Experimental and Clinical Treatment of Chagas Disease: A Review

Am J Trop Med Hyg. 2017 Nov;97(5):1289-1303. doi: 10.4269/ajtmh.16-0761. Epub 2017 Oct 10.

Abstract

Chagas disease (CD) is caused by the protozoan parasite Trypanosoma cruzi that infects a broad range of triatomines and mammalian species, including man. It afflicts 8 million people in Latin America, and its incidence is increasing in nonendemic countries owing to rising international immigration and nonvectorial transmission routes such as blood donation. Since the 1960s, the only drugs available for the clinical treatment of this infection have been benznidazole (BZ) and nifurtimox (NFX). Treatment with these trypanocidal drugs is recommended in both the acute and chronic phases of CD. These drugs have low cure rates mainly during the chronic phase, in addition both drugs present side effects that may result in the interruption of the treatment. Thus, more efficient and better-tolerated new drugs or pharmaceutical formulations containing BZ or NFX are urgently needed. Here, we review the drugs currently used for CD chemotherapy, ongoing clinical assays, and most-promising new experimental drugs. In addition, the mechanism of action of the commercially available drugs, NFX and BZ, the biodistribution of the latter, and the potential for novel formulations of BZ based on nanotechnology are discussed. Taken together, the literature emphasizes the urgent need for new therapies for acute and chronic CD.

Publication types

  • Review

MeSH terms

  • Animals
  • Chagas Disease / drug therapy*
  • Chagas Disease / epidemiology*
  • Chronic Disease
  • Clinical Trials as Topic
  • Disease Models, Animal
  • Drug Compounding
  • Humans
  • Incidence
  • Latin America / epidemiology
  • Nanoparticles / chemistry
  • Nifurtimox / pharmacokinetics
  • Nifurtimox / therapeutic use*
  • Nitroimidazoles / pharmacokinetics
  • Nitroimidazoles / therapeutic use*
  • Observational Studies as Topic
  • Randomized Controlled Trials as Topic
  • Tissue Distribution
  • Trypanocidal Agents / pharmacokinetics
  • Trypanocidal Agents / therapeutic use*
  • Trypanosoma cruzi

Substances

  • Nitroimidazoles
  • Trypanocidal Agents
  • Nifurtimox
  • benzonidazole