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The efficacy of treatment with nifurtimox and/or benznidazole among adults with chronic Chagas disease with no previous electrocardiographic disturbances was evaluated over a mean follow-up of 21 years, by means of conventional serology, xenodiagnosis, clinical examination, electrocardiograms and chest X-ray. One hundred and eleven patients, between 17 and 46 years old, were studied: 54 underwent treatment (nifurtimox 27, benznidazole 27) and 57 remained untreated (control group). Xenodiagnosis was performed on 65% of them: 36/38 of the treated and 9/34 of the untreated patients had previous positive xenodiagnosis. Post-treatment, 133 xenodiagnoses were performed on 41 patients, all resulting negative. In the control group, 29 xenodiagnoses were performed on 14 patients; 2 resulted positive. Sera stored during the follow-up were simultaneously analyzed through conventional serology tests (IHA; DA-2ME; IIF). The serological evolution in the treated group was: a) 37% underwent negative seroconversion (nifurtimox 11, benznidazole 9); b) 27.8% decreased titers (nifurtimox 9, benznidazole 6), 9 showed inconclusive final serology (nifurtimox 7, benznidazole 2); c) 35.2% remained positive with constant titers (nifurtimox 7; benznidazole 12). The control group conserved the initial antibody levels during the follow-up. In the clinical evolution, 2/54 (3.7%) of the treated and 9/57 (15.8%) of the untreated patients showed electrocardiographic disturbances attributable to Chagas myocardiopathy, with a statistically relevant difference (p

The aim of this work was to compare the evolution of chronic chagasic untreated patients (UTPs) with that of benznidazole or nifurtimox-treated patients (TPs). A longitudinal study from a low endemic area (Santa Fe city, Argentina) was performed during an average period of 14 years. Serological and parasitological analyses with clinical exams, ECG and X-chest ray were carried out. At the onset, 19/198 infected patients showed chagasic cardiomyopathy (CrChM) while 179 were asymptomatic. In this latter group the frequency of CrChM during the follow-up was lower in TPs compared with UTPs (3.2% vs 7%). Within the CrChM group, 2/5 TPs showed aggravated myopathy whereas this happened in 9/14 UTPs. Comparing the clinical evolution of all patients, 5.9% of TPs and 13% of UTPs had unfavourable evolution, but the difference is not statistically relevant. Serological titers were assessed by IIF. Titers equal to or lower than 1/64 were obtained in 86% of the TPs, but only in 38% of UTPs. The differences were statistically significant (geometric mean: 49.36 vs. 98.2). Antiparasitic assessment of the drugs (xenodiagnosis) proved to be effective. The low sensitivity in chronic chagasic patients must be born in mind. Despite treated patients showed a better clinical evolution and lower antibody levels than untreated ones, it is necessary to carry on doing research in order to improve therapeutic guidelines, according to the risk/benefit equation and based on scientific and ethical principles. Para comparar a evolução dos infectados chagásicos crônicos não tratados (UTPs) e tratados (TPs) com nifurtimox ou benznidazol, fez-se um estudo longitudinal numa área de baixa endemicidade (cidade de Santa Fe, Argentina), com média de seguimento de 14 anos. Em cada controle foram feitas análises sorológicas e parasitológicas, exames clínicos, eletrocardiográficos e radiológicos. No inicio, 19/198 infectados apresentaram miocardiopatia chagásica crônica (MChCr), enquanto 179 eram assintomáticos. A frequência de MChCr no seguimento destes últimos foi 3,2% para os tratados e 7% para os não tratados. Dos pacientes com MChCr no início, 2/5 dos tratados e 9/14 dos não tratados agravaram sua miocardiopatia. Comparando a evolução clínica dos infectados, 5,9% dos tratados e 13% dos não tratados tiveram evolução desfavorável, mas esta diferença não é estatisticamente significativa. Na avaliação sorológica por IFI, 86% dos TPs e só 38% dos UTPs apresentaram títulos menores ou iguais a 1/64. As diferenças são estatisticamente significativas (média geométrica: 49,36 vs 98,2). Os xenodiagnósticos seriados realizados, demonstraram efetividade das drogas (considerar a baixa sensibilidade deste método na etapa crônica). Os pacientes tratados mostraram melhor evolução clínica e mais baixos níveis de anticorpos do que os não tratados. É preciso continuar as investigações para estabelecer pautas terapêuticas mais claras sobre a relação risco-benefício, sustentadas nos princípios científicos e éticos.