Sequential measurement of Trypanosoma cruzi parasitic load in endomyocardial biopsies for early detection and follow-up of Chagas disease reactivation after heart transplantation

Autor(es)

Benvenuti, Luiz Alberto ^[1] ; Roggerio, Alessandra ^[1] ; Nishiya, Anna Shoko ^[2] ; Mangini, Sandrigo ^[1] ; Levi, Jose Eduardo ^[3]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Heart Inst InCor, Hosp Clin HCFMUSP, Fac Med, Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Fundacao Prosangue, Hosp Clin HCFMUSP, Fac Med, Hemoctr Sao Paulo, Sao Paulo, SP - Brazil

^[3] Univ Sao Paulo, Inst Med Trop, Sao Paulo, SP - Brazil

• Tipo de documento: Artigo Científico
• Fonte: TRANSPLANT INFECTIOUS DISEASE; v. 22, n. 1 NOV 2019.
• Citações Web of Science: 1

Resumo

Background Reactivation of Chagas disease after heart transplantation is characterized by proliferation and dissemination of Trypanosoma cruzi parasites to several organs. Reactivation affecting the allograft can simulate acute cellular rejection, from which it should be distinguished through the analysis of endomyocardial biopsies (EMB). Methods We evaluated retrospectively 100 EMB collected in the first year of follow-up from 13 heart-transplanted, chagasic patients who presented reactivation and were successfully treated. Additionally, 37 EMB from 8 patients who did not present reactivation constituted the control group. We reviewed histopathology and performed a real-time PCR-based assay in order to evaluate the T cruzi parasitic load of each EMB. Results The parasitic load of the EMB at the time of reactivation ranged from 22.80 to 190 000/10(6) cells (median: 1555). In 6 patients, none of the EMB obtained prior to reactivation amplified T cruzi DNA. On the other hand, 10 EMB from 7 patients, obtained 9-105 days before reactivation (median: 26 days), showed parasitic load ranging from 8.25 to 625/10(6) cells (median: 167.55). In all patients, the parasitic load increased at the time of reactivation, usually sharply. After initiation of treatment, all patients showed negative PCR or a dramatic reduction of the parasitic load in the following EMB. None of the EMB from the control group amplified T cruzi DNA. Conclusions Sequential measurement of T cruzi parasitic load in EMB is useful for monitoring Chagas disease reactivation after heart transplantation. Its increase suggests imminent reactivation and its decrease after treatment indicates favorable evolution for cure of the episode of reactivation. (AU)

• Processo FAPESP: 17/07946-8 - Análise da carga parasitária do Trypanosoma cruzi em biópsias endomiocárdicas sequenciais de paciente chagásicos transplantados cardíacos que apresentaram reativação da doença
• Beneficiário: Luiz Alberto Benvenuti
• Modalidade de apoio: Auxílio à Pesquisa - Regular