Transplant infectious Disease, Department of Transplantation, Instituto de Nefrología/Nephrology, Buenos Aires, Argentina.
Clin Microbiol Infect. 2014 Apr;20(4):300-9. doi: 10.1111/1469-0691.12585.
This review addresses relevant aspects of Chagas disease in the immunocompromised host. Chagas disease--one of the world's most neglected diseases-has become a global public health concern. Novel transmission modalities, such as organ transplantation, evidence of parasite persistence in chronically infected individuals--with the potential for reactivation under immunosuppression--and the prolonged survival of immunosuppressed patients call for an appraisal of the disease in this particular setting. The management and outcome of solid organ transplantation in the infected recipient with special focus on heart transplantation is addressed. The guidelines for management and the outcome of the recipients of organs from infected donors are discussed, and comments on haematopoietic stem cell transplantation are included. Finally, Chagas disease in other situations of impairment of the immune system, such as HIV/AIDS and autoimmune diseases, are considered. Immunosuppression has become an increasingly frequent condition that might modify the natural history of Trypanosoma cruzi infection. A number of strategies are available for Chagas disease management in the immunosuppressed patient. First, according to recent recommendations from the health authorities in Argentina, most infected patients would benefit from being treated at diagnosis. This has not been validated for patients with different immunosuppressive disorders. A different strategy would involve treating only patients with documented reactivation (either parasitaemia or clinical manifestations). These different approaches are discussed. To reach a diagnosis of parasitaemia, monitoring is essential, either with conventional methods or with molecular techniques that are not yet available in all centres. Collaborative studies are needed to improve the level of evidence, which will allow for better guidelines.
这篇综述讨论了免疫功能低下宿主中恰加斯病的相关方面。恰加斯病——世界上最被忽视的疾病之一——已成为全球公共卫生关注的问题。新的传播方式，如器官移植，慢性感染个体中寄生虫持续存在的证据——在免疫抑制下有重新激活的潜力——以及免疫抑制患者的生存时间延长，都需要在这种特殊情况下重新评估这种疾病。本文重点讨论了感染受者的实体器官移植的管理和结局，以及讨论了来自感染供者的器官受者的管理和结局指南，并对造血干细胞移植进行了评论。最后，还考虑了其他免疫系统受损情况下的恰加斯病，如 HIV/AIDS 和自身免疫性疾病。免疫抑制已成为一种越来越常见的情况，可能会改变克氏锥虫感染的自然史。有许多策略可用于免疫抑制患者的恰加斯病管理。首先，根据阿根廷卫生当局的最新建议，大多数感染患者在诊断时将受益于治疗。但对于不同免疫抑制疾病的患者，这尚未得到验证。另一种策略是仅治疗有明确再激活（寄生虫血症或临床表现）的患者。这些不同的方法正在讨论中。为了诊断寄生虫血症，监测至关重要，无论是使用传统方法还是尚未在所有中心都可用的分子技术。需要开展合作研究来提高证据水平，从而制定更好的指南。
