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

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Carvalho, Noemia Barbosa ; de Freitas, Vera Teixeira ; Bezerra, Rita Cristina ; Nakanishi, Erika Shimoda ; Velloso, Elvira Pereira ; Higashino, Hermes Ryoiti ; Batista, Marjorie Vieira ; Fonseca, Guilherme Henrique ; Rocha, Vanderson ; Costa, Silvia Figueiredo ; Shikanai-Yasuda, Maria Aparecida

• Tipo de documento: Artigo Científico
• Fonte: TROPICAL MEDICINE AND INFECTIOUS DISEASE; v. 7, n. 10, p. 11-pg., 2022-10-01.

Resumo

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. (AU)

• Processo FAPESP: 12/50273-0 - Monitoramento de pacientes imunodeprimidos com Doenças de Chagas: níveis de parasitemia e associação com o perfil, poliformismo de citonas sobrevidas e características dos isolados Trypanosoma cruzi em transplante de órgãos, uso de drogas imunossupressoras e co-infecção com o vírus da imunodeficiência humana
• Beneficiário: Maria Aparecida Shikanai Yasuda
• Modalidade de apoio: Auxílio à Pesquisa - Regular