Course of Chronic Trypanosoma cruzi Infection after Treatment Based on Parasitological and Serological Tests: A Systematic Review of Follow-Up Studies

摘要: Background Chagas disease is caused by the flagellate protozoan Trypanosoma cruzi (T. cruzi). It endemic in Latin American countries outside Caribbean. The current criterion for cure chronic phase of negativization at least two serological tests such as enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence (IIF) and hemagglutination (IHA). evolution treated subjects with T. infection variable. Treatment failure indicated a positive parasitological and/or molecular test (persistence parasitemia). Objectives To summarize pattern response to treatment parasitological, performed during follow-up infection. Methods Electronic searches relevant databases screening citations potentially eligible articles were accomplished. Organizations focusing on neglected infectious diseases asked help identifying studies. Included studies randomized controlled trials (RCTs), quasi-RCTs, cohort involving adults children who received trypanocidal (benznidazole or nifurtimox) followed over time. assessment risk bias was separately each study design. Cochrane Collaboration’s tool guidelines developed Hayden et al. used. Two reviewers extracted all data independently. A third review author consulted case discordant opinion. Additional analyses defined ad-hoc basis. Scatter plots percentage negative using lowess curve technique. Heterogeneity measured I2. The protocol registered PROSPERO, an international prospective register systematic protocols (Registration Number CRD42012002162). Results Out 2,136 screened, 54 (six RCTs 48 studies) included. smoothed curves xenodiagnosis polymerase chain reaction (PCR) characterized sharp decrease twelve month posttreatment. Afterwards, they reached 10–20% 40% PCR, respectively. conventional increased up 10% after months treatment. In long-term, rate between 20% 45%. The main sources identified across lack control confounding attrition bias. general, judged low domains. level heterogeneity included moderate high. Additional analysis incomplete because limited availability data. this regard, country origin participants might affect results tests, while outcomes. Subgroup suggested that seronegativization occurs earlier compared adults. Conclusions We acknowledge there dynamic based chronically infected Our findings suggest effect long-term follow-up. Further research needed explore potential conduct reliable subgroup analysis.