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Aplastic Anemia and Chagas Disease: T. cruzi Parasitemia Monitoring by Quantitative PCR and Preemptive Antiparasitic Therapy
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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9609300/ https://www.ncbi.nlm.nih.gov/pubmed/36288009 http://dx.doi.org/10.3390/tropicalmed7100268 |
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author | Carvalho, Noêmia 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 |
author_facet | Carvalho, Noêmia 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 |
author_sort | Carvalho, Noêmia Barbosa |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9609300 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-96093002022-10-28 Aplastic Anemia and Chagas Disease: T. cruzi Parasitemia Monitoring by Quantitative PCR and Preemptive Antiparasitic Therapy Carvalho, Noêmia 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 Trop Med Infect Dis Case Report 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. MDPI 2022-09-27 /pmc/articles/PMC9609300/ /pubmed/36288009 http://dx.doi.org/10.3390/tropicalmed7100268 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Case Report Carvalho, Noêmia 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 Aplastic Anemia and Chagas Disease: T. cruzi Parasitemia Monitoring by Quantitative PCR and Preemptive Antiparasitic Therapy |
title | Aplastic Anemia and Chagas Disease: T. cruzi Parasitemia Monitoring by Quantitative PCR and Preemptive Antiparasitic Therapy |
title_full | Aplastic Anemia and Chagas Disease: T. cruzi Parasitemia Monitoring by Quantitative PCR and Preemptive Antiparasitic Therapy |
title_fullStr | Aplastic Anemia and Chagas Disease: T. cruzi Parasitemia Monitoring by Quantitative PCR and Preemptive Antiparasitic Therapy |
title_full_unstemmed | Aplastic Anemia and Chagas Disease: T. cruzi Parasitemia Monitoring by Quantitative PCR and Preemptive Antiparasitic Therapy |
title_short | Aplastic Anemia and Chagas Disease: T. cruzi Parasitemia Monitoring by Quantitative PCR and Preemptive Antiparasitic Therapy |
title_sort | aplastic anemia and chagas disease: t. cruzi parasitemia monitoring by quantitative pcr and preemptive antiparasitic therapy |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9609300/ https://www.ncbi.nlm.nih.gov/pubmed/36288009 http://dx.doi.org/10.3390/tropicalmed7100268 |
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