Update in treatment of Chagas disease

Purpose of review This review discusses the recent data about the pathogenesis of Chagas disease, tolerance of drugs, and follow-up of patients impacting the treatment of Chagas disease in immunocompetent and immunocompromised patients. Recent findings The role of the parasite to promote direct or indirect organ damage in the chronic phase of the disease as well as the usefulness of antiparasitic treatment to slow or prevent the deterioration of cardiac function and the aggravation of Chagasic cardiomyopathy lead to an extension of the indications of treatment. Tolerance is poor for the two drugs, benznidazole and nifurtimox. The rates of adverse events and treatment discontinuation before 60 days are higher with nifurtimox. PCR, and in the near future immunologic tests, might allow assessment of the early success or failure of the antiparasitic treatment. Summary Assessment of alternative drugs, such as posaconazole, and of new strategies of treatment (combination of two antiparasitic drugs, association of antiparasitic and immunomodulatory drugs, and re-treatment), and follow-up are a global health priority.