Causality and Severity of Adverse Reactions and Biochemical Changes to Benznidazole Treatment in Patients with Chronic Chagas Disease. / Causalidade e Gravidade das Reações Adversas e Alterações Laboratoriais ao Tratamento com Benznidazol em Pacientes com Doença de Chagas Crônica.

BACKGROUND: Chagas disease (CD) is a serious public health problem in Latin America. Benznidazole (BNZ) is used for the treatment of CD and, despite its wide use, little information is available about its toxicity and mechanisms of adverse drug reactions (ADR). OBJECTIVES: To identify and classify clinical and laboratory adverse reactions caused by BNZ in terms of causality and severity. METHODS: Prospective cohort study from January 2018 to December 2021. Treatment follow-up included visits and biochemical tests (complete blood count, liver and kidney function tests) before, during and after treatment. ADR were classified according to causality and severity. In the statistical analysis, the significance level was set at p<0.05. RESULTS: Forty patients with chronic CD were included. A high prevalence of ADR was observed 161 ADR in 30 patients [90%]; of these, 104 (64.6%) were classified as possible and 57 (35.4%) as probable. The ADR were classified as moderate and mild. Of the 40 patients, nine (22.5%) discontinued treatment. ADR associated with treatment discontinuation and interventions were those that affected the dermatological system, central and peripheral nervous system and sense organs such as ageusia. Mild hematological and biochemical changes such as lymphopenia were observed after 30 days of treatment. CONCLUSION: Many patients were able to complete the treatment even with ADR, which can be attributed to the successful follow-up strategy with symptomatic treatment and counseling, leading to patient's awareness of symptoms and treatment adherence.

FUNDAMENTO: A Doença de Chagas (DC) representa um grave problema de saúde pública na América Latina. O Benznidazol (BNZ) é utilizado para o tratamento DC e, apesar do seu amplo uso, poucas informações estão disponíveis sobre sua toxicidade e mecanismos das Reações Adversas ao Medicamento (RAM). OBJETIVOS: Identificar e classificar as reações adversas clínicas e laboratoriais ocasionadas pelo uso do BNZ quanto à sua causalidade e gravidade. MÉTODOS: Estudo de coorte prospectivo realizado no período de janeiro de 2018 a dezembro de 2021. O acompanhamento do tratamento incluiu consultas e análises laboratoriais antes, 30 e 60 dias após o início do tratamento. As RAM foram classificadas quanto à causalidade e gravidade. Na análise estatística o nível de significância adotado foi p<0,05. RESULTADOS: Participaram do estudo 40 pacientes com DC crônica, observou-se alta prevalência de RAM com um total de 161 em 30 (90%) pacientes. Destas, 104 (64,6%) foram classificadas como possíveis e 57 (35,4%) como prováveis. As reações foram classificadas em moderadas e leves. Dos 40 pacientes, nove (22,5%) suspenderam o tratamento. As RAM associadas à interrupção e intervenções foram as que afetaram o sistema dermatológico, sistema nervoso central e periférico ou que culminaram em ageusia. Após 30 dias de tratamento, alterações hematológicas e bioquímicas leves foram observadas como linfopenia. CONCLUSÃO: Apesar do elevado percentual de RAM, muitos pacientes foram capazes de completar o tratamento, o que se atribui ao êxito da estratégia de acompanhamento com intervenções de tratamento sintomático juntamente ao aconselhamento, levando à compreensão da sintomatologia e manutenção do tratamento.

Immunosuppressive CD14+/HLA-DRlow/‒ monocytes in patients with Chagas Disease.

