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Volume 26, Number 8—August 2020

Plasma-Derived Extracellular Vesicles as Potential Biomarkers in Heart Transplant Patient with Chronic Chagas Disease

Nuria Cortes-Serra, Maria Tays Mendes, Clara Mazagatos1, Joan Segui-Barber, Cameron C. Ellis, Cristina Ballart, Ana Garcia-Alvarez, Montserrat Gállego, Joaquim Gascon, Igor C. Almeida, María Jesús PinazoComments to Author , and Carmen Fernandez-BecerraComments to Author 
Author affiliations: Barcelona Institute for Global Health (ISGlobal), Universitat de Barcelona, Barcelona, Spain (N. Cortes-Serra, C. Mazagatos, J. Segui-Barber, C. Ballart, M. Gállego, J. Gascon, M.J. Pinazo, C. Fernandez-Becerra); Border Biomedical Research Center, The University of Texas at El Paso, El Paso, Texas USA (M.T. Mendes, C.C. Ellis, I.C. Almeida); Secció de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Barcelona, Spain (C. Ballart, M. Gállego); Arrhythmias Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain (A. Garcia-Alvarez); Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain (C. Fernandez-Becerra)

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Table 1

Timeline of heart transplant patient with chronic Chagas disease from initial diagnosis to last follow-up and death*

Date Infection Observation, treatment, outcome
2015 Aug Cytomegalovirus, detected by serology Diagnosed only by positive IgG serology, no active infection (no positive IgM serology). No treatment.
2015 Aug Toxoplasmosis, detected by serology Diagnosed only by positive IgG serology, no active infection (no positive IgM serology). No treatment.
2015 Nov Heart transplantation on Nov. 28. Patient started with immunosuppressive therapy (tacrolimus, azathioprine, prednisone) until the end of follow-up.
2016 Jan Chagas disease reactivation, detection by qPCR Pretreatment sample collected on Jan 28. Patient started BZN treatment (2.5 mg/kg, twice a day, 60 d) on Feb 3.
2016 Mar Bronchopulmonary aspergillosis, 
detected by serology and CT BZN course interrupted on Mar 21. Completed 80% of the prescribed treatment.
2016 Mar Bronchopulmonary aspergillosis Aspergillosis treatment started on Mar 22. Initially with voriconazole and amphotericin B liposomal. Treatment was changed to posaconazole until the end of the follow-up.†
2016 Apr Chagas disease reactivation, detected by qPCR On Apr 14, patient started second round of BZN treatment until May 5, completing 100% of the prescribed treatment.
2016 May Posttreatment sample collected on May 11.
2016 Aug Late organ rejection. Patient died.

*BZN, benznidazole; CT, computed tomographic scan; qPCR, quantitative PCR.
†Parasite clearance could be related to the prolonged used of posaconazole, as previously reported (6), and/or the combined use of posaconazole and benznidazole because a second round of the latter was started in April 2016.

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1Current affiliation: CIBER Epidemiología y Salud Pública (CIBERESP); Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.

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