Chagas disease in the immunocompromised host.

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES
Current Opinion in Infectious Diseases Pub Date : 2024-10-01 Epub Date: 2024-07-04 DOI:10.1097/QCO.0000000000001035
Eva H Clark, Caryn Bern
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引用次数: 0

Abstract

Purpose of review: To highlight recent advances in our understanding of Trypanosoma cruzi infection in immunocompromised individuals, a condition that is increasingly recognized as populations shift and use of immunosuppressive medications becomes more commonplace.

Recent findings: Chagas disease screening programs should include people at risk for both Chagas disease and immunocompromise, e.g. people who have resided for ≥6 months in endemic Latin America who have an immunocompromising condition such as HIV or who are planned to start an immunosuppressive medication regimen. The goal of identifying such individuals is to allow management strategies that will reduce their risk of T. cruzi reactivation disease. For people with HIV- T. cruzi coinfection, strict adherence to antiretroviral therapy is important and antitrypanosomal treatment is urgent in the setting of symptomatic reactivation. People at risk for T. cruzi reactivation due to immunosuppression caused by advanced hematologic conditions or postsolid organ transplantation should be monitored via T. cruzi qPCR and treated with preemptive antitrypanosomal therapy if rising parasite load on serial specimens indicates reactivation. Reduction of the immunosuppressive regimen, if possible, is important.

Summary: Chronic Chagas disease can lead to severe disease in immunocompromised individuals, particularly those with advanced HIV (CD4 + < 200 cells/mm 3 ) or peri-transplantation.

免疫力低下宿主的南美锥虫病。
综述的目的:随着人口迁移和免疫抑制药物的使用越来越普遍,人们越来越认识到这种疾病:恰加斯病筛查计划应包括同时患有恰加斯病和免疫力低下的高危人群,例如,在拉丁美洲恰加斯病流行地区居住≥6 个月,患有艾滋病毒等免疫力低下疾病,或计划开始接受免疫抑制药物治疗的人群。识别这些人的目的是制定管理策略,降低他们罹患克鲁兹原虫再活化疾病的风险。对于同时感染艾滋病毒和克鲁兹绦虫的人来说,严格遵守抗逆转录病毒疗法非常重要,在出现症状性再活化的情况下,抗盘虫治疗是当务之急。对于因晚期血液病或实体器官移植后引起的免疫抑制而面临 T. cruzi 再激活风险的人群,应通过 T. cruzi qPCR 进行监测,如果连续标本中寄生虫量上升表明有再激活迹象,则应进行先期抗盘虫治疗。小结:慢性恰加斯病可导致免疫功能低下者,尤其是晚期艾滋病毒感染者(CD4+ < 200 cells/mm3)或移植前后的患者出现严重疾病。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.70
自引率
2.60%
发文量
121
审稿时长
6-12 weeks
期刊介绍: This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.
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