title: Evolutive behavior towards cardiomyopathy of treated (nifurtimox or benznidazole) and untreated chronic chagasic patients.
abstract: The aim of this work was to compare the evolution of chronic chagasic untreated patients (UTPs) with that of benznidazole or nifurtimox-treated patients (TPs). A longitudinal study from a low endemic area (Santa Fe city, Argentina) was performed during an average period of 14 years. Serological and parasitological analyses with clinical exams, ECG and X-chest ray were carried out. At the onset, 19/198 infected patients showed chagasic cardiomyopathy (CrChM) while 179 were asymptomatic. In this latter group the frequency of CrChM during the follow-up was lower in TPs compared with UTPs (3.2% vs 7%). Within the CrChM group, 2/5 TPs showed aggravated myopathy whereas this happened in 9/14 UTPs. Comparing the clinical evolution of all patients, 5.9% of TPs and 13% of UTPs had unfavourable evolution, but the difference is not statistically relevant. Serological titers were assessed by IIF. Titers equal to or lower than 1/64 were obtained in 86% of the TPs, but only in 38% of UTPs. The differences were statistically significant (geometric mean: 49.36 vs. 98.2). Antiparasitic assessment of the drugs (xenodiagnosis) proved to be effective. The low sensitivity in chronic chagasic patients must be born in mind. Despite treated patients showed a better clinical evolution and lower antibody levels than untreated ones, it is necessary to carry on doing research in order to improve therapeutic guidelines, according to the risk/benefit equation and based on scientific and ethical principles.
authors.affiliation: Centro de Investigaciones sobre Endemias Nacionales, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina. dfabbro@fbcb.unl.edu.ar
authors.forename: D
authors.initials: D
authors.lastname: Fabbro De Suasnábar
authors.forename: E
authors.initials: E
authors.lastname: Arias
authors.forename: M
authors.initials: M
authors.lastname: Streiger
authors.forename: M
authors.initials: M
authors.lastname: Piacenza
authors.forename: M
authors.initials: M
authors.lastname: Ingaramo
authors.forename: M
authors.initials: M
authors.lastname: Del Barco
authors.forename: N
authors.initials: N
authors.lastname: Amicone
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016022:Case-Control Studies; D002598:Chagas Cardiomyopathy / Q000188:drug therapy* / Q000276:immunology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009547:Nifurtimox / Q000627:therapeutic use*; D009593:Nitroimidazoles / Q000627:therapeutic use*; D017678:Sex Distribution; D014344:Trypanocidal Agents / Q000627:therapeutic use*
chemical_list: D009593:Nitroimidazoles; D014344:Trypanocidal Agents; D009547:Nifurtimox; C009999:benzonidazole