Immunosuppressive Agents for MS Can Be Lethal in Chagas Disease

As many as 1 million immigrants living in the United States and Canada have been estimated to carry latent infection with Trypanosoma cruzi, an amebic parasite that can reactivate in people who become immunosuppressed. That’s why Clay J. Goodman, MD, of Baylor College of Medicine in Houston, TX, warned healthcare providers at the American Neurological Association (ANA) 2013 meeting in New Orleans, LA, to consider the potential for immigrant patients in the US to develop severe neurological symptoms related to Chagas disease.

Because a variety of immunosuppressive agents are typically used to treat multiple sclerosis (MS), neuromyelitis optica, and other autoimmune conditions, Goodman said neurologists should be aware of the drugs’ risks in patients from Latin America.

Clinicians should also consider the possibility of Chagas disease in Latino patients who present with symptoms that appear as toxoplasmosis, Goodman said. However, physicians shouldn’t confuse Chagas disease with toxoplasmosis, because the two conditions require completely different treatments, he noted.

In patients who don’t have fully functional immune systems, cerebral manifestations of Chagas disease can be lethal, Goodman explained. As a broader range of immunosuppressive agents enters neurologists’ armamentarium, it’s possible that iatrogenically-triggered reactivation of Chagas disease will be seen in those patients.