Cancado J Romeu
Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Rev Inst Med Trop Sao Paulo. 2002 Jan-Feb;44(1):29-37.
The aim of this article is to present an investigation of cure rate, after long follow up, of specific chemotherapy with benznidazole in patients with both acute and chronic Chagas disease, applying quantitative conventional serological tests as the base of the criterion of cure. Twenty one patients with the acute form and 113 with one or other of the various chronic clinical forms of the disease were evaluated, after a follow up period of 13 to 21 years, for the acute, and 6 to 18 years, for the chronic patients. The duration of the acute as well as the chronic disease, a condition which influences the results of the treatment, was determined. The therapeutic schedule was presented, with emphasis on the correlation between adverse reactions and the total dose of 18 grams, approximately, as well as taking into consideration precautions to assure the safety of the treatment. Quantitative serological reactions consisting of complement fixation, indirect immunofluorescence, indirect hemagglutination, and, occasionally, ELISA, were used. Cure was found in 76 per cent of the acute patients but only in 8 per cent of those with chronic forms of the disease. In the light of such contrasting results, fundamentals of the etiological therapy of Chagas disease were discussed, like the criterion of cure, the pathogenesis and the role of immunosuppression showing tissue parasitism in long standing chronic disease, in support of the concept that post-therapeutic consistently positive serological reactions mean the presence of the parasite in the patient's tissues. In relation to the life-cycle of T. cruzi in vertebrate host, there are still some obscure and controversial points, though there is no proof of the existence of resistant or latent forms. However, the finding over the last 15 years, that immunosuppression brings about the reappearance of acute disease in long stand chronic patients justifies a revision of the matter. Facts were quoted in favor of the treatment of chronic patients.
本文旨在通过长期随访，对急性和慢性恰加斯病患者使用苯硝唑进行特异性化疗的治愈率展开调查，并采用定量常规血清学检测作为治愈标准的依据。对21例急性病患者和113例患有该病各种慢性临床形式之一的患者进行了评估，急性病患者的随访期为13至21年，慢性病患者的随访期为6至18年。确定了急性病和慢性病的病程，这一情况会影响治疗结果。介绍了治疗方案，重点强调了不良反应与约18克总剂量之间的相关性，并考虑了确保治疗安全的预防措施。使用了包括补体结合、间接免疫荧光、间接血凝，偶尔还有酶联免疫吸附测定在内的定量血清学反应。结果发现，76%的急性病患者治愈，但慢性病患者中只有8%治愈。鉴于这些截然不同的结果，讨论了恰加斯病病因治疗的基本原理，如治愈标准、发病机制以及免疫抑制在长期慢性病中显示组织寄生虫感染的作用，以支持治疗后血清学反应持续呈阳性意味着患者组织中存在寄生虫这一观点。关于克氏锥虫在脊椎动物宿主中的生命周期，尽管没有证据表明存在抗性或潜伏形式，但仍有一些模糊和有争议的问题。然而，过去15年的研究发现，免疫抑制会使长期慢性病患者再次出现急性病，这证明有必要对此问题进行重新审视。文中引用了支持治疗慢性病患者的事实。
