Abstract
BackgroundAntitrypanosomal treatment with Benznidazole (BZ) or Nifurtimox may be recommended for patients with chronic Chagas disease (CD) to reduce the onset or progression of symptoms. However, such treatment has limited efficacy and high level of toxic effects. In addition, the current cure biomarker (serology conversion) precludes any treatment assessment unless a prolonged follow-up is arranged. PCR is thus the most useful, alternative surrogate marker for evaluating responses to treatment.The aim of this study is to describe the usefulness of real-time PCR in monitoring BZ treatment within a large cohort of chronic CD cases in Barcelona.Methodology/Principal findingsA total of 370 chronic CD patients were monitored with real-time PCR post-BZ treatment. The median follow-up was 4 years (IQR 2.2–5.3y), with a median of 3 clinical visits (IQR 2–4). Only 8 patients (2.2%) presented with at least one incident of positive real-time PCR after treatment and were therefore considered as treatment failure. Four of those failure patients had completed full course treatment, whereas the remaining cases had defaulted with a statistical difference between both groups (p = 0.02). Half of the failure patients had undergone less than 4 years of follow-up monitoring all presented with parasitemia before treatment.Conclusions/SignificanceBZ treatment failure was highly infrequent in our cohort. BZ discontinuation was a risk factor for positive real-time PCR results during clinical follow-up. Regular testing with real-time PCR during follow-up allows for early detection of treatment failure in patients with chronic CD.
Highlights
Chagas disease (CD) is one of the most predominantly neglected diseases, in Latin America where it is endemic [1]
The aim of this study is to describe the usefulness of real-time PCR in monitoring BZ treatment within a large cohort of chronic CD cases in Barcelona
A total of 370 chronic CD patients who had previously undergone BZ treatment were monitored with real-time PCR
Summary
Chagas disease (CD) is one of the most predominantly neglected diseases, in Latin America where it is endemic [1]. The disease holds a varying clinical presentation, including a short acute phase characterized by high parasitemia and mild symptoms. Parasitological tests such as microscopic examination (including concentration methods like microhaematocrit and Strout test), blood culture, xenodiagnoses, or molecular techniques based on nucleic acid amplification (PCR) are the most commonly used techniques during this phase. Antitrypanosomal treatment with Benznidazole (BZ) or Nifurtimox may be recommended for patients with chronic Chagas disease (CD) to reduce the onset or progression of symptoms. Such treatment has limited efficacy and high level of toxic effects.
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