title: Treatment of Chagas' disease with itraconazole: electrocardiographic and parasitological conditions after 20 years of follow-up.
abstract: OBJECTIVE
  To evaluate cases of chronic Chagas' disease for the long-term effects of treatment with itraconazole on Trypanosoma cruzi infections and the regression or development of ECG abnormalities.
  
  
  METHODS
  In March 1992, we treated 46 patients with chronic Chagas' disease with 6 mg/kg/day of itraconazole for 120 days in a blind evaluation. The patients came from an area of Chile where the disease was endemic and were checked for ECG abnormalities and with xenodiagnosis (XD) or real-time XD-quantitative PCR (XD-qPCR) for Trypanosoma cruzi infection before treatment and once a year for 20 years.
  
  
  RESULTS
  Twenty-one patients proved to be uninfected after 20 years and 15 of the patients had a normal ECG. Of the latter cases, 32.6% could be considered cured, although all of them had positive serology. Itraconazole prevents the development of ECG abnormalities, because after 20 years of treatment only 10.86% of patients developed ECG abnormalities (Z = 1.70, P = 0.046). XD-qPCR performed on 16 patients demonstrated 10 cases with <1.42 parasites/mL: eight with <1 parasite/mL, one with 1.42 parasites/mL and one with 1.01 parasites/mL. Five patients had more than 11.75 parasites/mL, all of them with a positive XD; these cases correspond to therapy failure, since re-infection was ruled out. In one case, XD-qPCR did not present amplification.
  
  
  CONCLUSIONS
  Itraconazole is useful in the treatment of chronic Chagas' disease as it prevented the development of ECG abnormalities and cured 32.6% of patients.
authors: Laboratorio Parasitología Básico Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, PO Box 427, Santiago 3, Chile. wapt@med.uchile.cl
authors: Werner
authors: W
authors: Apt
authors: Arturo
authors: A
authors: Arribada
authors: Inés
authors: I
authors: Zulantay
authors: Jorge
authors: J
authors: Rodríguez
authors: Miguel
authors: M
authors: Saavedra
authors: Andrea
authors: A
authors: Muñoz
mesh_terms: D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D014355:Chagas Disease / Q000188:drug therapy* / Q000469:parasitology / Q000473:pathology; D002677:Chile; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage*; D010274:Parasitology; D013997:Time Factors; D016896:Treatment Outcome; D014349:Trypanosoma cruzi / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000981:Antiprotozoal Agents; D017964:Itraconazole
keywords: electrocardiographic abnormalities; nifurtimox; posaconazole; ravuconazole; triazole drugs