Chronic phase of Chagas disease: why should it be treated? A comprehensive review

• Published in: Memórias do Instituto Oswaldo Cruz Vol. 106; no. 6; pp. 641 - 645
• Main Authors: Coura, José Rodrigues, Borges-Pereira, José
• Format: Journal Article
• Language: English
• Published: Brazil Instituto Oswaldo Cruz, Ministério da Saúde 01.09.2011; Fundação Oswaldo Cruz (FIOCRUZ)
• Subjects: Animals; Chagas disease; Chagas Disease - complications; Chagas Disease - drug therapy; Chagas Disease - pathology; chemotherapy; Chronic Disease; chronic phase; combination of drugs; Disease Progression; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; new strategies; PARASITOLOGY; Pregnancy; repeated treatment; TROPICAL MEDICINE; Trypanocidal Agents - administration & dosage; Chagas disease; chronic phase; combination of drugs; repeated treatment; chemotherapy; new strategies
• ISSN: 0074-0276; 1678-8060; 1678-8060; 0074-0276
• DOI: 10.1590/S0074-02762011000600001

The pathogenesis and evolutive pattern of Chagas disease suggests that the chronic phase should be more widely treated in order to (i) eliminate Trypanosoma cruzi and prevent new inflammatory foci and the extension of tissue lesions, (ii) promote tissue regeneration to prevent fibrosis, (iii) reverse existing fibrosis, (iv) prevent cardiomyopathy, megaoesophagus and megacolon and (v) reduce or eliminate cardiac block and arrhythmia. All cases of the indeterminate chronic form of Chagas disease without contraindications due to other concomitant diseases or pregnancy should be treated and not only cases involving children or recently infected cases. Patients with chronic Chagas cardiomyopathy grade II of the New York Heart Association classification should be treated with specific chemotherapy and grade III can be treated according to medical-patient decisions. We are proposing the following new strategies for chemotherapeutic treatment of the chronic phase of Chagas disease: (i) repeated short-term treatments for 30 consecutive days and interval of 30-60 days for six months to one year and (ii) combinations of drugs with different mechanisms of action, such as benznidazole + nifurtimox, benznidazole or nifurtimox + allopurinol or triazole antifungal agents, inhibition of sterol synthesis.