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Central Nervous System Reactivation of Chagas Disease in Immunocompromised Patients with HIV/AIDS

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Global Virology II - HIV and NeuroAIDS

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Abstract

Chagas disease (CD) is an anthropozoonosis caused by Trypanosoma cruzi (T. cruzi) and can appear as an opportunistic infection in HIV-infected patients, especially in endemic Latin-American countries, but also in non-endemic regions, where its diagnosis is more challenging. The central nervous system (CNS) is most commonly affected during reactivation, and expansive lesions are commonly observed in AIDS patients. The diagnosis of CD reactivation in HIV patients requires a high suspicion. Serological tests are required to diagnose CD but are insufficient to confirm reactivation, which is characterized by high levels of parasite replication and parasitemia, usually detected by microscopy. The identification of trypomastigotes in the CNS is criteria sufficient for the definitive diagnosis of chagasic encephalitis. Treatment follows standard recommendations (benznidazole or nifurtimox), and initiation/optimization of anti-retroviral therapy must be carefully considered. Mortality is high for symptomatic reactivated T. cruzi infection, even in patients who receive chemotherapy. Data suggest that early recognition and treatment of reactivation may improve prognosis.

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Author information

Authors and Affiliations

  1. Department of Propedeutics, School of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte, 30.360-260, MG, Brazil

    Silvana Maria Eloi-Santos

  2. Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil

    Unai Tupinambás & Helena Duani

  3. Department of Pathology and Forensic Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil

    Jose Eymard Homem Pittella

Authors
  1. Silvana Maria Eloi-Santos
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  2. Unai Tupinambás
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  3. Helena Duani
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  4. Jose Eymard Homem Pittella
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Corresponding author

Correspondence to Silvana Maria Eloi-Santos .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine, Division of Infectious Diseases and International Health, University of South Florida, Tampa, Florida, USA

    Paul Shapshak

  2. Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California, USA

    Andrew J. Levine

  3. Theoretical Division, Los Alamos National Laboratory, Los Alamos, New Mexico, USA

    Brian T. Foley

  4. Department of Internal Medicine, Division of Infectious Diseases and International Health, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA

    Charurut Somboonwit

  5. Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California, USA

    Elyse Singer

  6. Department of Oral Biology and Medicine, UCLA School of Dentistry, Los Angeles, California, USA

    Francesco Chiappelli

  7. Department of Internal Medicine, Division of Infectious Diseases and International Health, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA

    John T. Sinnott

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Eloi-Santos, S.M., Tupinambás, U., Duani, H., Pittella, J.E.H. (2017). Central Nervous System Reactivation of Chagas Disease in Immunocompromised Patients with HIV/AIDS. In: Shapshak, P., et al. Global Virology II - HIV and NeuroAIDS. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7290-6_25

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