Chagas disease reactivation in rheumatologic patients: association with immunosuppressive therapy and humoral response

RINGER, ARIANA; RUFFINO, JUAN PABLO; LEIVA, RODOLFO; CUADRANTI, NADIA; ARGENTO, MARÍA CECILIA; MARTÍNEZ, MARÍA FLORENCIA; ROLLA, IGNACIO; CHULIBERT, SERENELA; CARBONE, DANIELA; PALATNIK, MARIANO; CORTESE, MARIA NOEL; LAGRUTTA, MARIANA; CÓRDOBA, LAURA; GONZÁLEZ, FLORENCIA BELÉN; PACINI, MARÍA FLORENCIA; VILLAR, SILVINA RAQUEL; ÁGUILA, DAMIAN; BOTTASSO, OSCAR ADELMO; PÉREZ, ANA ROSA; ABDALA, MARCELO

CLINICAL RHEUMATOLOGY.

SPRINGER

Año: 2021

0770-3198

Evidence for Chagas disease reactivation (CDR) in rheumatologic patients under rheumatologic treatments (RTs) is scarce. To screen and follow-up patients with rheumatic diseases and concomitant Chagas disease under RT to detect CDR and to describe a possible relationship between CDR and specific RT. An observational, longitudinal, prospective, consecutive study was carried out between 2018 and 2020. Included patients were evaluated during the follow-up for clinical and laboratorial manifestations of CDR. Direct blood parasitological examination (Strout method) and polymerase chain reaction (PCR) were employed to diagnose CDR. The dynamic of anti-T. cruzi?specific antibodies was also assessed by IHA and ELISA (total IgG and Anti-SAPA).Fifty-one patients were included (86% women). Rheumatoid arthritis was the predominant disease (57%). Classic DMARDs (86.3%) and corticosteroids (61%) were the most frequent RT. CDR was developed in 6 patients (11.7%), exhibiting both positive Strout and PCR. Symptomatic reactivation of CD (fever, asthenia, arthralgias, myalgias) occurred in two patients who had previously been diagnosed with it. Regardless of the different RT, all patientswho experienced CDR had previously received more than ≥ 20 mg/day of prednisone equivalent. Despite immunosuppression, patients with CDR exhibited increased levels of specific anti-T. cruzi and anti-SAPA antibodies, which decreased after anti-parasitic treatment. CDR is possible in rheumatologic patients, especially after receiving high doses of corticosteroids. Since CDR symptoms may mimic rheumatic disease activity, monitoring of Chagas disease is highly recommended before, during and after immunosuppression.