Aktuelles zur Chagas-Krankheit und das deutsche Chagas-Netzwerk ELCiD

ZUSAMMENFASSUNG

Die in Lateinamerika endemische Chagas-Krankheit gehört zu den vernachlässigten Erkrankungen und betrifft circa 8 Mio. Menschen. Nach einer akuten Krankheitsphase mit Indikation zur antiparasitären Therapie entwickeln ein Drittel der Infizierten chronische Organkomplikationen primär an Herz und am Darm. In der chronischen Phase steht die Behandlung der Komplikationen im Vordergrund. In Europa kann die Infektion über Blut- oder Organspende sowie konnatal übertragen werden, jedoch besteht hierfür bislang kein ausreichendes Bewusstsein. Die Herztransplantation ist mittlerweile eine gut etablierte Therapieoption bei chronischer Chagas-Kardiomyopathie. Im Rahmen des deutschen Chagas-Netzwerks ELCiD sollen niederschwellige Angebote zur Beratung und Testung sowie spezifische Expertise in der Behandlung von Komplikationen der chronischen Infektion aufgebaut werden.

ABSTRACT

Chagas is a neglected disease endemic in Latin America affecting 8 million people worldwide. Antiparasitic treatment cures the infection only in the first and acute phase. One third of infected patients develops chronic manifestations of the disease, particularly cardiac and gastrointestinal complications. In the chronic phase, antiparasitic treatment has no proven effect, and treatment is directed on management of complications. In Europe, there is a lack of awareness concerning the possibility of infection by blood or organ donation or by congenital infection. Heart transplantation is now a well-established therapeutic option for patients with chronic Chagas cardiomyopathy. The German Chagas network ELCiD aims to provide access to qualified counselling and testing for migrants as well as to build up a network of experts with specific expertise in diagnosis and treatment of complications.

Key words

Chagas disease - antiparasitic treatment - heart transplantation - German Chagas network ELCiD

