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Acute cases

Patients with clinical manifestations must receive treatment. This includes those with an infection of less than 4 months, as well as the acute cases with easy detection of parasites in fresh samples and smears, and those with positive conventional serology: IHA, CF, IF, ELISA, and immunoblotting (IB) with positive IgM. The idea is to treat these cases with NF 8 mg/kg/day for 30-60 days in adults and 10 mg/kg/day for the same period in children. This daily quantity must be divided into three doses taken after meals (every 8 h). In Brazil, where NF is not available, BNZ is used: 5 mg/kg/day with a maximum daily dose of 300 mg, for 60 days in adults, and 5—10 mg/kg/day (7.5 mg/kg/day) for 60 days in children, divided into two or three doses (every 8 or 12 h) after meals. In an investigation performed in Santiago del Estero (Argentina) in 470 cases, the majority (84.4%) of children aged 1—9 years with acute Chagas disease presented with an ophthalmic lymph node complex, 367 were treated with 25 mg/kg of NF for 15 days and continued with 15 mg/kg for another 77 days; 40 received placebo; and another 20 other antichaga- sic drugs. Drug tolerance was greater in small children and the 15-mg dose was better tolerated than the 25-mg. After 60 days of treatment the direct parasitological tests were negative in both groups who received therapy; however, in the placebo group there were 28.6% positive cases. After 18 months there was 69% seroconversion of the treated patients; in other words, they passed from positive to negative. However, the placebo group maintained positive serology (IHA, CF, and IF).60 With BNZ in acute acquired cases, a 76% cure is obtained (Table 31.3).61

 
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