Dear Sir:
Hollowed and others1 described a case of a rapidly progressing Chagas cardiomyopathy. This report highlights the importance of close monitoring of patients with Chagas disease and of offering antitrypanosomal therapy when indicated. However, factors that may have contributed to the rapid progression of the cardiomyopathy were lacking in the report. It is known that comorbidities such as human immunodeficiency virus infection or other immunosuppressive conditions can accelerate the course of Chagas disease or lead to reactivation.2,3 In addition, reinfection may enhance myocardial damage and accelerate progression to heart failure.4 This is especially important if a patient is returning to an environment with vector exposure. Severe cardiac outcomes including death are seen up to 30% of patients by 5 years in endemic areas irrespective of therapy with Benznidazole.5 Finally, oral exposure to trypomastigotes can cause rapid disease progression.6 The patient described in this report likely had a combination of factors contributing to speedy progression of myocarditis.
- 1.↑
Hollowed J, McCullough M, Sanchez D, Traina M, Hernandez S, Murillo E, 2016. Rapidly progressing Chagas cardiomyopathy. Am J Trop Med Hyg 94: 894–896.
- 2.↑
Diazgranados 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: 324–330.
- 3.↑
Pinazo MJ, Espinosa G, Gallego M, Lopez-Chejade PL, Urbina JA, Gascon J, 2010. Successful treatment with posaconazole of a patient with chronic Chagas disease and systemic lupus erythematosus. Am J Trop Med Hyg 82: 583–587.
- 4.↑
Kaplinski M, Jois M, Galdos-Cardenas G, Rendell VR, Shah V, Do RQ, Marcus R, Burroughs Pena MS, Del Carmen Abastoflor M, LaFuente C, Bozo R, Valencia E, Verastegui M, Colanzi R, Gilman RH, Bern C, 2015. Sustained domestic vector exposure is associated with increased Chagas cardiomyopathy risk but decreased parasitemia and congenital transmission risk among young women in Bolivia. Clin Infect Dis 61: 918–926.
- 5.↑
Morillo CA, Marin-Neto JA, Avezum A, Sosa-Estani S, Rassi A Jr, Rosas F, Villena E, Quiroz R, Bonilla R, Britto C, Guhl F, Velazquez E, Bonilla L, Meeks B, Rao-Melacini P, Pogue J, Mattos A, Lazdins J, Rassi A, Connolly SJ, Yusuf S, 2015. Randomized trial of benznidazole for chronic chagas' cardiomyopathy. N Engl J Med 373: 1295–1306.
- 6.↑
Pinto AY, Valente SA, Valente V da C, 2004. Emerging acute Chagas disease in Amazonian Brazil: case reports with serious cardiac involvement. Braz J Infect Dis 8: 454–460.