Usefulness of PCR for monitoring benznidazole response in patients with chronic Chagas' disease: a prospective study in a non-disease-endemic country.
OBJECTIVE
This prospective study focused on the evaluation of antiparasitic therapy in chronic Chagas' disease, monitored by PCR.


METHODS
One hundred and eighty-one patients, all seropositive for Trypanosoma cruzi infection, underwent specific chemotherapy with benznidazole. Twelve patients were classified as young (2-19 years), 122 patients were classified as adults (20-39 years) and 47 patients were classified as seniors (>or=40 years). In total, 116 (64%) were asymptomatic and 65 (36%) were symptomatic. Patients were monitored for 90, 150 and 420 days after treatment by PCR and serology.


RESULTS
Before treatment, 68% had a positive PCR result. PCR positivity was significantly more frequent in patients aged 2-19 years (P = 0.0007) and in short-term immigrants (P = 0.0076). No differences in PCR sensitivity were observed between samples of patients with chronic symptomatic or indeterminate Chagas' disease. All patients presented an early conversion of PCR results 90 days post-treatment. However, at the end of the follow-up period PCR had become positive in four patients (4 out of 58 patients; 6.9%) who had strictly adhered to the treatment and in one who did not complete the treatment. Only one patient showed an alternating PCR during follow-up.


CONCLUSIONS
We conclude that PCR is a useful tool for the early detection of parasite susceptibility to benznidazole and for the post-treatment parasitological follow-up of patients with chronic Chagas' disease.
Murcia
Laura
L
Unidad Regional de Medicina Tropical, Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca, Carretera Madrid-Cartagena sn, 30120 El Palmar Murcia, Spain.
Carrilero
Bartolomé
B
Muñoz
M Jose
MJ
Iborra
M Asunción
MA
Segovia
Manuel
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014355:Chagas Disease / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009593:Nitroimidazoles / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D014344:Trypanocidal Agents / Q000627:therapeutic use*; D014349:Trypanosoma cruzi / Q000302:isolation & purification*; D055815:Young Adult
D009593:Nitroimidazoles; D014344:Trypanocidal Agents; C009999:benzonidazole