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洪都拉斯约罗省近期慢性恰加斯感染患儿队列的治疗和血清转换。

Treatment and seroconversion in a cohort of children suffering from recent chronic Chagas infection in Yoro, Honduras.

机构信息

Médécins Sans Frontières-Spain, Barcelona, Spain.

出版信息

Mem Inst Oswaldo Cruz. 2009 Nov;104(7):986-91. doi: 10.1590/s0074-02762009000700008.

Abstract

Between 1999-2002, Médécins Sans Frontières-Spain implemented a project seeking to determine the efficacy and safety of benznidazole in the treatment of recent chronic Chagas disease in a cohort of seropositive children in the Yoro Department, Honduras. A total of 24,471 children were screened for Trypanosoma cruzi IgG antibodies through conventional enzyme-linked immunosorbent assays (ELISA) on filter paper. Recombinant ELISA (0.93% seroprevalence) showed 256 initially reactive cases, including 232 confirmed positive cases. Of these, 231 individuals were treated with benznidazole (7.5 mg/kg/day) for 60 days and were followed with a strict weekly medical control and follow-up protocol. At the end of the project, 229 patients were examined by the Honduras Secretariat of Health for post-treatment serological assessments; 88.2% seroconverted after 18 months and 93.9% seroconverted after three years. No differences were found in the seroconversion rates according to age or sex. Most of the side effects of the treatment were minor. These results support the argument that in areas where T. cruzi I is predominant and in areas affected by T. cruzi II, when vector transmission has been interrupted, Chagas disease diagnosis and treatment are feasible, necessary and ethically indisputable.

摘要

1999-2002 年期间,无国界医生组织-西班牙实施了一个项目,旨在确定苯并咪唑在洪都拉斯约罗省新近发生慢性恰加斯病的一组血清阳性儿童中的疗效和安全性。共有 24471 名儿童通过滤纸酶联免疫吸附试验(ELISA)进行了克氏锥虫 IgG 抗体的常规筛查。重组 ELISA(0.93%的血清阳性率)显示 256 例最初呈反应性的病例,其中包括 232 例确诊阳性病例。其中,231 人接受了苯并咪唑(7.5mg/kg/天)治疗 60 天,并按照严格的每周医疗控制和随访方案进行了随访。项目结束时,229 名患者由洪都拉斯卫生部进行了治疗后血清学评估;18 个月后 88.2%的患者发生血清转换,3 年后 93.9%的患者发生血清转换。血清转化率与年龄或性别无关。治疗的大多数副作用较小。这些结果支持了这样的论点,即在 T. cruzi I 占主导地位的地区和受 T. cruzi II 影响的地区,当媒介传播被中断时,恰加斯病的诊断和治疗是可行的、必要的,在伦理上也是无可争议的。

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