Electrocardiographic Abnormalities and Treatment with Benznidazole among Children with Chronic Infection by Trypanosoma cruzi: A Retrospective Cohort Study

• Published in: PLoS neglected tropical diseases 2016-05, Vol.10 (5), p.e0004651-e0004651
• Main Authors: Colantonio, Lisandro D, Prado, Nilda, Segura, Elsa L, Sosa-Estani, Sergio
• Format: Article
• Language: English
• Subjects: Adolescent; Argentina - epidemiology; Benznidazole; Biology and Life Sciences; Blood transfusions; Cardiac arrhythmia; Cardiomyopathy; Chagas Cardiomyopathy - drug therapy; Chagas Cardiomyopathy - epidemiology; Chagas Cardiomyopathy - parasitology; Child; Chronic diseases; Chronic illnesses; Clinical trials; Cohort Studies; Complications and side effects; Confidence intervals; Dosage and administration; Double-Blind Method; Electrocardiography; Female; Heart; Humans; Infections; Male; Medicine and Health Sciences; Nitroimidazoles - therapeutic use; People and Places; Protozoa; Public health; Research and Analysis Methods; Retrospective Studies; Risk factors; Studies; Tropical diseases; Trypanocidal Agents - therapeutic use; Trypanosoma cruzi
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0004651

Chronic infection by Trypanosoma cruzi could cause heart conduction disturbances. We sought to analyze electrocardiographic abnormalities among children with chronic T. cruzi infection with and without trypanocidal treatment with benznidazole. We studied 111 children 6-16 years of age with asymptomatic chronic T. cruzi infection who were recruited in 1991-1992 in Salta, Argentina. Most children were randomly assigned to benznidazole 5 mg/Kg/day (n = 47) or matching placebo (n = 48) for 60 days. Remaining children (n = 16) received treatment with benznidazole 5 mg/Kg/day open-label. Electrocardiograms were obtained at baseline and in 1995-1996, 1998, 2000 and 2005, and were analyzed using the Buenos Aires method. Among the 94 children with an electrocardiogram at baseline, 8 (8.5%) had electrocardiographic abnormalities, including 4 (4.7%) children with right bundle branch block. Proportion of abnormal electrocardiograms in the full population (n = 111) remained constant over time (media follow-up 8.6 years). Multivariable adjusted prevalence ratios (95% confidence interval [95%CI]) for electrocardiographic abnormalities in 1995-1996, 1998, 2000 and 2005 comparing children treated with benznidazole versus those not treated were 2.76 (0.66, 11.60), 2.33 (0.44, 12.31), 3.06 (0.48, 19.56), and 1.94 (0.33, 11.25), respectively. Among the 86 children with a normal electrocardiogram at baseline, 16 (18.6%) developed electrocardiographic abnormalities during follow-up. The multivariable adjusted hazard ratio for incident electrocardiographic abnormalities comparing children treated with benznidazole versus those not treated was 0.68 (95%CI: 0.25, 1.88). Electrocardiographic abnormalities are frequent among children with chronic T. cruzi infection. Treatment with benznidazole for 60 days may not be associated with less electrocardiographic abnormalities.