Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently...
Transcript of Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently...
![Page 1: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/1.jpg)
Leading research at:
Actualizació sobre la Malaltia de Chagas
Joaquim GasconCentre de Recerca en Salut Internacional de Barcelona (CRESIB)-Hospital ClinicInstitut de Salut Global de Barcelona (ISGlobal)
![Page 2: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/2.jpg)
Leading research at:
Índex
1. Qué es la Malaltia de Chagas
2. Que hi ha de nou en…
a. Epidemiología i control: Europa es desperta lentament
b. Noves eines
• Avenços i retrocessos en el tractament parasitari
![Page 3: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/3.jpg)
Leading research at:
Hotez, PLoSNTD, 2008
![Page 4: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/4.jpg)
Leading research at:
LYFE CYCLEChagas is a zoonotic disease
Endemic to LatinAmerica
![Page 5: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/5.jpg)
Leading research at:
AMASTIGOT TRYPOMASTIGOT
- In the insect digestive tract.- Host blood
- Non replicative form- EXTRACELLULAR
- Mobile (flagelate)
-Replicative form in the vertebrates.
- INTRACELLULAR.
- Not mobile.
Low and intermitent parasitaemia in chronic forms
![Page 6: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/6.jpg)
Leading research at:
The vector and the parasite
The parasite. Six lineages: (All of them associated with cardiac damage)T.cruzi I (widespread but the only form in the north of the Amazon region)
T.cruzi II, V i VI (Southamerica). (also associated to digestive tract lesions)T,cruzi III i IV (Amazonia).
From: Carlomagno M, et al. 1989
The triatomine.Domestic and peridomestic environments in rural
dwellings and domestic animals
![Page 7: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/7.jpg)
Leading research at:
Vectorial
Oral. Outbreaks due to contaminated food or drinks
Blood transfusion
Organ Transplants
Vertical Transmission
Lab accidents
Transmission
![Page 8: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/8.jpg)
Leading research at:Phases of Chagas Disease
Acute Phase
Digestive ChronicForm (10-20%)
Cardiac Chronic Form (25-35%)
Deaths (2-3%)Subacute cases(5-10%)
(<50% symptomatic)
Chronic Forms
Indeterminate Form
(no symptoms, and no pathologic changes
detected by ECG, Rx, esofagogram or barium
enema)
~60% of infected people
Chronic Phase
Neurological ChronicForm (< 5%)
![Page 9: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/9.jpg)
Leading research at:CLINICAL SYMPTOMS
Acute form (4-8 weeks): Symptoms in <5% of infected people.
. Fever . Diarrhea
. Hepato-splenomegaly . Vomiting
. Chagoma
. Weakness
. Limphadenopathies
. Cutaneous Rash
Usually self-limited, except in cases ofMeningitis or carditis
Oral Transmission: More severe.
![Page 10: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/10.jpg)
Leading research at:
CHRONIC FORMS OF CHAGAS
Cardiac Chronic Form(fibrosing cardiopathy and
inflammatory lesions)
Dilated miocardiopathycongestive failure
Rhythm disturbancesThromboembolism.
Digestive Chronic Form(loss of neurons in the gut and
inflammatory lesions)
MegaesophagusMegacolon
Other megaviscera
![Page 11: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/11.jpg)
Leading research at:
DIAGNOSIS OF CHAGAS DISEASE
Acute cases:Parasitological tests
Thick blood filmStroutMicrohematocrit (newborns)Hemoculture
Molecular testPCR
Chronic / Indeterminate forms:
Serology (two tests with different antigens)ELISA, IHA, IFI
![Page 12: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/12.jpg)
Leading research at:
TREATMENTBenznidazol and Nifurtimox
are the only drugs currentlyavailable for Chagas disease
treatment.
Both have a poor profile for side effects (~ 10% severe)
- cutaneous (rash, urticaria, pruritis)- polineuritis
- gastrointestinal disturbances
High efficacy in acute cases, but the efficacy declines with the duration
of infection 100%
![Page 13: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/13.jpg)
Leading research at:
Epidemiologia i control: Europa es desperta lentament
![Page 14: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/14.jpg)
Leading research at:
NEGLECTED DISEASES AND GLOBAL HEALTH, 31 MAY – 1 JUNE 2012, VENICE, ITALY
![Page 15: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/15.jpg)
Leading research at:
0100000200000300000400000500000600000700000
MarruecosArgentinaBoliviaColombiaEcuadorUruguayVenezuelaChinaFilipinasPakistán
Recent demographic changes in Spain.
