APHP Hôpital Tenon, Université Pierre et Marie Curie, Paris, France.
Lancet Infect Dis. 2010 Aug;10(8):556-70. doi: 10.1016/S1473-3099(10)70098-0.
More than 100 years after the discovery of human American trypanosomiasis by Carlos Chagas, our knowledge and management of the disease are profoundly changing. Substantial progress made by disease control programmes in most endemic areas contrasts with persisting difficulties in the Gran Chaco region in South America and the recent emergence of the disease in non-endemic areas because of population movements. In terms of pathogenesis, major discoveries have been made about the life cycle and genomics of Trypanosoma cruzi, and the role of the parasite itself in the chronic phase of the disease. From a clinical perspective, a growing number of arguments have challenged the notion of an indeterminate phase, and suggest new approaches to manage patients. New methods such as standardised PCR will be necessary to ensure follow-up of this chronic infection. Although drugs for treatment of Chagas disease are limited, poorly tolerated, and not very effective, treatment indications are expanding. The results of the Benznidazole Evaluation For Interrupting Trypanosomiasis (BENEFIT) trial in 2012 will also help to inform treatment. Mobilisation of financial resources to fund research on diagnosis and randomised controlled trials of treatment are international health priorities.
在 Carlos Chagas 发现人类美洲锥虫病 100 多年后，我们对该病的认识和管理正发生深刻变化。大多数流行地区的疾病控制规划取得了实质性进展，而南美洲大查科地区仍存在持续困难，且由于人口流动，该病最近又出现在非流行地区。在发病机制方面，对克氏锥虫的生命周期和基因组学以及寄生虫本身在该病慢性期的作用有了重大发现。从临床角度来看，越来越多的观点对不定型期的概念提出了质疑，并为患者的管理提出了新的方法。需要使用标准化 PCR 等新方法来确保对这种慢性感染的随访。虽然治疗锥虫病的药物有限，耐受性差，效果也不是很好，但治疗适应证正在扩大。2012 年 Benznidazole Evaluation For Interrupting Trypanosomiasis（BENEFIT）试验的结果也将有助于指导治疗。动员财政资源用于诊断研究和治疗的随机对照试验是国际卫生优先事项。