Chagas Disease (CD) is a neglected illness whose immunopathological mechanisms have not yet been plainly elucidated. The asymptomatic (indeterminate) form of CD is a long-term condition and approximately 20% to 35% of the individuals with this form evolve into one of the three chronic symptomatic clinical forms of CD, namely: cardiac, digestive or cardio-digestive (mixed). A variant of blood monocytes characterized by low expression of the HLA-DR antigen (CD14+/HLA-DRlow/‒) constitutes a subtype of myeloid-derived suppressor cells (MDSCs) whose main function is to regulate exacerbated inflammatory processes. The development of the symptomatic forms of CD can be related to the interaction between the host's immune system and the CD14+/HLA-DRlow/‒ immunosuppressive monocytes. Here, we evaluated, by flow cytometry, the absolute number and the HLA-DR antigenic density of this population of MDSCs in 57 patients with the diagnosis of CD: 34 with the symptomatic clinical forms (26 cardiac and 8 mixed) and 23 with the asymptomatic (indeterminate) form. The asymptomatic form exhibited a greater number of CD14+/HLA-DRlow/‒ monocytes and, accordingly, a low HLA-DR antigenic density, when compared to the symptomatic forms. It is possible to speculate that the predominance of CD14+/HLA-DRlow/- monocytes in the patients with the asymptomatic (indeterminate) form might have been a factor that could delay or even prevent the evolution of the asymptomatic form to the symptomatic forms of Chagas Disease.

Seroprevalence and risk factors of Chagas disease in a rural population of the Quixeré municipality, Ceará, Brazil.

INTRODUCTION: This study estimated the seroprevalence and risk factors of Chagas disease (CD) in a population of the Quixeré municipality, Ceará. METHODS: We conducted serological methods to detect the Trypanosoma cruzi infection. The other variables were evaluated by a standardized questionnaire. RESULTS: The estimated prevalence of CD was 3.7%. Male sex, age >40 years, being farmers, low education level, origin from rural areas, and being born in Quixeré were significantly associated with infection. CONCLUSION: CD persists in this rural population of Northeast Brazil. Poverty, low education, and limited information regarding CD are critical issues that need to be addressed.

Prevalence of Trypanosoma Cruzi Infection in Blood Donors. / Prevalência da Infecção pelo Trypanosoma cruzi em Doadores de Sangue.

BACKGROUND: Chagas disease (CD) is considered a public health problem in Latin America. The northeastern region, especially the state of Ceará, still represents a major concern in terms of the risk of transmission of CD. OBJECTIVE: To estimate the prevalence of T. cruzi in blood donors from the state of Ceará. METHODS: This is a retrospective descriptive study that was performed in the period from 2010 to 2015 from data recorded in the computerized system of the Hematology and Hemotherapy Center of Ceará (HEMOCE in Portuguese). RESULTS: Of the 763,731 potential blood donors, 14,159 were serologically ineligible; 1,982 (0.33%) were serologically ineligible due to positive / inconclusive diagnosis for CD. A total of 425 individuals came to the HEMOCE to repeat the test, with 28.2% (120/425) declared ineligible for donations due to CD. CONCLUSION: No significant reduction of positive / inconclusive serology was observed in the period between 2010 and 2015, but a reduction was observed when compared to 1996/1997 in the state. The determination of the prevalence of CD in blood banks may be relevant as an indicator of the risk of CD transmission through blood transfusions in a given region. New serological tests for triage with better accuracy in screening are needed, in an attempt to reduce the unnecessary disposal of blood bags, reduce costs for the Brazilian Unified Health System, and diminish insecurity for the patient and family members. (Arq Bras Cardiol. 2020; 115(6):1082-1091).

FUNDAMENTO: A doença de Chagas (DC) é considerada um problema de saúde pública na América Latina. A região nordeste, principalmente o estado do Ceará, ainda representa grande preocupação em termos de risco de transmissão da doença. OBJETIVO: Estimar a prevalência de T. cruzi em doadores de sangue do estado do Ceará. MÉTODOS: Trata-se um de estudo retrospectivo descritivo realizado no período de 2010 a 2015, a partir de dados registrados no sistema informatizado do Centro de Hematologia e Hemoterapia do Ceará (HEMOCE). RESULTADOS: Dos 763.731 potenciais doadores de sangue, 14.159 foram considerados impedidos de fazer a doação devido à sorologia, sendo que 1.982 (0,33%) o foram devido à positividade/inconclusão para doença de Chagas. Compareceram à Hemorrede para a repetição 425 indivíduos, sendo confirmados 28,2% (120/425) como impedidos de doar devido a DC. CONCLUSÃO: Não houve redução significativa das sorologias positivas/inconclusivas no período entre 2010-2015, porém foi observada redução em relação a 1996/1997 no estado. A determinação da prevalência da doença de Chagas em bancos de sangue pode ser relevante como indicador do risco de transmissão transfusional em determinada região. Novos testes sorológicos para triagem com melhor acurácia são necessários, reduzindo o descarte desnecessário de bolsas de sangue, os custos para o Sistema Único de Saúde e a insegurança para os pacientes e familiares. (Arq Bras Cardiol. 2020; 115(6):1082-1091).