• Literatur

• 1 Sabino EC, Ribeiro AL, Salemi VM. Et al. Ten-year incidence of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi-seropositive former blood donors.. Circulation 2013; 127: 1105-1115
• 2 Gascon J, Bern C, Pinazo MJ. Chagas disease in Spain, the United States and other non-endemic countries.. Acta Trop 2010; 115: 22-27
• 3 Requena-Méndez A, Aldasoro E, de Lazzari E. et al Prevalence of Chagas disease in Latin-American migrants living in Europe: a systematic review and meta-analysis.. PLoS Negl Trop Dis 2015; 9: e0003540
• 4 Strasen J, Williams T, Ertl G. et al Epidemiology of Chagas disease in Europe: many calculations, little knowledge.. Clin Res Cardiol 2014; 103: 1-10
• 5 Rassi Jr A , Rassi A, Marin-Neto JA. Chagas disease.. Lancet 2010; 375: 1388-1402
• 6 Frank M, Hegenscheid B, Janitschke K. et al. Prevalence and epidemiological significance of Trypanomosoma cruzi infection among latin american immigrants in Berlin, Germany.. Infection 1997; 25: 255-358
• 7 Navarro M, Berens-Riha N, Hohnerlein S. et al. Cross-sectional, descriptive study of Chagas disease among citizens of Bolivian origin living in Munich, Germany.. BMJ Open 2017; 7: e013960
• 8 Antinori S, Galimberti L, Bianco R. et al. Chagas disease in Europe: A review for the internist in the globalized world.. Eur J Intern Med 2017; 43: 6-15
• 9 Kitchen AD, Hewitt PE, Chiodini PL. The early implementation of Trypanosoma cruzi antibody screening of donors and donations within England: preempting a problem.. Transfusion 2012; 52: 1931-1939
• 10 Pérez-Molina JA, Molina I. Chagas disease.. Lancet 2018; 391: 82-94
• 11 Alonso-Padilla J, Gallego M, Schijman AG. et al. Molecular diagnostics for Chagas disease: up to date and novel methodologies.. Expert Rev Mol Diagn 2017; 17: 699-710
• 12 Centers for Disease Control and Prevention. Congenital Chagas Disease. Im Internet www.cdc.gov/parasites/chagas/health_professionals/congenital_chagas.html
• 13 Abras A, Muñoz C, Ballart C. et al. Towards a New Strategy for Diagnosis of Congenital Trypanosoma cruzi Infection.. J Clin Microbiol 2017; 55: 1396-1407
• 14 Ludwig-Maximilians-Universität München. Laboratorien der Abteilung. Im Internet www.klinikum.uni-muenchen.de/Abteilung-fuer-Infektions-und-Tropenmedizin/de/Diagnostik/index.html
• 15 Borda E, Pascual J, Cossio P. et al. A circulating IgG in Chagas’ disease which binds to beta-adrenoceptors of myocardium and modulates their activity.. Clin Exp Immunol 1984; 57: 679-686
• 16 Wallukat G, Nissen E, Morwinski R. et al. Autoantibodies against the beta- and muscarinic receptors in cardiomyopathy.. Herz 2000; 25: 261-266
• 17 Wallukat G, Muñoz Saravia SG, Haberland A. et al. Distinct patterns of autoantibodies against G-protein-coupled receptors in Chagas’ cardiomyopathy and megacolon. Their potential impact for early risk assessment in asymptomatic Chagas’ patients.. J Am Coll Cardiol 2010; 55: 463-468
• 18 Wallukat G, Müller J, Haberland A. et al. Aptamer BC007 for neutralization of pathogenic autoantibodies directed against G-protein coupled receptors: A vision of future treatment of patients with cardiomyopathies and positivity for those autoantibodies.. Atherosclerosis 2016; 244: 44-47
• 19 Capuani L, Bierrenbach AL, Pereira Alencar A. et al. Mortality among blood donors seropositive and seronegative for Chagas disease (1996–2000) in São Paulo, Brazil: A death certificate linkage study.. PLoS Negl Trop Dis 2017; 11: e0005542
• 20 Morillo CA, Marin-Neto JA, Avezum A. et al. Randomized Trial of Benznidazole for Chronic Chagas’ Cardiomyopathy.. N Engl J Med 2015; 373: 1295-1306
• 21 Rassi Jr A , Neto Marin JA, Rassi A. Chronic Chagas cardiomyopathy: a review of the main pathogenic mechanisms and the efficacy of aetiological treatment following the BENznidazole Evaluation for Interrupting Trypanosomiasis (BENEFIT) trial.. Mem Inst Oswaldo Cruz 2017; 112: 224-235
• 22 Bern C, Montgomery SP, Herwaldt BL. et al. Evaluation and treatment of chagas disease in the United States: a systematic review.. JAMA 2007; 298: 2171-2181
• 23 Torrico F, Gascon J, Ortiz L. et al. Treatment of adult chronic indeterminate Chagas disease with benznidazole and three E1224 dosing regimens: a proof-of-concept, randomised, placebo-controlled trial.. Lancet Infect Dis 2018; 18: 419-430
• 24 U.S. National Library of Medicine. BENDITA Benznidazole New Doses Improved Treatment and Associations (BENDITA). Im Internet https://clinicaltrials.gov/ct2/show/NCT03378661
• 25 Drugs for Neglected Diseases initiative. R&D Portfolio Update March 2018: DNDi Chagas disease programme. Im Internet www.dndi.org/2018/media-centre/news-views-stories/news/chagas_rnd_status_2018/
• 26 Drugs for Neglected Diseases initiative. Paediatric benznidazole to treat Chagas disease. Im Internet www.dndi.org/achievements/paediatric-benznidazole/
• 27 Benatti RD, Oliveira GH, Bacal F. Heart Transplantation for Chagas Cardiomyopathy.. J Heart Lung Transplant 2017; 36: 597-603
• 28 Pérez-Molina JA. Management of Trypanosoma cruzi coinfection in HIV-positive individuals outside endemic areas.. Curr Opin Infect Dis 2014; 27: 9-15
• 29 Lattes R, Lasala MB. Chagas disease in the immunosuppressed patient.. Clin Microbiol Infect 2014; 20: 300-309
• 30 Carter YL, Juliano JJ, Montgomery SP. et al Acute Chagas disease in a returning traveler.. Am J Trop Med Hyg 2012; 87: 1038-1040
• 31 Centers for Disease Control and Prevention. Chagas Disease (American Trypanosomiasis). Im Internet wwwnc.cdc.gov/travel/diseases/chagas-disease-american-trypanosomiasis
• 32 Robert Koch-Institut. Epidemiologisches Bulletin Nr 13, 1. April 2005. Im Internet https://edoc.rki.de/handle/176904/4247