title: Update in treatment of Chagas disease.
abstract: OBJECTIVE
  This review discusses the recent data about the pathogenesis of Chagas disease, tolerance of drugs, and follow-up of patients impacting the treatment of Chagas disease in immunocompetent and immunocompromised patients.
  
  
  RESULTS
  The role of the parasite to promote direct or indirect organ damage in the chronic phase of the disease as well as the usefulness of antiparasitic treatment to slow or prevent the deterioration of cardiac function and the aggravation of Chagasic cardiomyopathy lead to an extension of the indications of treatment. Tolerance is poor for the two drugs, benznidazole and nifurtimox. The rates of adverse events and treatment discontinuation before 60 days are higher with nifurtimox. PCR, and in the near future immunologic tests, might allow assessment of the early success or failure of the antiparasitic treatment.
  
  
  CONCLUSIONS
  Assessment of alternative drugs, such as posaconazole, and of new strategies of treatment (combination of two antiparasitic drugs, association of antiparasitic and immunomodulatory drugs, and re-treatment), and follow-up are a global health priority.
authors.affiliation: Service des Maladies Infectieuse et Tropicales, Hôpitaux Universitaires Paris Est - Tenon, AP-HP, Université Pierre et Marie Curie, Paris, France. guillaume.le-loup@tnn.aphp.fr
authors.forename: Guillaume
authors.initials: G
authors.lastname: Le Loup
authors.forename: Gilles
authors.initials: G
authors.lastname: Pialoux
authors.forename: François Xavier
authors.initials: FX
authors.lastname: Lescure
mesh_terms: D014355:Chagas Disease / Q000188:drug therapy*; D002908:Chronic Disease; D006801:Humans; D007108:Immune Tolerance; D016867:Immunocompromised Host; D009593:Nitroimidazoles / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D014344:Trypanocidal Agents / Q000627:therapeutic use*; D014349:Trypanosoma cruzi / Q000472:pathogenicity
chemical_list: D009593:Nitroimidazoles; D014230:Triazoles; D014344:Trypanocidal Agents; C101425:posaconazole