Volume 82, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



American Trypanosomiasis or Chagas disease (CD) is a neglected disease that affects Latin American people worldwide. Two old antiparasitic drugs, benznidazole and nifurtimox, are currently used for specific CD treatment with limited efficacy in chronic infections and frequent side effects. New drugs are needed for patients with chronic CD as well as for immunosuppressed patients, for whom the risk of reactivation is life-threatening. We describe a case of chronic CD and systemic lupus erythematosus (SLE) that required immunosuppression to control the autoimmune process. It was found that benznidazole induced a reduction, but not an elimination, of circulating levels, whereas subsequent treatment with posaconazole led to a successful resolution of the infection, despite the maintenance of immunosuppressive therapy.


Article metrics loading...

Loading full text...

Full text loading...



  1. Bern C, Montgomery SP, Katz L, Caglioti S, Stramer SL, , 2008. Chagas disease and the US blood supply. Curr Opin Infect Dis 21: 476482.[Crossref]
  2. Muñoz J, Gómez i Prat J, Gállego M, Gimeno F, Treviño B, López-Chejade P, Ribera O, Molina L, Sanz S, Pinazo MJ, Riera C, Posada EJ, Sanz G, Portús M, Gascon J, , 2009. Clinical profile of Trypanosoma cruzi infection in a non-endemic setting: immigration and Chagas disease in Barcelona (Spain). Acta Trop 111: 5155.[Crossref]
  3. Dias JC, Silveira AC, Schofield CJ, , 2002. The impact of Chagas disease control in Latin America: a review. Mem Inst Oswaldo Cruz 97: 603612.[Crossref]
  4. Urbina JA, Docampo R, , 2003. Specific chemotherapy of Chagas disease: controversies and advances. Trends Parasitol 19: 495501.[Crossref]
  5. Cançado JR, , 2002. Long term evaluation of etiological treatment of Chagas disease with benznidazole. Rev Inst Med Trop Sao Paulo 44: 2937.[Crossref]
  6. Pinto Dias JC, , 2006. The treatment of Chagas disease (South American trypanosomiasis). Ann Intern Med 144: 772774.[Crossref]
  7. Tarleton RL, Reithinger R, Urbina JA, Kitron U, Gürtler RE, , 2007. The challenges of Chagas disease—grim outlook or glimmer of hope. PLoS Med 4: e332.[Crossref]
  8. Gomes YM, Lorena VM, Luquetti AO, , 2009. Diagnosis of Chagas disease: what has been achieved? What remains to be done with regard to diagnosis and follow up studies? Mem Inst Oswaldo Cruz 104: 115121.[Crossref]
  9. Britto C, Cardoso MA, Vanni CM, Hasslocher-Moreno A, Xavier SS, Oelemann W, Santoro A, Pirmez C, Morel CM, Wincker P, , 1995. Polymerasa chain reaction detection of Trypanosoma cruzi in human blood samples as a tool for diagnosis and treatment evaluation. Parasitology 110: 241247.[Crossref]
  10. Añez N, Carrasco H, Parada H, Crisante G, Rojas A, Fuenmayor C, Gonzalez N, Percoco G, Borges R, Guevara P, Ramirez JL, , 1999. Myocardial parasite persistence in chronic Chagasic patients. Am J Trop Med Hyg 60: 726732.
  11. Castro AM, Luquetti AO, Rassi A, Rassi GG, Chiari E, Galvão LM, , 2002. Blood culture and polymerase chain reaction for the diagnosis of the chronic phase of human infection with Trypanosoma cruzi . Parasitol Res 88: 894900.[Crossref]
  12. Coronado X, Zulantay I, Reyes E, Apt W, Venegas J, Rodriguez J, Solari A, Sanchez G, , 2006. Comparison of Trypanosoma cruzi detection by PCR in blood and dejections of Cursive: Triatoma infestans fed on patients with chronic Chagas disease. Acta Trop 98: 314317.[Crossref]
  13. Benvenuti LA, Roggério A, Freitas HF, Mansur AJ, Fiorelli A, Higuchi ML, , 2008. Chronic American trypanosomiasis: parasite persistence in endomyocardial biopsies is associated with high-grade myocarditis. Ann Trop Med Parasitol 102: 481487.[Crossref]
  14. Diaz-Granados CA, Saavedra-Trujillo CH, Mantilla M, Valderrama SL, Alquichire C, Franco-Paredes C, , 2009. Chagasic encephalitis in HIV patients: common presentation of an evolving epidemiological and clinical association. Lancet Infect Dis 9: 324330.[Crossref]
  15. Metze K, Lorand-Metze I, Almeida EA, Moraes SL, , 1991. Reactivation of Chagas' disease myocarditis during therapy of Hodgkin's disease. Trop Geogr Med 43: 228230.
  16. Santos-Neto LL, Polcheira MF, Castro C, Correa Lima RA, Kozak C, Correa Lima FA, , 2003. Alta parasitemia pelo Trypanosoma cruzi em paciente com lupus eritematoso sistêmico. Rev Soc Bras Med Trop 36: 613615.[Crossref]
  17. Barousse AP, Costa JA, Eposto M, Laplume H, Segura EL, , 1980. Chagas disease and immunosuppression. Medicina (B Aires) 40: (Suppl 1): 1726.
  18. Riera C, Vergés M, López-Chejade P, Piron M, Gascón M, Fisa R, Gállego M, Portús M, , 2009. Desarrollo y evaluación de una técnica ELISA con antígeno crudo de Trypanosoma cruzi para el diagnóstico de la Enfermedad de Chagas. Enfermedades Emergentes 11: 2229.
