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Review
. 2018;10(3):373-388.
doi: 10.1007/s40506-018-0170-z. Epub 2018 Jun 26.

Treatment of Chagas Disease in the United States

Sheba Meymandi  1 , Salvador Hernandez  1 , Sandy Park  1 , Daniel R Sanchez  1 , Colin Forsyth  1
Affiliations
Review

Treatment of Chagas Disease in the United States

Sheba Meymandi et al. Curr Treat Options Infect Dis. 2018.

Abstract

Purpose of review: Chagas disease (CD) is endemic to much of Latin America, but also present in the United States (U.S.). Following a lengthy asymptomatic period, CD produces serious cardiac or gastrointestinal complications in 30-40% of people. Less than 1% of the estimated six million cases in the Americas, including 326,000-347,000 in the U.S., are diagnosed. Infected persons are typically unaware and the bulk of clinicians are unfamiliar with current treatment guidelines. This review provides U.S. and other clinicians with the latest knowledge of CD treatment.

Recent findings: Chagas cardiomyopathy (CCM) causes severe fibrosis and autonomic damage in the myocardium. Eliminating the parasite through antitrypanosomal therapy with benznidazole, a nitroimidazole derivative or nifurtimox, a nitrofuran compound, potentially prevents heart failure and other sequelae of advanced CCM. Benznidazole, recently approved by the U.S. Food and Drug Administration (FDA) for children 2-12 years old, is the first-line therapy; optimal dosages are currently being studied. Antitrypanosomal therapy prevents congenital transmission; produces high cure rates for acute, congenital, and early chronic cases; and improves clinical outcomes in adult chronic indeterminate cases. However, this benefit was not observed in a large clinical trial that included patients with advanced CCM.

Summary: Treatment with antitrypanosomal drugs can cure CD in acute, congenital, and early chronic cases and provides improved clinical outcomes for chronic indeterminate cases. This treatment should be offered as early as possible, before advanced CCM develops.

Keywords: Benznidazole; Chagas disease; Neglected tropical diseases; Nifurtimox; Trypanosoma cruzi.

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Conflict of interest statement

Colin Forsyth received salary from the Drugs for Neglected Diseases initiative and Médecins sans Frontières/Doctors without Borders USA while working on this article. Sheba Meymandi has agreed to a consultant relationship with Bayer, manufacturer of nifurtimox, and Exeltis, which distributes benznidazole in the U.S. Salvador Hernandez declares that he has no conflict of interest. Sandy Park declares that she has no conflict of interest. Daniel R. Sanchez declares that he has no conflict of interest.With regard to the authors’ research cited in this paper, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In addition, all applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

Figures

Fig. 1
Fig. 1
Diagnostic process of the center of excellence for Chagas disease at olive view-UCLA medical center. Patients eligible for treatment are first tested at a commercial laboratory. If that result is positive, patients receive further testing (a Wiener ELISA and TESA blot) at the CDC.
Fig. 2
Fig. 2
Clinical management of patients at the center of excellence for Chagas disease at Olive View-UCLA Medical Center. Patients are evaluated for chronic Chagas cardiomyopathy and undergo requisite labs (renal and hepatic function and complete blood count) to determine eligibility for etiological treatment. The right side of the figure illustrates management of side effects, which depends on their severity.
See this image and copyright information in PMC

References

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance.
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