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Today, approximately 8 million people in Latin American countries are affected with Chagas disease [1], caused by a parasite, Trypanosoma cruzi , which is transmitted primarily by a triatomine insect. The eradication of the insect vectors of transmission (Hemiptera triatominae ) in one sense would represent the true treatment of the disease and, therefore, lead to its future disappearance. However, the presence of Chagas disease years before the pre-Colombian era [2], together with the multiple intermediary hosts of the disease and only the possible elimination of domestic Chagas disease vectors (but not the selvatic ones) can make this objective difficult to achieve. In its origin, the disease developed principally in endemic areas; however, with the migration of populations to cities where there was no presence of the disease, Chagas disease became a common pathology diagnosed as urban Chagas [3,4]. In addition to this, some of the populations migrated to other continents, such as to Europe and the USA, where it is now necessary for medical professionals to check blood donations for Chagas disease [5,6].
The principal aim of the management of the chronic disease is to avoid the development of cardiomyopathy and transmission by blood transfusion, congenital and organ transplants.Two drugs, benznidazole and nifurtimox, are currently available for treatment of acute and chronic Chagas disease. Allopurinol and ketaconazol are other alternative drugs [7,8], used in some selected cases [9,10] in the absence of benznidazole or nifurtimox or when serious side effects occur with the two latter drugs.
The efficacy and tolerance of benznidazole can be inversely related to the age of the patient [11] and its side effects are more frequent in elderly patients [12].
In this article, we discuss the benefits and risks of the treatment with benznidazole from a clinical point of view to be considered for the management of chronic adult Chagas disease patients in current medical practice. The treatments of acute, congenital, accidental or immunosuppressive patients were not the objective of this article.
History of benznidazole
Benznidazole was launched in 1972 [13] and rapidly showed its efficacy in the treatment of the acute phase of the disease [14]. The characteristics of the chronic phase, with the scarcity of the parasitemia and intense immune response [15,16], deviated from knowledge about...