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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
Rassi Jr, Anis; Marin-Neto, José Antonio & Rassi, Anis
Abstract
Chagas cardiomyopathy is the most frequent and most severe manifestation of chronic Chagas disease, and is one
of the leading causes of morbidity and death in Latin America. Although the pathogenesis of Chagas cardiomyopathy
is incompletely understood, it may involve several mechanisms, including parasite-dependent myocardial damage,
immune-mediated myocardial injury (induced by the parasite itself and by self-antigens), and microvascular and
neurogenic disturbances. In the past three decades, a consensus has emerged that parasite persistence is crucial to
the development and progression of Chagas cardiomyopathy. In this context, antiparasitic treatment in the chronic
phase of Chagas disease could prevent complications related to the disease. However, according to the results of the
BENEFIT trial, benznidazole seems to have no benefit for arresting disease progression in patients with chronic
Chagas cardiomyopathy. In this review, we give an update on the main pathogenic mechanisms of Chagas disease,
and re-examine and discuss the results of the BENEFIT trial, together with its limitations and implications.
Keywords
chronic Chagas cardiomyopathy; Chagas heart disease; pathogenesis; aetiological treatment; Benznidazole; BENEFIT trial
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