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Organ Transplantation and Chagas Disease—Reply
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In Reply: Dr Altclas and colleagues present issues related to posttransplantation reactivation of Trypanosoma cruzi infection. We believe that our recommendations do not conflict substantially with their viewpoint.
We do not recommend routine pretransplantation chemotherapy for patients who have received treatment in the past. Our recommendation to treat patients with impending immunosuppression (from human immunodeficiency virus infection, induction for organ transplant, or other etiologies) who have not previously received antitrypanosomal therapy should be interpreted in the context of our overall BII recommendation for T cruzi–infected adults up to age 50 years without advanced heart disease. The major objective of etiologic treatment in this setting is to prevent development or progression of cardiomyopathy.
Our intention in explicitly listing anticipated immunosuppression as a patient category for treatment was to lend additional weight to the recommendation since we assume that antitrypanosomal therapy would be better tolerated, and theoretically more effective, before immunosuppression . . . [Full Text of this Article]
Caryn Bern, MD, MPH
cxb9@cdc.gov
Anne Moore, MD, PhD
Parasitic Diseases Branch
Division of Parasitic Diseases
National Center for Zoonotic, Vector-Borne and Enteric Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia
Anis Rassi Jr, MD, PhD
Anis Rassi Hospital
Goiania, Brazil
Jose Antonio Marin-Neto, MD, PhD
Medical School of Ribeirão Preto
University of Sao Paulo
Ribeirão Preto, Sao Paulo, Brazil
James H. Maguire, MD, MPH
University of Maryland
Baltimore
RELATED LETTER
Organ Transplantation and Chagas Disease
Javier D. Altclas, Laura Barcan, Claudia Nagel, Roberta Lattes, and Adelina Riarte
JAMA. 2008;299(10):1134.
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