Aplastic Anemia and Chagas Disease: T. cruzi Parasitemia Monitoring by Quantitative PCR and Preemptive Antiparasitic Therapy.

Autor: Carvalho NB; Division of Infectious and Parasitic Diseases, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo (HC-FMUSP), Av. Enéias C. Aguiar, 255, Sao Paulo 05403000, Brazil., de Freitas VT; Department of Infectious and Parasitic Diseases, Faculdade Medicina, University of Sao Paulo (FMUSP), Av. Enéias C. Aguiar, 470, Sao Paulo 05403000, Brazil.; Laboratory of Medical Investigation in Immunology (LIM 48), Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Av. Enéias C. Aguiar, 470, Sao Paulo 05403000, Brazil., Bezerra RC; Laboratory of Medical Investigation in Parasitology (LIM 46), Av. Enéias C. Aguiar, 470, Sao Paulo 05403000, Brazil., Nakanishi ES; Laboratory of Medical Investigation in Immunology (LIM 48), Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Av. Enéias C. Aguiar, 470, Sao Paulo 05403000, Brazil., Velloso EP; Service of Hematology, Transfusion and Cell Therapy and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Av. Enéias C. Aguiar, 255, Sao Paulo 05403000, Brazil., Higashino HR; Division of Infectious and Parasitic Diseases, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo (HC-FMUSP), Av. Enéias C. Aguiar, 255, Sao Paulo 05403000, Brazil., Batista MV; Division of Infectious and Parasitic Diseases, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo (HC-FMUSP), Av. Enéias C. Aguiar, 255, Sao Paulo 05403000, Brazil., Fonseca GH; Service of Hematology, Transfusion and Cell Therapy and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Av. Enéias C. Aguiar, 255, Sao Paulo 05403000, Brazil., Rocha V; Service of Hematology, Transfusion and Cell Therapy and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Av. Enéias C. Aguiar, 255, Sao Paulo 05403000, Brazil.; Churchill Hospital, Oxford University, Old Rd, Headington, Oxford OX3 7LE, UK., Costa SF; Laboratory of Medical Investigation in Protozoology (LIM 49), Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, Av. Enéias C. Aguiar, 470, Sao Paulo 05403000, Brazil., Shikanai-Yasuda MA; Department of Infectious and Parasitic Diseases, Faculdade Medicina, University of Sao Paulo (FMUSP), Av. Enéias C. Aguiar, 470, Sao Paulo 05403000, Brazil.; Laboratory of Medical Investigation in Immunology (LIM 48), Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Av. Enéias C. Aguiar, 470, Sao Paulo 05403000, Brazil.
Jazyk: angličtina
Zdroj: Tropical medicine and infectious disease [Trop Med Infect Dis] 2022 Sep 27; Vol. 7 (10). Date of Electronic Publication: 2022 Sep 27.
DOI: 10.3390/tropicalmed7100268
Abstrakt: Background: Aplastic anemia is a rare and life-threatening condition, seldomly witnessed concomitantly with Chagas disease. We aim to discuss the management of these patients under risk of chronic Chagas disease reactivation (CDR), a severe condition with a high morbimortality that occurs in chronic Chagas disease patients under immunosuppression. Case reports: Trypanosoma cruzi (T. cruzi) parasitemia was monitored in three patients for 4−58 months by conventional PCR (cPCR), quantitative PCR (qPCR), microhematocrit/buffy coat, blood culture, and/or xenodiagnosis. One patient received antiparasitic treatment (benznidazole) and the other received allopurinol. Although parasitemia was controlled during and after benznidazole treatment at 300 mg/d for 51 days, in one patient, hematologic parameters worsened continuously before, during, and after treatment. Allopurinol led only to the temporary suppression of T. cruzi parasitemia in the second patient, but after danazol and hematological improvement, parasitemia became undetectable until the end of monitoring. Discussion and Conclusion: Unexpected undetectable or low parasitemia by cPCR/qPCR was reported. We show that the monitoring of parasitemia by qPCR and the use of preemptive therapy when the parasitemia was positive proved to be beneficial to our patients. As a result of the toxicity of more effective antiparasitics, shorter regimens of benznidazole or less toxic drugs in preemptive therapy are options that deserve future studies.
Databáze: MEDLINE
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