Article

Manifestations of Chagas disease (American trypanosomiasis) in patients with HIVAIDS

University of São Paulo, San Paulo, São Paulo, Brazil
Pathogens and Global Health (Impact Factor: 1.66). 02/2007; 101(1):31-50. DOI: 10.1179/136485907X154629
Source: PubMed

ABSTRACT Between June 1989 and December 2005, an observational study of adults co-infected with HIV and Trypanosoma cruzi was conducted, to investigate the spectrum of manifestations of chronic Chagas disease (American trypanosomiasis) in the HIV-positive. The 31 men and 22 women investigated were aged 23-59 years. Each subject was investigated by ambulatory (Holter) and non-ambulatory electrocardiography, chest X-ray, oesophagography and echocardiography (to determine the clinical form of trypanosomiasis), by xenodiagnosis, blood culture and the microscopical examination of blood (to explore their T. cruzi parasitaemia), and by counting their CD4 T cells (to stage their HIV infection). The subjects were followed-up for 1-190 months (median = 58 months) and checked for re-activation of their Chagas disease, which was usually defined by the occurrence of unusual clinical manifestations and/or the detection, by microscopical examination, of trypanosomes in the blood or cerebrospinal fluid. Eleven (20.8%) of the subjects showed re-activation, another nine (17.0%) were found to have developed high T. cruzi parasitaemias but these were only detected by xenodiagnosis or culture, and 15 (28.3%) had illnesses typical of chronic Chagas disease in HIV-negative individuals, with low parasitaemias. Anti-T. cruzi therapy (benznidazole), recommended for 17 patients, resulted in the sustained reduction of parasitaemia in 11 of the 12 subjects who completed treatment. Chagas disease was the cause of death of eight of the 14 subjects who died during the study. Four of the women investigated gave birth, each to a single child, during follow-up, and three of the four babies showed evidence of the congenital transmission of T. cruzi.

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    • "Central nervous system involvement is present in 74% of reactivations (meningoencephalitis , space-occupying lesions) and has high mortality; myocarditis appears in up to 17% of the reactivations [16]. The risk of Chagas disease reactivation in HIV-infected patients has been evaluated in some studies performed in endemic countries , ranging from 15% to 20.8% [14] [17]. Other opportunistic infections affecting the brain such as toxoplasmosis, may present with similar signs in neuroimaging studies [18]. "
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    ABSTRACT: Reactivation of Chagas disease in the chronic phase may occur when immunosuppression is established, sometimes resulting in high parasitaemia and severe clinical manifestations such as meningitis and meningoencephalitis. Although this situation is being increasingly described, there is still scarce information. This is a retrospective observational study was performed in three Tropical Medicine Units of Barcelona (Spain) included in the International Health Program of the Catalan Health Institute (PROSICS). The objective of the study was to describe epidemiological, clinical, microbiological, prognostic, and therapeutic data from patients with Chagas disease and any kind of immunosuppressive condition attended in these three institutions from January 2007 to October 2014. From 1823 patients with Chagas disease attended in these three centers during the study period, 38 (2%) had some kind of immunosuppressive condition: 12 patients had HIV infection, 8 patients had neoplasia, 4 patients underwent organ transplantation, and 14 patients had an autoimmune disease. Eight (21.1%) patients had cardiac involvement, and 6 (15.8%) patients had gastrointestinal involvement. Acute T. cruzi infection was detected in two Spanish patients. Thirty-one (81.6%) patients received treatment with benznidazole, from which 17 (54.8%) patients had some kind of adverse event. No patient had a severe manifestation or reactivation of Chagas disease. Chagas disease patients under immunosuppressive conditions are being increasingly described, especially in non-endemic countries. More information about this topic is required and international consensus in the diagnosis, treatment and follow-up of these patients must be established in order to reduce the morbidity and mortality. Copyright © 2015. Published by Elsevier Ltd.
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    • "The reactivation of T. cruzi infection is observed in individuals who undergo immunosuppressive therapy for malignancies and organ transplantation as well as in individuals with human immunodeficiency virus (HIV) infection and AIDS (Tanowitz et al, 2009; Sartori et al, 2007; Vaidian et al, 2004; Barcán et al, 2005). "
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    • "It is being recognized with increasing frequency among persons emigrating from endemic regions to non-endemic regions of North America, Europe, Australia and Japan [2]. Chagas disease may also undergo reactivation during periods of immunosuppression such as during the administration of immunosuppressive therapy or HIV/AIDS [3] [4]. Parasites have been demonstrated to persist in heart tissue of the mammalian host [5]. "
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