![Page 16: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/16.jpg)
Leading research at:Latinamerican immigration by country
in Spain 2008
COUNTRIESESTIMATED Nº of
MIGRANTSESTIMATED T.cruzi
PREVALENCEESTIMATED INFECTED
MIGRANTS
ARGENTINA 287,760 4,13% 11,882
BOLIVIA 238,605 6,75% - 15% 16,106 – 35,791
BRASIL 140,942 1,02% 1,436
CHILE 66,270 0,99% 653
COLOMBIA 326,459 0,96% 3,121
ECUADOR 451,072 1,74% 7,844
MEXICO 42,413 1,03% 436
PARAGUAY 68,234 2,54% 1,735
PERU 160.603 0,69% 1,102
URUGUAY 86,601 0,66% 568
VENEZUELA 142,709 1,16% 1,654
TOTAL 2,090,000 47,738 – 67,423
![Page 17: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/17.jpg)
Leading research at:
Avenços i retrocessos en el tractament parasitari
![Page 18: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/18.jpg)
Leading research at:
Viotti, PLoS NTD, Sept 2011
![Page 19: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/19.jpg)
Leading research at:
SEMTSI
Ahora que habíamos decidido tratar a los adultos
con benznidazol
![Page 20: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/20.jpg)
Leading research at:
• Tabletas de 12,5 mg adaptadas para su uso en bebés y niños menores de 2 años (<20Kg), de fácil disolución en líquido para facilitar la administración
• Contribuye a mejorar la seguridad y adherencia al tratamiento, ya que permite la administración de la dosis correcta para la edad / peso del niño.
• No es necesario el fraccionamiento (a excepción de los niños prematuros nacidos con menos de 2,5 kg de peso corporal)
![Page 21: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/21.jpg)
Leading research at:
![Page 22: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/22.jpg)
Leading research at:
Nature Reviews Cardiology, 2012
![Page 23: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/23.jpg)
Leading research at:
¿Com avaluar l’eficàcia del tractament?
![Page 24: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/24.jpg)
Leading research at:
Mètodes actuals
• Disminució dels títols en la serología convencional
• PCR– Detecció precoç dels casos amb fallida terapeútica*
*Schijman A. et al. 2003
![Page 25: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/25.jpg)
Leading research at:
Assajos Clínics
Avaluació de la
resposta terapeútica ?
CARRERA EN LA RECERCA DE NOUS TRACTAMENTS ANTIPARASITARIS
![Page 26: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/26.jpg)
Leading research at:
1. ¿Com avaluar l’eficàcia del tractament?2. ¿Quina és la importancia dels diferents llinatges
del paràsit en la malaltia humana, i en els mecanismes de resistència?
![Page 27: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/27.jpg)
Leading research at:
Zingales, Inf Gen Evol, 2012
![Page 28: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/28.jpg)
Leading research at:
1. ¿Com avaluar l’eficàcia del tractament?2. ¿Quina és la importancia dels diferents llinatges
del paràsit en la malaltia humana, i en els mecanismes de resistència?
3. Podem predir el desenvolupament de la miocardiopatía?
![Page 29: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/29.jpg)
Leading research at:
1. ¿Com avaluar l’eficàcia del tractament?2. ¿Quina és la importancia dels diferents llinatges
del paràsit en la malaltia humana, i en els mecanismes de resistència?
3. Podem predir el desenvolupament de la miocardiopatía?
4. Quant de temps ha de durar el tractament?
![Page 30: Actualizació sobre la Malaltia de Chagas · 2014. 12. 5. · are the only drugs currently available for Chagas disease treatment. Both have a poor profile for side effects (~ 10%](https://reader036.fdocuments.in/reader036/viewer/2022071515/6137e15a0ad5d2067648e939/html5/thumbnails/30.jpg)
Leading research at: