Belkisyolé Alarcón de Noya1, Raiza Ruiz-Guevara2, Oscar Noya3,4, Julio Castro5, John Ossenkopp5, Zoraida Díaz-Bello1, Cecilia Colmenares1,2, José Antonio Suárez5, Oscar Noya-Alarcón6, Laura Naranjo5, Humberto Gutiérrez7, Giuseppa Quinci8, Jaime Torres5. 1. a Sección de Inmunología, Instituto de Medicina Tropical, Facultad de Medicina , Universidad Central de Venezuela (IMT-FM-UCV) , Caracas , Venezuela. 2. b Cátedra de Parasitología , Escuela de Medicina 'Luís Razetti', FM-UCV , Caracas , Venezuela. 3. c Sección de Biohelmintiasis , IMT-FM-UCV , Caracas , Venezuela. 4. d Centro para Estudios sobre Malaria , Instituto de Altos Estudios 'Dr. Arnoldo Gabaldón', Instituto Nacional de Higiene 'Rafael Rangel', Ministerio del Poder Popular para la Salud , Caracas , Venezuela. 5. e Sección de Infectología , IMT-FM-UCV , Caracas , Venezuela. 6. f Seccion de Ecología Parasitaria , IMT-FM-UCV , Caracas , Venezuela. 7. g Cátedra de Pediatría , Escuela 'Luis Razetti', FM-UCV , Caracas , Venezuela. 8. h Instituto Municipal de Cooperación y Atención de la Salud (IMCAS) , Salud Chacao. Alcaldía del Municipio Chacao , Caracas , Venezuela.
Abstract
BACKGROUND: Two old drugs are the only choice against Trypanosoma cruzi and little is known about their secondary effects in the acute stage of oral-transmitted Chagas disease (ChD). METHODS: A cross-sectional analytical surveillance study was conducted in a sizable cohort of patients seen during the largest acute foodborne ChD microepidemic registered so far. Individuals were treated with benznidazole (BNZ) or nifurtimox (NFX). 'Common Terminology Criteria for Adverse Events' was assessed to categorize side effects according to severity. RESULTS: Out of 176 treatments applied, 79% had one or more adverse effects, which predominated in adults (97.8%) as compared to children (75.5%). Risk of side effects with NFX was significantly higher than BNZ. Four adults and a child treated with NFX had severe side effects (pulmonary infarction, facial paralysis, neutropenia, blurred vision, bone marrow hypoplasia) warranting hospitalization, and drug suspension. Adverse effects frequently reported with NFX were abdominal pain, hyporexia, weight loss, headache, nausea and lymphocytosis, whereas skin rash, neurosensory effects, hyporexia, fatigue, pyrosis, abdominal pain and eosinophilia were observed with BNZ. CONCLUSIONS: Frequency and severity of side effects during treatment of acute oral infection by T. cruzi demand direct supervision and close follow-up, even in those asymptomatic, to prevent life-threatening situations.
BACKGROUND: Two old drugs are the only choice against Trypanosoma cruzi and little is known about their secondary effects in the acute stage of oral-transmitted Chagas disease (ChD). METHODS: A cross-sectional analytical surveillance study was conducted in a sizable cohort of patients seen during the largest acute foodborne ChD microepidemic registered so far. Individuals were treated with benznidazole (BNZ) or nifurtimox (NFX). 'Common Terminology Criteria for Adverse Events' was assessed to categorize side effects according to severity. RESULTS: Out of 176 treatments applied, 79% had one or more adverse effects, which predominated in adults (97.8%) as compared to children (75.5%). Risk of side effects with NFX was significantly higher than BNZ. Four adults and a child treated with NFX had severe side effects (pulmonary infarction, facial paralysis, neutropenia, blurred vision, bone marrow hypoplasia) warranting hospitalization, and drug suspension. Adverse effects frequently reported with NFX were abdominal pain, hyporexia, weight loss, headache, nausea and lymphocytosis, whereas skin rash, neurosensory effects, hyporexia, fatigue, pyrosis, abdominal pain and eosinophilia were observed with BNZ. CONCLUSIONS: Frequency and severity of side effects during treatment of acute oral infection by T. cruzi demand direct supervision and close follow-up, even in those asymptomatic, to prevent life-threatening situations.
Entities:
Keywords:
Chagas disease; benznidazole; nifurtimox; pharmacovigilance; side effects; treatment
Authors: A J Berenstein; N Falk; G Moscatelli; S Moroni; N González; F Garcia-Bournissen; G Ballering; H Freilij; J Altcheh Journal: Antimicrob Agents Chemother Date: 2021-01-20 Impact factor: 5.191
Authors: Julio Alonso-Padilla; Marcelo Abril; Belkisyolé Alarcón de Noya; Igor C Almeida; Andrea Angheben; Tania Araujo Jorge; Eric Chatelain; Monica Esteva; Joaquim Gascón; Mario J Grijalva; Felipe Guhl; Alejandro Marcel Hasslocher-Moreno; Manuel Carlos López; Alejandro Luquetti; Oscar Noya; María Jesús Pinazo; Janine M Ramsey; Isabela Ribeiro; Andres Mariano Ruiz; Alejandro G Schijman; Sergio Sosa-Estani; M Carmen Thomas; Faustino Torrico; Maan Zrein; Albert Picado Journal: PLoS Negl Trop Dis Date: 2020-04-23