Plasma Anandamide Concentration and Pregnancy Outcome in Women With Threatened Miscarriage

We do not recommend routine pretransplantation chemotherapy for patients who have received treatment in the past.Our recommendation to treat patients with impending immunosuppression (from human immunodeficiency virus infection, induction for organ transplant, or other etiologies) who have not previously received antitrypanosomal therapy should be interpreted in the context of our overall BII recommendation for T cruzi-infected adults up to age 50 years without advanced heart disease.The major objective of etiologic treatment in this setting is to prevent development or progression of cardiomyopathy.Our intention in explicitly listing anticipated immunosuppressionasapatientcategoryfortreatmentwastolendadditional weight to the recommendation since we assume that antitrypanosomal therapy would be better tolerated, and theoretically more effective, before immunosuppression develops or is induced.Althoughdataarelackingonthispoint,asecondarytheoretical benefit is a possible reduction in the risk of reactivation.Advanced renal, hepatic, or cardiac dysfunction would certainly complicate therapy and constitutes a contraindication.We agree with Altclas et al that posttransplantation monitoring is indicated whether or not a course of antitrypanosomal treatment was completed prior to transplant.As stated in the Clinical Review, we recommend that treatment decisions be individualized for all adult patients with Chagas disease, balancing the potential benefit vs the risk of drug toxicity.