates in positive peripheral blood rt-PCR are higher than that obtained with the current treatments of choice.

Highlights

Current available treatments for Chagas disease (CD) show limited efficacy in chronic phase and frequent undesirable effects
Despite of the growing consensus of treating Chagas disease (CD) in chronic stages to avoid the progression of chagasic cardiomyopathy, current available treatments show limited efficacy reaching cure rates between 15 and 35% [1] and frequent undesirable effects, which leads to definitive withdrawal of the treatment in 13–32% of patients [2]
Triazole derivatives have been used for years as antifungal treatments with a good pharmacokinetic and safety profile. They act as selective inhibitors of T. cruzi ergosterol synthesis showing potent intrinsic activity against the parasite in both in-vitro and in-vivo models, and had been considered as promising drugs for CD treatment [3]

Summary

Conclusion

Several studies using different ESI had been published for CD treatment. Either in vitro or in vivo assays demonstrated activity against T. cruzi of the different triazole derivatives so different clinical trials had been carried out to evaluate its efficacy and safety. Despite contradictory evidence in the animal model, longer treatments along with other treatment strategies previously proposed suggests that ESI failure rates in positive peripheral blood rt-PCR are higher than that obtained with the current treatments of choice

Findings

Background

Discussion and conclusions