Article
Chronic phase of Chagas disease: why should it be treated? A comprehensive review
Registro en:
COURA, José Rodrigues; PEREIRA, José Borges. Chronic phase of Chagas disease: why should it be treated? A comprehensive review. Mem Inst Oswaldo Cruz, v.106, n.6, p.641-645, Sept.2011.
0074-0276
Autor
Coura, José Rodrigues
Pereira, José Borges
Resumen
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.