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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
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.
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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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