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Premium Usefulness of PCR Strategies For Early Diagnosis of Chagas' Disease Reactivation and Treatment Follow‐Up in Heart Transplantation
Author(s)
Diez M.,
Favaloro L.,
Bertolotti A.,
Burgos J. M.,
Vigliano C.,
Lastra M. P.,
Levin M. J.,
Arnedo A.,
Nagel C.,
Schijman A. G.,
Favaloro R. R.
Publication year2007
Publication title
american journal of transplantation
Resource typeJournals
PublisherBlackwell Publishing Ltd
Heart transplantation (HTx) is a useful therapy for end‐stage Chagaś cardiomyopathy; however, Chagas reactivation remains a mayor complication. Parasitological methods offer poor diagnostic sensitivity, and use of more sensitive tools such as the Polymerase chain reaction (PCR) is usually necessary. In the present study, reactivation incidence and PCR usefulness for early reactivation diagnosis, as well as for treatment response evaluation during follow‐up, were analyzed using Strout parasite detection test, in 10 of 222 consecutive HTx patients suffering Chagas cardiomyopathy. PCR strategies targeted to minicircle sequences (kDNA, detection limit 1 parasite/ 10 mL blood) and miniexon genes (SL‐DNA, 200 parasite/10 mL) were performed to compare parasite burdens between samples. No patients received prophylactic antiprotozoal therapy (benznidazole). Five patients (50%) exhibited clinical reactivation within a mean period of 71.6 days; positive Strout results were observed in most cases presenting clinical manifestations. kDNA‐PCR was positive 38–85 days before reactivation, whereas SLDNA‐PCR became positive only 7–21 days later, revealing post‐HTx parasitic load enhancement present prior to clinical reactivation development. Reactivations were successfully treated with benznidazole and generated negative PCR results. Results observed in this study indicate the value of PCR testing for an early diagnosis of Chagas reactivation as well as for monitoring treatment efficacy.
Subject(s)benznidazole , biochemistry , biology , cardiomyopathy , chagas disease , computer science , gene , heart failure , heart transplantation , immune system , immunology , incidence (geometry) , medicine , minicircle , nifurtimox , optics , parasite hosting , parasite load , physics , polymerase chain reaction , transplantation , trypanosoma cruzi , trypanosomiasis , world wide web
Language(s)English
SCImago Journal Rank2.89
H-Index188
eISSN1600-6143
pISSN1600-6135
DOI10.1111/j.1600-6143.2007.01820.x

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