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Título

Neurologic manifestations in patients with acute Chagas disease treated with benznidazole

Resumo

INTRODUCTION: Chagas disease (CD) is a serious public health problem and more than 70% of transmission in Brazil occurs by consumption of foods contaminated. Neurologic manifestations in the acute phase are rare, with a predominance of headache. Common side effects of Benznidazole include headache and peripheral neuropathy. Given the infrequency of neurologic findings associated with acute CD, it is important to differentiate between manifestations associated with the disease itself or the imidazole treatment.
OBJECTIVE: Describe the neurologic manifestations in patients with acute CD treated with Benznidazole.
METHOD: Cross-sectional observational study with 32 patients treated at a referral hospital for infectious and parasitic diseases in the city of Recife-PE between May and July 2019 during an outbreak in the backlands of the state. Previous, post-infection and post-use antiparasitic neurologic symptoms were evaluated, such as headache, tremor, drowsiness, dyskinesia, syncope, or pre-syncope and sensory complaints. The project was approved by the local Ethics Committee under No. 2,107,217.
RESULTS: Mean age was 30.7 years (range: 9-56 years), 50% female. From a personal history, 15 patients (46.8%) had a headache, predominantly migraine (60%), 6 (18.7%) drowsiness, 3 (3.3%) postural tremor in upper or lower limbs and 2 (6.2%) paresthesia. After infection, 26 (81.2%) had a new headache, mostly with a migraine pattern (76.9%). With the introduction of the antiparasitic drug at a dose of 200-300 mg/day, 7 patients (21.8%) had a new headache with a migraine pattern in 5 cases (71.4%) and 17 (53.1%) had tremor in their majority of postural character (82.3%) and may affect upper and lower limbs and head. Different sensory complaints were also reported: 7 cases of hypoesthesia (21.8%), 3 of pain (9.3%) and 7 of paresthesia (21.8%), all symptoms predominantly in the upper limbs. A 10-year-old child, after 300 mg/day of Benznidazole, developed dyskinesia on the seventh day of treatment. Dose reduction to 150 mg/day led to full recovery.
CONCLUSIONS: Acute CD is infrequent and neurologic manifestations may be a consequence of the infection itself or treatment. Headache and tremor were the predominant findings, the latter being associated with Benznidazole use.