Clinical Care of Chagas Disease

Key points

  • Antiparasitic treatment is necessary for all acute or reactivated Chagas cases.
  • Nifurtimox and benznidazole are the drugs for T. cruzi infection.
  • About 20 – 30% of people with chronic T. cruzi infection develop cardiac disease, characterized by conduction abnormalities and potentially leading to cardiomyopathy.

Treatment options

Antiparasitic treatment is indicated for all cases of acute or reactivated Chagas disease and for chronic T. cruzi infection in children up to age 18. Congenital infections are considered acute disease. Treatment is strongly recommended for adults up to 50 years old with chronic infection who do not already have advanced cardiomyopathy. For adults older than 50 years with chronic T. cruzi infection, the decision to treat with antiparasitic drugs should be individualized, weighing the potential benefits and risks for the patient. Physicians should consider factors such as the patient's age, clinical status, preference, and overall health.

The two drugs used to treat infection with T. cruzi are nifurtimox and benznidazole. Benznidazole is approved by FDA for use in children 2 – 12 years of age and is available from www.benznidazoletablets.com. Lampit® (nifurtimox) is FDA approved for treatment of children from birth to younger than 18 years and is commercially available for pharmacies to purchase from several drug wholesalers. Side effects are fairly common with both drugs and tend to be more frequent and more severe with increasing age.

Common side effects of benznidazole treatment include the following:

  • Allergic dermatitis
  • Peripheral neuropathy
  • Anorexia and weight loss
  • Insomnia

The most common side effects of nifurtimox include the following:

  • Anorexia and weight loss
  • Polyneuropathy
  • Nausea
  • Vomiting
  • Headache
  • Dizziness or vertigo

Contraindications for treatment include severe hepatic and/or renal disease. As safety for infants exposed through breastfeeding has not been documented, withholding treatment while breastfeeding is also recommended. The following table outlines recommended dosage regimens by age group:

Drug

Age group

Dosage and duration

Benznidazole

2–12 years of age*

5–8 mg/kg per day orally in 2 divided doses for 60 days

Lampit®
(nifurtimox)

Birth to younger than 18 years of age,
weighing at least 2.5 kg**

Body weight greater than or equal to 41 kg:

8–10 mg/kg per day orally in 3 divided doses for 60 days

Body weight less than 41 kg:

10–20 mg/kg per day orally in 3 divided doses for 60 days

Questions regarding treatment should be directed to CDC's Parasitic Diseases Inquiries (404-718-4745; e-mail chagas@cdc.gov).

For emergencies (for example, acute Chagas disease with severe manifestations, Chagas disease in a newborn, or Chagas disease in an immunocompromised person) outside of regular business hours, call the CDC Emergency Operations Center (770-488-7100) and ask for the person on call for Parasitic Diseases.

* Benznidazole is FDA-approved for the treatment of Chagas disease (American trypanosomiasis) caused by Trypanosoma cruzi in pediatric patients 2 – 12 years of age. Use of benznidazole to treat a patient outside of the FDA-approved age range of 2 – 12 years is based on clinical diagnosis and decision by a treating physician under practice of medicine.

** Lampit® (nifurtimox) is FDA approved for treatment of Chagas disease (American trypanosomiasis) caused by Trypanosoma cruzi in pediatric patients from birth to younger than 18 years (weighing at least 2.5 kg). Use of nifurtimox to treat a patient outside of the FDA-approved age range of birth to younger than 18 years is based on clinical diagnosis and decision by the treating physician under practice of medicine.

Care precautions

About 20 – 30% of people with chronic Trypanosoma cruzi infection eventually develop clinical disease, predominantly cardiac disease. Cardiac disease usually begins with conduction abnormalities such as right bundle branch block and/or left anterior fascicular block, which may be followed years later by dilated cardiomyopathy. Later cardiac disease is sometimes accompanied by apical aneurysm and thrombus formation.

Less frequently, patients with Chagas disease experience gastrointestinal disease (megasyndromes). Once the characteristic pathology is established (e.g., dilated cardiomyopathy, megaesophagus), antiparasitic treatment will not reverse it.

Resources

For more detailed information on evaluation and treatment, the following links provide free access to review articles:

Use of trade names is for identification only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Services.

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)