Objectives To analyze the main features at diagnosis and Chagas' Disease (CD) reactivation in patients with autoimmune diseases (AD) receiving immunosuppressive therapy (IT).
Methods 13 patients with AD diagnosed with CD admitted to our Units between January to December 2016. In addition, we performed a systematic analysis of cases reported to date through a MEDLINE search. Inclusion criteria 1) adults with AD treat with iT (glucocorticoids [GC], disease-modifying anti rheumatic drugs [DMARDs] and biological drugs [BD]); 2) had confirmed or were positive for 2 serological test for CD. Reviews, experimental studies, duplicate publications, and abstracts were excluded.
Results A total of 48 patients (13 from our Units and 35 from the literature search) fulfilled the inclusion criteria. There were 41 (85.4%) women, mean age of 43.8 years (range: 17–80). The main underlying disease was SLE in 22 (45.8%). Previous/current treatment at time CD diagnosis included GC >40mg/day in 27/48 (56.3%), DMARDs in 32/48 (66.7%) and 7 patients had previously received DB. CD was reactivated in 36 (75%) cases (mean 40.9 months [range: 0–252]) with the following patterns: high T. cruzi load by quantitative real-time polymerase chain reaction (qRTPCR) in 23 (63.8%) from which 20 (86.9%) had no clinical manifestation and 3 (13%) had panniculitis, the remaining 11 patients (30.5%) had positive XD with one of them had myositis, only one patient (2.7%) had fever. After a mean follow-up of 47 (range: 1–120) months, 4 patients with SLE died (8.3%), all had received GC>40mg/day, 3 had CD reactivation and all died due to SLE flare. No statistical differences were found with respect to CD diagnosis, use of GC, DMARDs, BD; in contrast, patients who had CD reactivation on therapy with GC >40mg/day showed higher cardiac involvement (83.3% vs 43.5%, p=0.03 OR 6.50 CI95% 1.15–36.57) where the time of immunosuppression in this group was lower in those who died median 0.53 (IQR 0.46–0.53) vs 3.00 (IQR 1.26–78.00) months, p=0.04. Patients with SLE and CD reactivation showed a higher risk of death (18.8% vs 0.0%, p=0.04, OR: 1.23, CI95% 0.97–1.57). Survival rate of the entire cohort was 91.5%. The poorest survival rates were observed in who had CD reactivation (log rank p=0.037).
Conclusions Reactivation was presented mainly as high T. cruzi load by qRTPCR without clinical manifestation of CD. Use GC>40mg/day showed a higher risk of CD reactivation with cardiac involvement. Considering this data it's reasonable to screen serologic and molecular tests before to start treatment with immunosuppressive drugs.
Disclosure of Interest None declared