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Chagas disease reactivation in rheumatologic patients: association with immunosuppressive therapy and humoral response

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Abstract

Evidence for Chagas disease reactivation (CDR) in rheumatologic patients under rheumatologic treatments (RTs) is scarce. To screen and follow-up patients with rheumatic diseases and concomitant Chagas disease under RT to detect CDR and to describe a possible relationship between CDR and specific RT. An observational, longitudinal, prospective, consecutive study was carried out between 2018 and 2020. Included patients were evaluated during the follow-up for clinical and laboratorial manifestations of CDR. Direct blood parasitological examination (Strout method) and polymerase chain reaction (PCR) were employed to diagnose CDR. The dynamic of anti-T. cruzi–specific antibodies was also assessed by IHA and ELISA (total IgG and Anti-SAPA). Fifty-one patients were included (86% women). Rheumatoid arthritis was the predominant disease (57%). Classic DMARDs (86.3%) and corticosteroids (61%) were the most frequent RT. CDR was developed in 6 patients (11.7%), exhibiting both positive Strout and PCR. Symptomatic reactivation of CD (fever, asthenia, arthralgias, myalgias) occurred in two patients who had previously been diagnosed with it. Regardless of the different RT, all patients who experienced CDR had previously received more than ≥ 20 mg/day of prednisone equivalent. Despite immunosuppression, patients with CDR exhibited increased levels of specific anti-T. cruzi and anti-SAPA antibodies, which decreased after anti-parasitic treatment. CDR is possible in rheumatologic patients, especially after receiving high doses of corticosteroids. Since CDR symptoms may mimic rheumatic disease activity, monitoring of Chagas disease is highly recommended before, during and after immunosuppression.

Key Points

• Chagas disease reactivation (CDR) in the context of rheumatological treatment was associated to high doses of corticosteroids.

• CDR was associated with an increase in anti-T. cruzi antibodies despite the immunosuppressive treatment.

• Suspecting and anticipating CDR is mandatory in this patient population to diagnose and treat it.

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Acknowledgments

We thank Milagros Zafra, Telma Gambande (Microbiology, Hospital Provincial del Centenario), Camila Bulfoni Balbi (IDICER) and Patricia Sciarrata (Central Laboratory, Rosario National University Faculty of Biochemistry and Pharmaceutical Sciences) for the technical and laboratorial help, Dr. Juan Beloscar (Cardiology Department of Hospital Centenario) for Chagas disease patients’ recruitment help and Wiener Lab for the donation of SAPA antigens for ELISA.

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Authors and Affiliations

  1. Rheumatology Department, Hospital Provincial del Centenario, National University of Rosario (UNR), Santa Fe 3100, Rosario, Argentina

    Ariana Ringer, Juan Pablo Ruffino, Nadia Cuadranti, María Cecilia Argento, María Florencia Martínez, Ignacio Rolla, Serenela Chulibert, Daniela Carbone, Mariano Palatnik, Maria Noel Cortese & Marcelo Abdala

  2. Cardiology Department, Hospital Provincial del Centenario, National University of Rosario (UNR), Rosario, Santa Fe, Argentina

    Rodolfo Leiva

  3. Internal Medicine Department, Hospital Provincial del Centenario, National University of Rosario (UNR), Rosario, Santa Fe, Argentina

    Mariana Lagrutta

  4. Microbiology Department, Faculty of Medicine, National University of Rosario (UNR), Rosario, Santa Fe, Argentina

    Laura Córdoba

  5. Institute of Clinical and Experimental Immunology of Rosario (IDICER, CONICET, UNR), Faculty of Medical Sciences, National University of Rosario (UNR), Rosario, Santa Fe, Argentina

    Florencia Belén González, María Florencia Pacini, Silvina Raquel Villar, Oscar Adelmo Bottasso & Ana Rosa Pérez

  6. Faculty of Medical Sciences, National University of Rosario (UNR), Rosario, Santa Fe, Argentina

    Silvina Raquel Villar, Oscar Adelmo Bottasso, Ana Rosa Pérez & Marcelo Abdala

  7. Infectology Department, Hospital Provincial del Centenario, National University of Rosario (UNR), Rosario, Santa Fe, Argentina

    Damian Águila

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  1. Ariana Ringer
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  2. Juan Pablo Ruffino
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  19. Ana Rosa Pérez
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  20. Marcelo Abdala
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Corresponding authors

Correspondence to Ariana Ringer or Ana Rosa Pérez.

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The research protocol was approved by Institutional Bioethical Boards, and the study was conducted in line with the Declaration of Helsinki’s standards (Resolutions n° 681/2018, 704/2018, 2854/2008).

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Written informed consent was obtained from all patients.

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Ringer, A., Ruffino, J., Leiva, R. et al. Chagas disease reactivation in rheumatologic patients: association with immunosuppressive therapy and humoral response. Clin Rheumatol 40, 2955–2963 (2021). https://doi.org/10.1007/s10067-021-05581-2

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  • DOI: https://doi.org/10.1007/s10067-021-05581-2

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