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Parasitología al día

versão impressa ISSN 0716-0720


APT, Werner. TREATMENT OF CHAGAS DISEASES. Parasitol. día [online]. 1999, vol.23, n.3-4, pp.100-112. ISSN 0716-0720.

Up to day, it is accepted that human Chagas disease must be treated in any of its evolution periods , with the only exception of the chronical terminal phase In the acute clinical period infection of less than two months and in the biological period with demonstration of parasites in fresh blood smears, stick drop, with positive conventional serology and positive IgM. Treatment is with nifurtimox (NF) 8-10 mg/kg per day in adults and 15 mg/kg per day in children for 60-90 days. The dosis is given in three daily intakes. The clinical and serology cure 60%. In Brazil where this drug is not used benznidazol (BNZ) is prescribed at dosis of 5 mg/kg per day for adults and 5-10 mg/kg per day in children during 60 days. In congenital infection therapy must be applied as soon as the dignosis is confirmed by clinic and demonstration of parasites at fresh blood, smear microstraut, etc. In the new born often the dignosis is done when he has the chronic period of the infection by persistence of the conventional serology for more than 6 months. In these cases a clinical, serological and parasitological follow up have to be performed. Accidental infections must receive treatment during 10 days. In organ transplant with a chagasic recipient or donor treatment is indicated with NF or BNZ in the same dosis and time as was written above. Reactivations in chronic cases, example persons who acquire AIDS, or present a depresion of cellular immunity like leukemia, Hodgkin, etc. must be treated as acute cases with NF or BNZ for 5 or more months. In these cases prevention is the best to perform : Chagas serology to patiens with AIDS, etc. In the chronic period there is consensus in the treatment due that either in the indeterminate or in the recent chronic period therapy has compliance since there are always tissue parasites demonstrated by PCR.In children less than 10 years of age with chronic recent infection, treatment with NF during 60 días or BNZ at dosis of 5 mg/kg per day in children with the indeterminate phase has given good results. In adults itraconazol at dosis of 6 mg/kg per day during 120 days, in twc daily intake a 60% of cure is obtained. With BNZ at a dosis of 5 mg/kg per day during 30 days a decrease of the new electrocardiographic in chronic cardiophats has been observed. It is important to point out that generally in the chronic period there is no negativation of conventional serology and the criteria of cure is based in others parameters , such as negativization of xenodiagnosis or hemocultures, change positive PCR to negative.

Palavras-chave : Chagas disease; Tratment; Nifurtimox; Benznidazol; Itraconazol.

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