Chagas disease: Management of acute disease, early chronic disease, and disease in immunosuppressed hosts
- 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 management of acute Chagas, congenital Chagas, chronic Chagas, and Chagas in the setting of immunosuppression are reviewed here. The approach to antitrypanosomal therapy for Chagas disease varies by phase and form of disease (table 1 and table 2).
Management of cardiac and gastrointestinal manifestations of chronic Chagas disease is discussed separately (see "Chagas gastrointestinal disease" and "Chagas heart disease: Treatment and prognosis", section on 'Management'). Dosing and adverse effects for antitrypanosomal drugs are discussed in detail separately. (See "Chagas disease: Antitrypanosomal drug therapy".)
ACUTE CHAGAS DISEASE
The natural history and diagnosis of acute and congenital Chagas disease are discussed in detail separately. (See "Chagas disease: Natural history and diagnosis", section on 'Acute phase'.)
Antitrypanosomal therapy with benznidazole or nifurtimox can reduce the severity of symptoms, shorten the clinical course, and reduce the duration of detectable parasitemia in acute and early congenital Chagas disease [1-4]. In the acute phase, parasitological cure (as well as clinical cure) is thought to occur in 60 to 85 percent of patients treated [1-4].
Among congenitally infected infants treated in the first year of life, parasitological cure is thought to occur in >90 percent of cases [1,4-6]. Treatment of infected infants should be initiated as soon as the diagnosis is made; the drugs are well tolerated in infancy [1,7,8]. Successful treatment is assumed to decrease or eliminate risk of later complications, although longitudinal data are lacking [9,10].
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- ACUTE CHAGAS DISEASE
- CHRONIC CHAGAS DISEASE
- Initial evaluation
- Antitrypanosomal therapy
- IMMUNOSUPPRESSED HOSTS
- Chagas reactivation
- - HIV/AIDS
- - Treatment and prevention
- Organ transplant
- - Donor transmission in organ transplant recipients
- - Heart transplantation for Chagas cardiomyopathy
- Monitoring for reactivation
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- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS