Table 1.

Etiological treatment recommendations for Chagas disease in the context of COVID-19 coinfection.*

Chagas disease status	COVID-19 status	Guidance for etiological treatment with benznidazole or nifurtimox
Chronic, indeterminate	Negative	Consider delaying treatment to minimize risk of COVID-19 exposure based on local epidemiological context and current physical distancing regulations.
Chronic, indeterminate	Positive, with or without symptoms	Consider delaying treatment until COVID-19 is completely resolved and based on local epidemiological context and current physical distancing regulations.
Acute cases	Negative or positive, with or without symptoms	Initiate treatment.
Clinical and/or parasitological evidence of reactivation	Negative or positive, with or without symptoms	Initiate treatment.
Chronic, indeterminate, currently undergoing etiological treatment	Positive, symptomatic	Postpone treatment; if immunosuppressive drugs are prescribed in the context of COVID-19 management, closely monitor for reactivation of T. cruzi infection by direct microscopy on peripheral blood or fluids and/or quantitative PCR (if available). If reactivation is evident, restart benznidazole/nifurtimox treatment.
Chronic, indeterminate, currently undergoing etiological treatment	Positive, asymptomatic	Continue treatment.