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Antiparasitic treatment… 2022 JVIM article

Title: Antiparasitic treatment with itraconazole and amiodarone in 2 dogs with severe, symptomatic Chagas cardiomyopathy

Authors: Elizabeth L. Malcolm, Ashley B. Saunders, Jordan P. Vitt, Bruno G. Boutet, and Sarah A. Hamer

Journal/Date of Publication: Journal of Veterinary Internal Medicine, 2022

DOI: 10.1111/jvim.16422

Objective: To describe 2 dogs with severe, symptomatic Chagas cardiomyopathy characterized by myocardial dysfunction and electrocardiographic abnormalities that were managed with a combination of cardiac medications and antiparasitic treatment with itraconazole and amiodarone.

Type of Study: Case Report

Conclusions:

  1. The combination of itraconazole and amiodarone was used to manage symptoms of Chagas cardiomyopathy.
  2. Both dogs died suddenly within six months, highlighting the challenges in treating advanced Chagas disease and the need for more effective antiparasitic protocols.

Clinical Application

  1. Combination therapy with itraconazole and amiodarone can be considered for managing symptomatic Chagas cardiomyopathy, though close monitoring is essential due to potential adverse effects.
  2. Early detection and treatment of T. cruzi infection are critical as advanced cases have poor prognosis.
  3. Awareness of antiparasitic treatment limitations emphasizes the importance of preventive measures against Chagas disease in endemic areas.
four-panel figure of transthoracic echocardiographic images of the 2 dogs in the study as described in the caption
Figure 1. Transthoracic echocardiographic images documenting dilatation of the right ventricle (RV) in both dogs with chronic Chagas cardiomyopathy. Case 1 includes images obtained in right parasternal short axis (A) and long axis (B) views to show very severe right atrial and ventricular enlargement compared to the left heart. Case 2 includes images obtained from right parasternal short axis (C) and left apical long axis (D) views to show moderate to severe right ventricular enlargement. LA, left atrium; LV, left ventricle; RA, right atrium

Fatal Chagas myocarditis… 2021 Veterinary Parasitology: Regional Studies and Reports article

Title: Fatal Chagas myocarditis in government working dogs in the southern United States: Cross-reactivity and differential diagnoses in five cases across six months

Authors: Alyssa C. Meyers, Erin E. Edwards, John P. Sanders, Ashley B. Saunders, and Sarah A. Hamer

Journal/Date of Publication: Veterinary Parasitology: Regional Studies and Reports, 2021

DOI: 10.1016/j.vprsr.2021.100545

Objective: A case series describing Chagas myocarditis in working dogs in the southern United States. 

Type of Study: Case series

Conclusions:

  1. Chagas myocarditis can be rapidly fatal in dogs, characterized by sudden death, elevated cardiac troponin I concentrations, and ECG abnormalities.
  2. Serological cross-reactivity with Leishmania spp. poses challenges in diagnosis, requiring multiple testing methods to confirm T. cruzi infection.
  3. Postmortem analysis showed severe myocarditis in all cases, though only one had histological evidence of amastigotes, while three tested positive for T. cruzi DNA with PCR.

Clinical Application:

  1. Diagnostic Approach: Use a combination of serology, PCR, and histopathology to increase diagnostic accuracy, particularly in endemic areas.
  2. Monitoring: Routine cTnI and ECG monitoring is recommended for seropositive dogs to detect early signs of myocarditis.
  3. Cross-Reactivity Considerations: In areas where both T. cruzi and Leishmania spp. are present, clinicians should be aware of cross-reactivity and confirm diagnoses with multiple testing modalities.
  4. Management of Infected Dogs: Despite infection, some dogs may continue to perform duties; however, sudden death highlights the need for heightened surveillance and potentially pre-emptive retirement in high-risk cases.
  5. Public Health Implications: Awareness of Chagas disease in working dog populations can be indicative of broader public health risks due to vector exposure.
AI generated rendering of T. cruzi parasite in blood
Trypanosoma cruzi parasite in blood (Generated with Adobe Stock AI)