title: Usefulness of qualitative polymerase chain reaction for Trypanosoma cruzi DNA in endomyocardial biopsy specimens of chagasic heart transplant patients.
abstract: BACKGROUND
  Chagas' disease reactivation (CDR) after heart transplantation is characterized by relapse of the infectious disease, with direct detection of Trypanosoma cruzi parasites in blood, cerebrospinal fluid, or tissues. CDR affecting the myocardium induces lymphocytic myocarditis and should be distinguished from acute cellular rejection in endomyocardial biopsy (EMB) specimens.
  
  
  METHODS
  We performed retrospectively qualitative polymerase chain reaction for T cruzi DNA using 2 sets of primers targeting nuclear DNA (nDNA) or kinetoplast DNA (kDNA) in 61 EMB specimens of 11 chagasic heart transplant recipients who presented with CDR. Thirty-five EMB specimens were obtained up to 6 months before (pre-CDR group) and 26 up to 2 years after the diagnosis of CDR. The control group consisted of 6 chagasic heart transplant recipients with 18 EMB specimens who never experienced CDR.
  
  
  RESULTS
  Amplification of kDNA occurred in 8 of 35 (22.9%) EMB specimens of the pre-CDR group, in 5 of 18 (27.8%) of the control group, and in 17 of 26 (65.4%) EMB specimens obtained after the successful treatment of CDR. Amplification of nDNA occurred in 3 of 35 (8.6%) EMB specimens of the pre-CDR group, 0 of 18 (0%) of the control group, and 6 of 26 (23.1%) EMB specimens obtained after the successful treatment of CDR.
  
  
  CONCLUSIONS
  Amplification of kDNA in EMB specimens is not specific for the diagnosis of CDR, occurring also in patients with no evidence of CDR (control group). However, amplification of nDNA occurred in a few EMB specimens obtained before CDR, but in none of the control group specimens. Qualitative PCR for T cruzi DNA in EMB specimens should not be used as a criterion for cure of CDR because it can persist positive despite favorable clinical evolution of the patients.
authors.affiliation: Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil. anpluiz@incor.usp.br
authors.forename: Luiz A
authors.initials: LA
authors.lastname: Benvenuti
authors.forename: Alessandra
authors.initials: A
authors.lastname: Roggério
authors.forename: Guilherme
authors.initials: G
authors.lastname: Coelho
authors.forename: Alfredo I
authors.initials: AI
authors.lastname: Fiorelli
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002467:Cell Nucleus; D014355:Chagas Disease / Q000175:diagnosis* / Q000469:parasitology / Q000601:surgery; D018105:DNA, Kinetoplast / Q000032:analysis; D016054:DNA, Protozoan / Q000032:analysis*; D004699:Endocardium / Q000469:parasitology; D005260:Female; D006321:Heart / Q000469:parasitology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D016133:Polymerase Chain Reaction / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D014349:Trypanosoma cruzi / Q000235:genetics / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D018105:DNA, Kinetoplast; D016054:DNA, Protozoan