Seroprevalence and risk factors of Chagas disease in a rural population of the Quixeré municipality, Ceará, Brazil

Abstract INTRODUCTION: This study estimated the seroprevalence and risk factors of Chagas disease (CD) in a population of the Quixeré municipality, Ceará. METHODS: We conducted serological methods to detect the Trypanosoma cruzi infection. The other variables were evaluated by a standardized questionnaire. RESULTS: The estimated prevalence of CD was 3.7%. Male sex, age >40 years, being farmers, low education level, origin from rural areas, and being born in Quixeré were significantly associated with infection. CONCLUSION: CD persists in this rural population of Northeast Brazil. Poverty, low education, and limited information regarding CD are critical issues that need to be addressed.

Prevalência da Infecção pelo Trypanosoma cruzi em Doadores de Sangue / Prevalence of Trypanosoma Cruzi Infection in Blood Donors

Resumo Fundamento A doença de Chagas (DC) é considerada um problema de saúde pública na América Latina. A região nordeste, principalmente o estado do Ceará, ainda representa grande preocupação em termos de risco de transmissão da doença. Objetivo Estimar a prevalência de T. cruzi em doadores de sangue do estado do Ceará. Métodos Trata-se um de estudo retrospectivo descritivo realizado no período de 2010 a 2015, a partir de dados registrados no sistema informatizado do Centro de Hematologia e Hemoterapia do Ceará (HEMOCE). Resultados Dos 763.731 potenciais doadores de sangue, 14.159 foram considerados impedidos de fazer a doação devido à sorologia, sendo que 1.982 (0,33%) o foram devido à positividade/inconclusão para doença de Chagas. Compareceram à Hemorrede para a repetição 425 indivíduos, sendo confirmados 28,2% (120/425) como impedidos de doar devido a DC. Conclusão Não houve redução significativa das sorologias positivas/inconclusivas no período entre 2010-2015, porém foi observada redução em relação a 1996/1997 no estado. A determinação da prevalência da doença de Chagas em bancos de sangue pode ser relevante como indicador do risco de transmissão transfusional em determinada região. Novos testes sorológicos para triagem com melhor acurácia são necessários, reduzindo o descarte desnecessário de bolsas de sangue, os custos para o Sistema Único de Saúde e a insegurança para os pacientes e familiares. (Arq Bras Cardiol. 2020; 115(6):1082-1091)

Abstract Background Chagas disease (CD) is considered a public health problem in Latin America. The northeastern region, especially the state of Ceará, still represents a major concern in terms of the risk of transmission of CD. Objective To estimate the prevalence of T. cruzi in blood donors from the state of Ceará. Methods This is a retrospective descriptive study that was performed in the period from 2010 to 2015 from data recorded in the computerized system of the Hematology and Hemotherapy Center of Ceará (HEMOCE in Portuguese). Results Of the 763,731 potential blood donors, 14,159 were serologically ineligible; 1,982 (0.33%) were serologically ineligible due to positive / inconclusive diagnosis for CD. A total of 425 individuals came to the HEMOCE to repeat the test, with 28.2% (120/425) declared ineligible for donations due to CD. Conclusion No significant reduction of positive / inconclusive serology was observed in the period between 2010 and 2015, but a reduction was observed when compared to 1996/1997 in the state. The determination of the prevalence of CD in blood banks may be relevant as an indicator of the risk of CD transmission through blood transfusions in a given region. New serological tests for triage with better accuracy in screening are needed, in an attempt to reduce the unnecessary disposal of blood bags, reduce costs for the Brazilian Unified Health System, and diminish insecurity for the patient and family members. (Arq Bras Cardiol. 2020; 115(6):1082-1091)