infectious diseases
Chagas Disease
Treatment of Chagas Disease
Benznidazoleornifurtimox Supportive care Treatment of acute-stage Chagas disease with antiparasitic drugs does the following: Rapidly reduces parasitemia Shortens the clinical illness Reduces risk of mortality Decreases the likelihood of chronic disease Antiparasitic treatment is indicated for all cases of acute, congenital, or reactivated Chagas disease and for chronic indeterminate infection in children up to age 18 years. The younger the patient and the earlier treatment is started, the more likely that treatment will result in parasitologic cure. The efficacy of treatment decreases as the duration of infection lengthens, and adverse effects are more likely in adults. Treatment is indicated forT. cruzi-infected children up to age 18 years. It is recommended for those 18 to 50 years unless they have evidence of advanced cardiac or gastrointestinal (GI) disease. For patients > 50 years, treatment is individualized based on potential risks and benefits. Once signs of advanced cardiac or GI disease appear, antiparasitic drugs are not recommended. Supportive measures include Treatment , pacemakers for The only effective antiparasitic drugs are Benznidazole:For adults and children>12 years, 2.5 to 3.5 mg/kg orally twice a day for 60 days For children≤12 years, 2.5 to 3.75 mg/kg twice a day for 60 days Nifurtimox:For patients ≥ 17 years, 2 to 2.5 mg/kg orally 4 times a day for 90 days For children aged 11 to 16 years, 3 to 3.75 mg/kg 4 times a day for 90 days For children aged 1 to 10 years, 4 to 5 mg/kg 4 times a day for 90 days Benznidazoleis generally better tolerated, and the duration of treatment is shorter. Bothbenznidazoleandnifurtimoxhave substantial toxicity, which increases with age. Contraindications for treatment include severe liver or kidney disease. Young children usually tolerate treatment better than adults. When women are diagnosed with Chagas during pregnancy, treatment is typically delayed until after delivery, and the infant is then treated if infected. Common adverse effects ofbenznidazoleinclude allergic dermatitis, anorexia, weight loss, peripheral neuropathy, and insomnia. Common adverse effects ofnifurtimoxare anorexia, nausea, vomiting, weight loss, polyneuropathy, headache, dizziness, and vertigo. It is recommended that these medications not be used in pregnant women or in breastfeeding mothers. 