title: Using polymerase chain reaction in early diagnosis of re-activated Trypanosoma cruzi infection after heart transplantation.
abstract: BACKGROUND
  Heart transplantation is an effective treatment for patients with end-stage Chagas' heart disease. Re-activation of Chagas' disease in transplant recipients is frequent, triggered by immunosuppression level. Therefore, highly sensitive methods for early diagnosis of Chagas' disease relapse are necessary to initiate appropriate therapy. We analyzed the use of polymerase chain reaction (PCR) in the clinical follow-up of heart transplant recipients.
  
  
  METHODS
  We prospectively evaluated 4 heart transplant recipients at the Hospital Privado, Cordoba, Argentina, who had terminal Chagas' disease. The parameters analyzed were presence of parasites in the blood (blood culture, Strout) and in endomyocardial biopsy (EMB) samples, and PCR was performed with oligonucleotides directed to a nuclear repetitive sequence of Trypanosoma cruzi. We evaluated these parameters weekly from the day of transplantation until results were negative and then during regular follow-up visits.
  
  
  RESULTS
  In 2 patients, we detected T cruzi using PCR in peripheral blood 30 days before clinical evidence of re-activation. In the 3rd case, PCR results in peripheral blood were positive from the day before transplantation, followed by positive results in EMB and sub-cutaneous chagomas biopsy specimens. Only 1 patient had positive Strout results for parasites in skin lesions, and none showed amastigotes in the biopsy specimens. After clinical diagnosis, all patients received 5 mg/kg/day benzimidazole for 6 months, with acceptable tolerance and good clinical outcome. All patients had negative peripheral blood PRC results after 30 days of treatment. One patient had intermittent positive PCR results during follow-up, with no evidence of clinical re-activation.
  
  
  CONCLUSIONS
  Polymerase chain reaction detection of T Cruzi in heart transplant recipients is a more sensitive and specific procedure in diagnosing Chagas' disease re-activation.
authors.affiliation: Molecular Diagnosis Laboratory, Fundación para el Progreso de la Medicina, Córdoba, Argentina.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Maldonado
authors.forename: Susana
authors.initials: S
authors.lastname: Albano
authors.forename: Lorena
authors.initials: L
authors.lastname: Vettorazzi
authors.forename: Oscar
authors.initials: O
authors.lastname: Salomone
authors.forename: Juan C
authors.initials: JC
authors.lastname: Zlocowski
authors.forename: Claudio
authors.initials: C
authors.lastname: Abiega
authors.forename: Marcos
authors.initials: M
authors.lastname: Amuchastegui
authors.forename: Roque
authors.initials: R
authors.lastname: Córdoba
authors.forename: Teresita
authors.initials: T
authors.lastname: Alvarellos
mesh_terms: D000818:Animals; D002598:Chagas Cardiomyopathy / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012008:Recurrence; D012680:Sensitivity and Specificity; D014349:Trypanosoma cruzi / Q000302:isolation & purification*
chemical_list: D007166:Immunosuppressive Agents