Immunosuppression and Chagas disease: a management challenge.
Immunosuppression, which has become an increasingly relevant clinical condition in the last 50 years, modifies the natural history of Trypanosoma cruzi infection in most patients with Chagas disease. The main goal in this setting is to prevent the consequences of reactivation of T. cruzi infection b...
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ftdoajarticles:oai:doaj.org/article:0a5808df7f544e2eb10ed0e328c35aca 2023-05-15T15:13:23+02:00 Immunosuppression and Chagas disease: a management challenge. María-Jesús Pinazo Gerard Espinosa Cristina Cortes-Lletget Elizabeth de Jesús Posada Edelweiss Aldasoro Inés Oliveira Jose Muñoz Montserrat Gállego Joaquim Gascon 2013-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0001965 https://doaj.org/article/0a5808df7f544e2eb10ed0e328c35aca EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC3547855?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 doi:10.1371/journal.pntd.0001965 1935-2727 1935-2735 https://doaj.org/article/0a5808df7f544e2eb10ed0e328c35aca PLoS Neglected Tropical Diseases, Vol 7, Iss 1, p e1965 (2013) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2013 ftdoajarticles https://doi.org/10.1371/journal.pntd.0001965 2022-12-31T04:44:00Z Immunosuppression, which has become an increasingly relevant clinical condition in the last 50 years, modifies the natural history of Trypanosoma cruzi infection in most patients with Chagas disease. The main goal in this setting is to prevent the consequences of reactivation of T. cruzi infection by close monitoring. We analyze the relationship between Chagas disease and three immunosuppressant conditions, including a description of clinical cases seen at our center, a brief review of the literature, and recommendations for the management of these patients based on our experience and on the data in the literature. T. cruzi infection is considered an opportunistic parasitic infection indicative of AIDS, and clinical manifestations of reactivation are more severe than in acute Chagas disease. Parasitemia is the most important defining feature of reactivation. Treatment with benznidazole and/or nifurtimox is strongly recommended in such cases. It seems reasonable to administer trypanocidal treatment only to asymptomatic immunosuppressed patients with detectable parasitemia, and/or patients with clinically defined reactivation. Specific treatment for Chagas disease does not appear to be related to a higher incidence of neoplasms, and a direct role of T. cruzi in the etiology of neoplastic disease has not been confirmed. Systemic immunosuppressive diseases or immunosuppressants can modify the natural course of T. cruzi infection. Immunosuppressive doses of corticosteroids have not been associated with higher rates of reactivation of Chagas disease. Despite a lack of evidence-based data, treatment with benznidazole or nifurtimox should be initiated before immunosuppression where possible to reduce the risk of reactivation. Timely antiparasitic treatment with benznidazole and nifurtimox (or with posaconazole in cases of therapeutic failure) has proven to be highly effective in preventing Chagas disease reactivation, even if such treatment has not been formally incorporated into management protocols for ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLoS Neglected Tropical Diseases 7 1 e1965 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 María-Jesús Pinazo Gerard Espinosa Cristina Cortes-Lletget Elizabeth de Jesús Posada Edelweiss Aldasoro Inés Oliveira Jose Muñoz Montserrat Gállego Joaquim Gascon Immunosuppression and Chagas disease: a management challenge. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Immunosuppression, which has become an increasingly relevant clinical condition in the last 50 years, modifies the natural history of Trypanosoma cruzi infection in most patients with Chagas disease. The main goal in this setting is to prevent the consequences of reactivation of T. cruzi infection by close monitoring. We analyze the relationship between Chagas disease and three immunosuppressant conditions, including a description of clinical cases seen at our center, a brief review of the literature, and recommendations for the management of these patients based on our experience and on the data in the literature. T. cruzi infection is considered an opportunistic parasitic infection indicative of AIDS, and clinical manifestations of reactivation are more severe than in acute Chagas disease. Parasitemia is the most important defining feature of reactivation. Treatment with benznidazole and/or nifurtimox is strongly recommended in such cases. It seems reasonable to administer trypanocidal treatment only to asymptomatic immunosuppressed patients with detectable parasitemia, and/or patients with clinically defined reactivation. Specific treatment for Chagas disease does not appear to be related to a higher incidence of neoplasms, and a direct role of T. cruzi in the etiology of neoplastic disease has not been confirmed. Systemic immunosuppressive diseases or immunosuppressants can modify the natural course of T. cruzi infection. Immunosuppressive doses of corticosteroids have not been associated with higher rates of reactivation of Chagas disease. Despite a lack of evidence-based data, treatment with benznidazole or nifurtimox should be initiated before immunosuppression where possible to reduce the risk of reactivation. Timely antiparasitic treatment with benznidazole and nifurtimox (or with posaconazole in cases of therapeutic failure) has proven to be highly effective in preventing Chagas disease reactivation, even if such treatment has not been formally incorporated into management protocols for ... |
format |
Article in Journal/Newspaper |
author |
María-Jesús Pinazo Gerard Espinosa Cristina Cortes-Lletget Elizabeth de Jesús Posada Edelweiss Aldasoro Inés Oliveira Jose Muñoz Montserrat Gállego Joaquim Gascon |
author_facet |
María-Jesús Pinazo Gerard Espinosa Cristina Cortes-Lletget Elizabeth de Jesús Posada Edelweiss Aldasoro Inés Oliveira Jose Muñoz Montserrat Gállego Joaquim Gascon |
author_sort |
María-Jesús Pinazo |
title |
Immunosuppression and Chagas disease: a management challenge. |
title_short |
Immunosuppression and Chagas disease: a management challenge. |
title_full |
Immunosuppression and Chagas disease: a management challenge. |
title_fullStr |
Immunosuppression and Chagas disease: a management challenge. |
title_full_unstemmed |
Immunosuppression and Chagas disease: a management challenge. |
title_sort |
immunosuppression and chagas disease: a management challenge. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2013 |
url |
https://doi.org/10.1371/journal.pntd.0001965 https://doaj.org/article/0a5808df7f544e2eb10ed0e328c35aca |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 7, Iss 1, p e1965 (2013) |
op_relation |
http://europepmc.org/articles/PMC3547855?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 doi:10.1371/journal.pntd.0001965 1935-2727 1935-2735 https://doaj.org/article/0a5808df7f544e2eb10ed0e328c35aca |
op_doi |
https://doi.org/10.1371/journal.pntd.0001965 |
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PLoS Neglected Tropical Diseases |
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7 |
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1 |
container_start_page |
e1965 |
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1766343938914910208 |