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The Treatment of Chagas Disease (South American Trypanosomiasis)

João Carlos Pinto Dias, MD, PhD
[+] Article and Author Information

From Federal University of Minas Gerais and Oswaldo Cruz Foundation, Brazil.


Note: The quote at the beginning of this editorial was translated from the Spanish by Dr. Dias, with additional modifications by the Editor.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: João Carlos Pinto Dias, MD, PhD, Federal University of Minas Gerais and Oswaldo Cruz Foundation, Augusto de Lima 1715, Belo Horizonte, Minas Gerais State, 30190-002 Brazil; e-mail, jcpdias@cpqrr.fiocruz.br.


Ann Intern Med. 2006;144(10):772-774. doi:10.7326/0003-4819-144-10-200605160-00012
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In every way, Chagas disease remains as a sad shadow that defines poverty, as it reflects the political and social difficulties of Latin America. Its control represents a moral and ethical imperative, since the disease means a great social debt that Latin American people have incurred and must pay (1).

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Managment Difficulties in Chronic Chagas Disease
Posted on June 2, 2006
Arun Prasath Jeevagan
University Hospital Aintree
Conflict of Interest: None Declared

The article is good in explaining the current difficulties in managing the cardiac morbidity and mortality arising out of chronic chagas disease.Eventhough Benznidazole has shown some benefits, still its efficacy is controversial.

One of the meta-analysis clearly deducts and explains the need for a well organised double blind randomised controlled trial in establishing the role and efficacy of newer drugs for chronic chagas disease and the cardiac problems.(1)

Benznidazole doesn't completely eradicates the parasite. According to a recent research on mechanism of the drug, showcases the fact that only the antibodies against T. cruzi antigens against peptides of the second extracellular loops of beta1-adrenergic and M2-muscarinic cardiac receptors were redcued in the sera from benznidazole-treated patients, despite the lack of complete parasite eradication(2)

Many research results points to the fact that phylogenetic divergence among T. cruzi clonal genotypes must be taken in account in chemotherapy and studies dealing with all aspects of the parasite and the disease.Different drugs work well in different types.(3)

Finally, regarding the latest developments in chronic phase of chagas disease treatment,is the latest triazole antifungal compounds which are potent inhibitors of the sterol C14alpha demethylase of the parasite , are capable of inducing parasitological cures in murine models of both acute and chronic Chagas disease. They are currently the most advanced candidates for clinical traial.Other potential chemotherapeutic agents currently in development include antiproliferative lysophospholipid analogs , cysteine proteinase (cruzipain) inhibitors, and compounds that interfere with purine salvage and inositol metabolism.(4)

I am confident within next few years patients with chronic chagas disease will get a cure for sure.

References:

1) Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004102. Reyes PA et al

2)Antimicrob Agents Chemother. 2005 Apr;49(4):1521-8. Garcia S, et al

3) J Antimicrob Chemother. 2004 Jun;53(6):1045-53. Epub 2004 Apr 21. Toledo MJ et al

4) Curr Opin Infect Dis. 2001 Dec;14(6):733-41

Conflict of Interest:

None declared

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