Caryn Bern1. 1. Prevention and Public Health Group, Global Health Sciences, Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco, California 94105, USA. Caryn.Bern@UCSF.edu
Abstract
PURPOSE OF REVIEW: This review examines recent literature on Chagas disease in the immunosuppressed host. RECENT FINDINGS: Chagas disease in immunosuppressed patients may represent acute transmission in an organ recipient, or reactivation of chronic infection in an HIV-infected individual or patient receiving cardiac transplantation for Chagas cardiomyopathy. Transplantation of the kidney or liver from an infected donor resulted in transmission in 18-19 and 29%, respectively. Prospective monitoring usually detects acute infection before symptom onset; early treatment is highly effective. In heart transplant patients, reactivation symptoms include fever, myocarditis and skin lesions, and may mimic rejection. Approximately 20% of HIV- Trypanosoma cruzi infected patients experience reactivation; manifestations include meningoencephalitis and/or myocarditis. SUMMARY: Transplantation of the heart from a T. cruzi-infected donor is contraindicated; use of other organs can be considered. Guidelines recommend prospective monitoring rather than prophylactic treatment in recipients. Posttransplant monitoring for acute infection or reactivation relies on PCR, culture and microscopy of blood specimens regularly for at least 6 months. Treatment employs standard courses of benznidazole or nifurtimox, and immune reconstitution for the HIV-coinfected patient. Case reports suggest some HIV-T. cruzi-infected patients may benefit from secondary prophylaxis, but more data are needed to determine efficacy and specific regimens.
PURPOSE OF REVIEW: This review examines recent literature on Chagas disease in the immunosuppressed host. RECENT FINDINGS:Chagas disease in immunosuppressed patients may represent acute transmission in an organ recipient, or reactivation of chronic infection in an HIV-infected individual or patient receiving cardiac transplantation for Chagas cardiomyopathy. Transplantation of the kidney or liver from an infected donor resulted in transmission in 18-19 and 29%, respectively. Prospective monitoring usually detects acute infection before symptom onset; early treatment is highly effective. In heart transplant patients, reactivation symptoms include fever, myocarditis and skin lesions, and may mimic rejection. Approximately 20% of HIV- Trypanosoma cruzi infectedpatients experience reactivation; manifestations include meningoencephalitis and/or myocarditis. SUMMARY: Transplantation of the heart from a T. cruzi-infecteddonor is contraindicated; use of other organs can be considered. Guidelines recommend prospective monitoring rather than prophylactic treatment in recipients. Posttransplant monitoring for acute infection or reactivation relies on PCR, culture and microscopy of blood specimens regularly for at least 6 months. Treatment employs standard courses of benznidazole or nifurtimox, and immune reconstitution for the HIV-coinfectedpatient. Case reports suggest some HIV-T. cruzi-infectedpatients may benefit from secondary prophylaxis, but more data are needed to determine efficacy and specific regimens.
Authors: Fernando Salvador; Adrián Sánchez-Montalvá; Elena Sulleiro; Francesc Moreso; Cristina Berastegui; Mireia Caralt; María-Jesús Pinazo; Zaira Moure; Ibai Los-Arcos; Oscar Len; Joan Gavaldà; Israel Molina Journal: Am J Trop Med Hyg Date: 2018-02-01 Impact factor: 2.345
Authors: Glauco Adrieno Westphal; Valter Duro Garcia; Rafael Lisboa de Souza; Cristiano Augusto Franke; Kalinca Daberkow Vieira; Viviane Renata Zaclikevis Birckholz; Miriam Cristine Machado; Eliana Régia Barbosa de Almeida; Fernando Osni Machado; Luiz Antônio da Costa Sardinha; Raquel Wanzuita; Carlos Eduardo Soares Silvado; Gerson Costa; Vera Braatz; Milton Caldeira Filho; Rodrigo Furtado; Luana Alves Tannous; André Gustavo Neves de Albuquerque; Edson Abdala Journal: Rev Bras Ter Intensiva Date: 2016-09
Authors: Fernando Salvador; Adrián Sánchez-Montalvá; Elena Sulleiro; Cristina Berastegui; Alberto Jauregui; Teresa Pont; Ibai Los-Arcos; Óscar Len; Joan Gavaldà; Israel Molina Journal: Am J Trop Med Hyg Date: 2017-07-27 Impact factor: 2.345