Service des Maladies Infectieuse et Tropicales, Hôpitaux Universitaires Paris Est - Tenon, AP-HP, Université Pierre et Marie Curie, Paris, France.
Curr Opin Infect Dis. 2011 Oct;24(5):428-34. doi: 10.1097/QCO.0b013e32834a667f.
This review discusses the recent data about the pathogenesis of Chagas disease, tolerance of drugs, and follow-up of patients impacting the treatment of Chagas disease in immunocompetent and immunocompromised patients.
The role of the parasite to promote direct or indirect organ damage in the chronic phase of the disease as well as the usefulness of antiparasitic treatment to slow or prevent the deterioration of cardiac function and the aggravation of Chagasic cardiomyopathy lead to an extension of the indications of treatment. Tolerance is poor for the two drugs, benznidazole and nifurtimox. The rates of adverse events and treatment discontinuation before 60 days are higher with nifurtimox. PCR, and in the near future immunologic tests, might allow assessment of the early success or failure of the antiparasitic treatment.
Assessment of alternative drugs, such as posaconazole, and of new strategies of treatment (combination of two antiparasitic drugs, association of antiparasitic and immunomodulatory drugs, and re-treatment), and follow-up are a global health priority.
本综述讨论了克氏锥虫病发病机制、药物耐受性以及对免疫功能正常和免疫功能低下患者治疗有影响的患者随访方面的最新数据。
寄生虫在疾病慢性期促进直接或间接器官损伤的作用，以及抗寄生虫治疗减缓或预防心功能恶化和加重恰加斯心肌病的作用，导致治疗适应证的扩大。苯硝唑和硝呋替莫这两种药物的耐受性都很差。在 60 天之前，使用硝呋替莫的不良事件和停药率更高。PCR，以及在不久的将来免疫检测，可能可以评估抗寄生虫治疗的早期成败。
评估替代药物，如泊沙康唑，以及新的治疗策略（两种抗寄生虫药物联合治疗、抗寄生虫和免疫调节药物联合治疗以及再治疗）和随访，是全球卫生的重点。
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