  19. Piron M, Fisa R, Casamitjana N, López-Chejade P, Puig L, Vergés M, Gascón J, Gómez i Prat J, Portús M, Sauleda S, , 2007. Development of a real-time PCR assay for Trypanosoma cruzi detection in blood samples. Acta Trop 103: 195200.[Crossref]
  20. Schijman AG, Altcheh J, Burgos JM, Biancardi M, Bisio M, Levin MJ, Freilij H, , 2003. Aetiological treatment of congenital Chagas' disease diagnosed and monitored by the polymerase chain reaction. J Antimicrob Chemother 52: 441449.[Crossref]
  21. Sosa Estani S, Segura EL, Ruiz AM, Velazquez E, Porcel BM, Yampotis C, , 1998. Efficacy of chemotherapy with benznidazole in children in the indeterminate phase of Chagas' disease. Am J Trop Med Hyg 59: 526529.
  22. Lauria-Pires L, Braga MS, Vexenat AC, Nitz N, Simões-Barbosa A, Tinoco DL, Teixeira AR, , 2000. Progressive chronic Chagas heart disease ten years after treatment with anti-Trypanosoma cruzi nitroderivatives. Am J Trop Med Hyg 63: 111118.
  23. Fernandes CD, Tiecher FM, Balbinot MM, Liarte DB, Scholl D, Steindel M, Romanha A, , 2009. Efficacy of benznidazol treatment for asymptomatic Chagasic patients from state of Rio Grande do Sul evaluated during a three years follow-up. Mem Inst Oswaldo Cruz 104: 2732.[Crossref]
  24. Viotti R, Vigliano C, Lococo B, Bertocchi G, Petti M, Alvarez MG, Postan M, Armenti A, , 2006. Long-term cardiac outcomes of treating chronic Chagas disease with benznidazole versus no treatment: a nonrandomized trial. Ann Intern Med 144: 724734.[Crossref]
  25. Filardi LS, Brener Z, , 1987. Susceptibility and natural resistance of Trypanosoma cruzi strains to drugs used clinically in Chagas disease. Trans R Soc Trop Med Hyg 81: 755759.[Crossref]
  26. Ferreira MS, Borges AS, , 2002. Some aspects of protozoan infections in immunocompromised patients—a review. Mem Inst Oswaldo Cruz 97: 443457.[Crossref]
  27. D'Avila SC, D'Avila AM, Pagliari C, Gonçalves VM, Duarte MI, , 2005. Erythema nodoso in reactivation of Chagas' disease after cardiac transplantation. Rev Soc Bras Med Trop 38: 6163.[Crossref]
  28. Rassi A, Amato-Neto V, Siqueira AF, Ferriolli Filho F, Amato VS, Rassi Junior A, , 1999. Benznidazol as a prophylactic drug to prevent reactivation in chronic chagasic patients treated with corticoid for associated disease. Rev Soc Bras Med Trop 32: 475482.[Crossref]
  29. National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, 2009. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. Available at: http://aidsinfo.nih.gov/contenfiles/Adult_OI.pdf. Accessed July 29, 2009.
  30. Duffy T, Bisio M, Altcheh J, Burgos JM, Diez M, Levin MJ, Favaloro RR, Freilij H, Schijman AG, , 2009. Accurate real-time PCR strategy for monitoring bloodstream parasitic loads in Chagas disease patients. PLoS Negl Trop Dis 3: e419.[Crossref]
  31. Diez M, Favaloro L, Bertolotti A, Burgos JM, Vigliano C, Lastra MP, Levin MJ, Arnedo A, Nagel C, Schijman AG, Favaloro RR, , 2007. Usefulness of PCR strategies for early diagnosis of Chagas' disease reactivation and treatment follow-up in heart transplantation. Am J Transplant 7: 16331640.[Crossref]
  32. Molina J, Martins Filho O, Brener Z, Romanha AJ, Loebenberg D, Urbina JA, , 2000. Activities of the triazole derivative SCH 56592 (posaconazole) against drug-resistant strains of the protozoan parasite Trypanosoma (Schizotrypanum) cruzi in immunocompetent and immunosuppressed murine hosts. Antimicrob Agents Chemother 44: 150155.[Crossref]
  33. Ferraz M, Gazzinelli RT, Alves RO, Urbina JA, Romanha AJ, , 2007. The anti-Trypanosoma cruzi activity of posaconazole in a murine model of acute Chagas' disease is less dependent on gamma interferon than that of benznidazole. Antimicrob Agents Chemother 51: 13591364.[Crossref]
  34. Urbina JA, Payares G, Contreras LM, Liendo A, Sanoja C, Molina J, Piras M, Piras R, Perez N, Wincker P, Loebenberg D, , 1998. Antiproliferative effects and mechanism of action of SCH56592 against Trypanosoma (Schizotrypanum) cruzi: in vitro and in vivo studies. Antimicrob Agents Chemother 42: 17711777.
  35. Bustamante JM, Bixby LM, Tarleton RL, , 2008. Drug-induced cure drives conversion to a stable and protective CD8+ T central memory response in chronic Chagas disease. Nat Med 14: 542550.[Crossref]
  36. Galvao LM, Nunes RM, Cancado JR, Brener Z, Krettli AU, , 1993. Lytic antibody titre as a means of assessing cure after treatment of Chagas disease: a 10 years follow-up study. Trans R Soc Trop Med Hyg 87: 220223.[Crossref]

Data & Media loading...

  • Received : 13 Oct 2009
  • Accepted : 09 Jan 2010

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error