{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:13:18Z","timestamp":1780319598971,"version":"3.54.1"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,11,21]],"date-time":"2019-11-21T00:00:00Z","timestamp":1574294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2017\/07946\u20108"],"award-info":[{"award-number":["2017\/07946\u20108"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Reactivation of Chagas disease after heart transplantation is characterized by proliferation and dissemination of <jats:italic>Trypanosoma cruzi<\/jats:italic> parasites to several organs. Reactivation affecting the allograft can simulate acute cellular rejection, from which it should be distinguished through the analysis of endomyocardial biopsies (EMB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated retrospectively 100 EMB collected in the first year of follow\u2010up from 13 heart\u2010transplanted, chagasic patients who presented reactivation and were successfully treated. Additionally, 37 EMB from 8 patients who did not present reactivation constituted the control group. We reviewed histopathology and performed a real\u2010time PCR\u2010based assay in order to evaluate the <jats:italic>T\u00a0cruzi<\/jats:italic> parasitic load of each EMB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The parasitic load of the EMB at the time of reactivation ranged from 22.80 to 190\u00a0000\/10<jats:sup>6<\/jats:sup> cells (median: 1555). In 6 patients, none of the EMB obtained prior to reactivation amplified <jats:italic>T\u00a0cruzi<\/jats:italic> DNA. On the other hand, 10 EMB from 7 patients, obtained 9\u2010105\u00a0days before reactivation (median: 26\u00a0days), showed parasitic load ranging from 8.25 to 625\/10<jats:sup>6<\/jats:sup> cells (median: 167.55). In all patients, the parasitic load increased at the time of reactivation, usually sharply. After initiation of treatment, all patients showed negative PCR or a dramatic reduction of the parasitic load in the following EMB. None of the EMB from the control group amplified <jats:italic>T\u00a0cruzi<\/jats:italic> DNA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Sequential measurement of <jats:italic>T\u00a0cruzi<\/jats:italic> parasitic load in EMB is useful for monitoring Chagas disease reactivation after heart transplantation. Its increase suggests imminent reactivation and its decrease after treatment indicates favorable evolution for cure of the episode of reactivation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.13209","type":"journal-article","created":{"date-parts":[[2019,11,8]],"date-time":"2019-11-08T00:20:02Z","timestamp":1573172402000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Sequential measurement of <i>Trypanosoma cruzi<\/i> parasitic load in endomyocardial biopsies for early detection and follow\u2010up of Chagas disease reactivation after heart transplantation"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5673-165X","authenticated-orcid":false,"given":"Luiz Alberto","family":"Benvenuti","sequence":"first","affiliation":[{"name":"Heart Institute (InCor) Hospital das Cl\u00ednicas HCFMUSP Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Rogg\u00e9rio","sequence":"additional","affiliation":[{"name":"Heart Institute (InCor) Hospital das Cl\u00ednicas HCFMUSP Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Shoko","family":"Nishiya","sequence":"additional","affiliation":[{"name":"Funda\u00e7\u00e3o Pr\u00f3\u2010Sangue\/Hemocentro de S\u00e3o Paulo Hospital das Cl\u00ednicas HCFMUSP Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandrigo","family":"Mangini","sequence":"additional","affiliation":[{"name":"Heart Institute (InCor) Hospital das Cl\u00ednicas HCFMUSP Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Eduardo","family":"Levi","sequence":"additional","affiliation":[{"name":"Instituto de Medicina Tropical da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,11,21]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"519","article-title":"Chagas disease (American trypanosomiasis) \u2010 factsheet (revised in August 2012)","volume":"87","author":"World Health Organization","year":"2012","journal-title":"Wkly Epidemiol 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