Chagas disease: Antitrypanosomal drug therapy
- Caryn Bern, MD, MPH
Caryn Bern, MD, MPH
- Professor, Global Health Sciences
- University of California, San Francisco
Chagas disease is caused by infection with the protozoan parasite Trypanosoma cruzi. Issues related to antitrypanosomal drugs will be reviewed here. The approach to management of Chagas disease varies by phase and form of disease and is discussed in detail separately (table 1). (See "Chagas disease: Management of acute disease, early chronic disease, and disease in immunocompromised hosts".)
The only drugs with proven efficacy against Chagas disease in human trials are benznidazole and nifurtimox [1,2]. In general, benznidazole is better tolerated and so is favored by most experts as the first-line treatment for Chagas disease . However, some patients tolerate nifurtimox better than benznidazole; when treatment with one drug must be discontinued, the other can be used as an alternative. Limited human data, supported by findings in animal models, suggest that T. cruzi strains may vary in their drug susceptibility [4-8].
Both benznidazole and nifurtimox are contraindicated in pregnancy, so effective contraception should be assured. In addition, both drugs demonstrate in vitro mutagenicity and have been associated with increased risk of lymphomas in experimental animals [9-12]. No increase in incidence of lymphoma has been observed among immunocompetent humans, although no long-term studies examining this issue have been conducted . An increased incidence of neoplasm was reported in a small series of heart transplantation recipients for Chagas disease .
Antitrypanosomal agents are contraindicated in patients with severe renal or hepatic dysfunction.
Neither drug is approved in the United States, but both can be obtained from the Centers for Disease Control and Prevention (CDC) and used under investigational protocols. Consultations and drug requests should be addressed to Division of Parasitic Diseases Public Inquiries line (404-718-4745; email email@example.com), the CDC Drug Service (404-639-3670), and, for emergencies after business hours, on weekends and federal holidays, through the CDC Emergency Operations Center (770-488-7100).
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