Congenital Chagas disease: long term follow-up of treated children, preliminary report

MOSCATELLI, GUILLERMO; BOCHOEYER A; BALLERING, GRISELDA; GONZALEZ NICOLAS; GOLDSMAN A; FREILIJ HECTOR; MORONI, SAMANTA; GRIPPO MARIA; ALTCHEH, JAIME

New Orleans

Congreso; ASTMH meeting; 2018

ASTMH

The aim of pharmacological treatment for patients with Chagas is to prevent cardiac involvement.Electrocardiogram (ECG) is the first indicator of cardiac involvement. A novel echocardiography (ECO) method for quantitative assessment of myocardial contractility deformation has been validated for detection of subclinical left ventricular dysfunction.Children treated for Chagas disease, with benznidazole or nifurtimox (for 60 days), with long term follow-up were enrolled. Clinical (ECG), parasitological (qPCR) and serological (IHA, EIA) data were collected at diagnosis, end of treatment and every 6 months thereafter. ECG was performed at diagnosis and every year after treatment. Also, Holter (24-hour ECG) and strain and speckle-tracking ECO were carried out at end of follow up for this study. As a control group, healthy children underwent the same cardiological evaluations.A total of 50 treated patients and 17 controls were enrolled. Treated patients: median age: 18.6 years (range 7-33). Median age at diagnosis was 2.35 years (range 0.04-20.3). Median follow-up: 12.5 years (range 6-19). Subjects were born in Argentina, and mainly congenitally infected. Persistent negative T cruzi qPCR and a decay of T.cruzi antibodies titers by IHA, EIA were observed. In 21/43 (48.8%) antibodies became negative.Cardiological evaluation by Holter and strain ECO were normal in 48/50 (96%) and in 41/41 (100%) patients, respectively. Only 2 treated patients showed sinus bradycardia and isolated premature ventricular beats (with normal strain ECO tests) and one beat 1st and 2nd AV blockade (with normal ECO) respectively. In control group (n: 17) median age was 12.91 years (range 6-23.8) One patient shown 2nd degree AV block with Wenckebach pattern and normal ECO and ergometer test. All infected patients showed parasitological and serological signs of treatment response. Only 2/50 patients in treated group and 1/17 in non-infective group showed signs of cardiac pathology, but we cannot rule out a chance finding at this stage. Further patients need to be included to evaluate cardiological involvement related to Chagas disease.