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Long-Term Parasitological Clearance and Cardiac Progression in Trypanosoma cruzi TcI: A Phase-Stratified Cohort from
Mario J Olivera1, Adriana Arévalo1, Alejandro Marcel Hasslocher-Moreno2
1Grupo de Parasitología, Instituto Nacional de Salud, Bogotá 111321, Colombia.
Insights
Trypanosoma cruzi (TcI) infection delays parasite clearance and increases cardiac risk. Early molecular response, however, predicts reduced progression, guiding better patient management in TcI-endemic areas.
Area of Science:
- Infectious Diseases
- Parasitology
- Cardiology
Background:
- Clinical outcomes of Trypanosoma cruzi infection vary significantly.
- Determinants of parasitological clearance and cardiac progression after treatment are not fully understood, especially in TcI-predominant regions.
Purpose of the Study:
- To investigate the association between TcI infection and molecular clearance kinetics.
- To assess the impact of TcI on cardiac progression.
- To evaluate the prognostic value of early molecular response in patients with acute or indeterminate chronic Chagas disease.
Main Methods:
- An ambispective cohort study in Colombia (2000-2023) included patients with acute or indeterminate chronic T. cruzi infection.
- Quantitative polymerase chain reaction (qPCR) was used to monitor molecular clearance, defined as two consecutive negative results.
- Time-to-event analyses, including Kaplan-Meier curves and Cox proportional hazards models, were employed.
Main Results:
- TcI infection was linked to delayed molecular clearance in both acute and indeterminate chronic phases.
- Despite achieving long-term clearance in most patients, TcI infection independently predicted a higher risk of cardiac progression.
- Negative qPCR at 12 months was associated with a decreased risk of subsequent cardiac progression, highlighting its prognostic significance.
Conclusions:
- Early molecular monitoring can aid in risk-stratified follow-up strategies for Trypanosoma cruzi infections in TcI-predominant settings.
- Clinical management approaches should be tailored to specific disease phases.
- Sustained molecular response is a clinically meaningful prognostic marker for cardiac progression.
Abstract:
Clinical trajectories following Trypanosoma cruzi infection are heterogeneous, and the determinants of post-treatment parasitological dynamics and cardiac progression remain incompletely characterized, particularly in TcI-predominant regions. This study assessed, in both the acute phase and the indeterminate chronic form, the association between TcI infection and molecular clearance kinetics, cardiac progression, and the prognostic value of early molecular response. An ambispective cohort in Colombia included patients with acute or indeterminate chronic infection followed between 2000 and 2023. Sustained clearance was defined as two consecutive negative quantitative polymerase chain reaction results obtained at separate visits. Time-to-event analyses were conducted using Kaplan-Meier curves and Cox proportional hazards models. TcI infection was consistently associated with delayed molecular clearance in both clinical presentations. Although long-term clearance was achieved in most patients, TcI infection was independently associated with a higher risk of cardiac progression. In contrast, quantitative polymerase chain reaction negativity at 12 months was associated with reduced subsequent progression risk, indicating that sustained molecular response is a clinically meaningful prognostic marker. Collectively, these findings support the incorporation of early molecular monitoring into risk-stratified follow-up strategies in TcI-predominant settings and reinforce the need for phase-specific clinical management approaches.
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