title: Electrocardiographic Abnormalities and Treatment with Benznidazole among Children with Chronic Infection by Trypanosoma cruzi: A Retrospective Cohort Study.
abstract: Chronic infection by Trypanosoma cruzi could cause heart conduction disturbances. We sought to analyze electrocardiographic abnormalities among children with chronic T. cruzi infection with and without trypanocidal treatment with benznidazole.
  
  
  
  We studied 111 children 6-16 years of age with asymptomatic chronic T. cruzi infection who were recruited in 1991-1992 in Salta, Argentina. Most children were randomly assigned to benznidazole 5 mg/Kg/day (n = 47) or matching placebo (n = 48) for 60 days. Remaining children (n = 16) received treatment with benznidazole 5 mg/Kg/day open-label. Electrocardiograms were obtained at baseline and in 1995-1996, 1998, 2000 and 2005, and were analyzed using the Buenos Aires method. Among the 94 children with an electrocardiogram at baseline, 8 (8.5%) had electrocardiographic abnormalities, including 4 (4.7%) children with right bundle branch block. Proportion of abnormal electrocardiograms in the full population (n = 111) remained constant over time (media follow-up 8.6 years). Multivariable adjusted prevalence ratios (95% confidence interval [95%CI]) for electrocardiographic abnormalities in 1995-1996, 1998, 2000 and 2005 comparing children treated with benznidazole versus those not treated were 2.76 (0.66, 11.60), 2.33 (0.44, 12.31), 3.06 (0.48, 19.56), and 1.94 (0.33, 11.25), respectively. Among the 86 children with a normal electrocardiogram at baseline, 16 (18.6%) developed electrocardiographic abnormalities during follow-up. The multivariable adjusted hazard ratio for incident electrocardiographic abnormalities comparing children treated with benznidazole versus those not treated was 0.68 (95%CI: 0.25, 1.88).
  
  
  
  Electrocardiographic abnormalities are frequent among children with chronic T. cruzi infection. Treatment with benznidazole for 60 days may not be associated with less electrocardiographic abnormalities.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.|Department of Public Health, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Lisandro D
authors.initials: LD
authors.lastname: Colantonio
authors.affiliation: National Institute of Parasitology "Dr. Mario Fatala Chaben"-CONICET-ANLIS, Ministry of Health, Buenos Aires, Argentina.
authors.forename: Nilda
authors.initials: N
authors.lastname: Prado
authors.affiliation: National Institute of Parasitology "Dr. Mario Fatala Chaben"-CONICET-ANLIS, Ministry of Health, Buenos Aires, Argentina.
authors.forename: Elsa L
authors.initials: EL
authors.lastname: Segura
authors.affiliation: National Institute of Parasitology "Dr. Mario Fatala Chaben"-CONICET-ANLIS, Ministry of Health, Buenos Aires, Argentina.
authors.forename: Sergio
authors.initials: S
authors.lastname: Sosa-Estani
mesh_terms: D000293:Adolescent; D001118:Argentina / Q000453:epidemiology; D002598:Chagas Cardiomyopathy / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D002648:Child; D015331:Cohort Studies; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D009593:Nitroimidazoles / Q000627:therapeutic use*; D012189:Retrospective Studies; D014344:Trypanocidal Agents / Q000627:therapeutic use*; D014349:Trypanosoma cruzi
chemical_list: D009593:Nitroimidazoles; D014344:Trypanocidal Agents; C009999:benzonidazole