Background/Purpose: American Trypanosomiasis or Chagas Disease (CD) is a zoonotic infection, endemic in Latin America. It is a major cause of morbidity, mortality and economic burden in developing countries. Because of population movements, it has spread out around the globe. CD behavior has been well-described in patients with HIV infection, oncologic and organ transplant-related immunosuppression, but little is known in rheumatic diseases (RD) with rheumatologic treatments (RT).
The purpose of this research is to screen and follow up (clinical and serologically) patients with RD under RT, with concomitant CD. To detect clinical and serological reactivation.

Methods: Prospective, observational study. A systematic screening for CD in the Rheumatology and Internal Medicine Departments was conducted for eighteen months in a third-level Hospital in Argentina. Patients with CD and concomitant RD under RT were included for follow up. Assessments were done before and after RT and if it was already established, subsequently. Clinical features were examined by anamnesis, physical examination, Electrocardiogram, Echocardiogram and Chest X-ray. In order to detect parasitemia, two methods were performed: Strout and Polymerase chain reaction (PCR). Levels of antibodies were evaluated by three techniques: enzyme-linked immunosorbent assay (ELISA), indirect hemagglutination assay (IHA) and indirect immunofluorescence assay (IFA). Every patient received, at least, two assessments. A descriptive analysis was performed.

Results: From the population screened, 46 patients with RD under RT, infected with Trypanosoma Cruzi were detected by two of three techniques (ELISA, IHA, IFA).

Table 1: Population characteristics, Rheumatic Diseases and Treatments.

Table 2: Clinical and Serological Follow up.

In search of reactivation, two patients with parasitemia (both Strout and PCR positive) and concomitant signs and symptoms were detected. They had chagasic cardiomyopathy. A 64-years old lady with Microscopic Polyangiitis, under prednisone 60 mg/day and a 57-years old lady with Systemic Lupus Erythematosus under prednisone 40 mg/day and hydroxychloroquine. They developed high fever, myalgias, arthralgias and asthenia. Other infections were ruled out. They received Benznidazole and Nifurtimox respectively. After one-week treatment, Strout and PCR became negative, with clinical improvement.

Conclusion: Of the 46 patients detected in the screening, 2 (4,35%) had parasitemia and clinical features suggestive of reactivation, in context of high doses of steroids. As they were sisters, a genetic relationship may be present. In the rest of the patients, no clinical or serological variation in the follow up was recognized, considering all treatments. As reactivation is possible, parasite´s screening before and during rheumatologic immunosuppression should be performed routinely in endemic countries and suspected in non-endemic countries with epidemiological nexus. CD specific antibodies determination, Strout and PCR are economic and practical techniques. The benefits of this measures would outweigh morbidity and mortality costs. Further studies are required to broaden our knowledge and make recommendations.

Table 1

Table 2

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/screening-and-follow-up-of-patients-with-rheumatic-diseases-and-rheumatological-treatments-infected-with-trypanosoma-cruzi-american-trypanosomiasis-or-chagas-disease-is-it-possible-a-reactivation/