The Chagas disease It is a disease caused by the Trypanosoma cruzi parasite, which is transmitted to humans through a bedbug bite.
In it Southern United States and throughout Latin America is a major public health problem. because this pathology is endemic.
It affects around the world 6 million people, and due to population movements, its presence has increased significantly in non-endemic areas, where it presents high rates of underdiagnosis. In Europe, an estimated 123,000 people are infected.
And although it seems like a disease that is far away, we must not forget that, according to data from specialists, in Spain there are almost 87,000 cases.
Besides the bed bug bitethere are other ways of transmission:
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Vertical transmission from infected mother to child during childbirth.
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Blood transfusions.
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Organ transplant.
Symptoms of Chagas disease
As with other pathologies, Chagas disease no symptoms in the majority of infected people, hence the problems of underdiagnosis.
They explain that the disease develops in two phases:
1 – Acute phase. In this phase there are usually no symptoms, or those that do occur (fever, fatigue, skin rash, body or headache,…) can be confused with other pathologies.
“The acute disease, after an incubation period of seven to ten days, simulates a flu condition, which is why it normally goes unnoticed,” they explain from the Catalan hospital.
2 – Chronic phase. In the event that Chagas disease is not treated, affected patients may end up developing chronic Chagas disease, after many years.
Specifically, between 30 and 40% of them will suffer visceral involvement in about 20 years, cardiomyopathy being the most common complication.
Do you have treatment?
There are currently only two treatments, dating from the 1960s and 1970s: the benznidazole and nifurtimox.
Benznidazole, the drug of first choice for this pathology and is indicated for the treatment of the acute phase of the disease, in congenital transmission and in reactivations of immunocompromised people.
However, its efficacy in the chronic phase is much more doubtful and controversial.
In the case of children in the chronic phase, the treatment is effective, but in adults it shows little positive effect.
This is the conclusion of a meta-analysis carried out by a team from the area of , the National Reference Center for Tropical Diseases, the Ramón y Cajal Hospital and the Ramón y Cajal Institute for Health Research (IRYCIS), which publishes the journal .
Poor tolerance to available treatments
Both benznidazole and nifurtimox are drugs poorly tolerated by patients. This leads to treatment abandonment due to the adverse effects they cause.
In addition, there is much uncertainty about its indication, dosage, and benefits, especially in chronically infected adult populations.
For this reason, this CIBERINFEC team has carried out a review of the existing literature on this treatment for chronic Chagas disease, analyzing 17 studies in which 6,640 patients participated.
Specifically, they focused on evaluating the effectiveness of the drug in preventing the clinical course of the disease (which could lead to a cardiovascular or digestive clinical event or even death), or its ability to cure the disease after treatment.
Effective treatment in children but not in adults
“Our meta-analysis shows a benefit of treating chronic Chagas disease with benznidazole to achieve seroreversion (cure) in children,” explains Clara Crespillo, a researcher at CIBERINFEC, the National Reference Center for Tropical Diseases, the Ramón y Cajal Hospital. and the Ramón Institute and IRYCIS, and one of the main authors of the work.
“In the pediatric population, the indication is well established thanks to some clinical trials carried out in the 1990s and the clinical experience accumulated to date,” he explains.
Regarding the adult population with chronic Chagas disease, despite the fact that most of the most recent studies have been carried out in this population, they provide low or very low certainty about the effectiveness of benznidazole.
“Benznidazole did not show benefit in the treatment of patients with chronic Chagas disease who present with established cardiomyopathy,” points out José A. Pérez Molina, head of the CIBERINFEC group at the Ramón y Cajal Hospital and another of the study coordinators.
However, “the data on the treatment of indeterminate chronic infection are insufficient, so there is still a very important area of research to cover,” he stresses.
Therefore, and “since new drugs are not expected in the near future, it would be desirable to promote trials with clinical results and long follow-up periods to evaluate the efficacy of current drugs for the treatment of indeterminate chronic Chagas disease”, they conclude. .