Abstract
Heart transplantation (HT) is an established treatment for patients with advanced heart failure (HF). Chagas disease (CD), caused by the Trypanosoma cruzi (T.cruzi) is an important cause of HF in Latin America. Considering CD is a chronic infectious disease, the use of immunosuppressive therapy after HT can reactivate T. cruzi infection and compromise outcomes. Early diagnosis and treatment of this complication is extremely important, which requires knowledge, experience, and a high degree of suspicion by transplant physicians. Furthermore, with the international immigration of people, CD is no longer exclusive to Latin America, since a large number of immigrants with T. cruzi infection are living in non-endemic countries. This phenomenon represents not only a new global epidemiological problem, but also a challenge for transplant teams. This review aims to discuss the peculiarities of HT in the context of CD, with a focus on reactivation of the infection, clinical manifestations, etiological treatment of T. cruzi and differential diagnosis with allograft rejection, among HT recipients.
Keywords
Trypanosoma cruzi; Chagas disease; Cardiomyopathy; Heart failure; Heart transplantation
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A: Endomyocardial biopsy fragment showing myocarditis and a nest of amastigotes in the transplanted heart (hematoxylin-eosin staining). B: Bullous skin lesions and dermatitis in the legs. The bubble fluid analysis showed trypomastigote forms. C: Expansive lesion in the brain as shown by magnetic resonance imaging. A stereotaxic brain biopsy demonstrated nests of amastigotes upon hematoxylin-eosin staining and immunohistochemistry for T. cruzi and confirmed the diagnosis (not shown) (Authors file).