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


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.
    Full-text · Article · Jun 2015 · Clinical Microbiology and Infection
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    • "The more frequently haematological alterations are anaemia and thrombocytopenia [14, 32]. In children born to mothers infected with HIV and T. cruzi, infections were more severe and frequently fatal [65, 66]. "
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    ABSTRACT: Chagas disease is a chronic infection that kills approximately 12,000 people a year. Mass migration of chronically infected and asymptomatic persons has caused globalization of Chagas disease and has made nonvectorial infection, including vertical and blood-borne transmission, more of a threat to human communities than vectorial infection. To control transmission, it is essential to test all pregnant women living in endemic countries and all pregnant women having migrated from, or having lived in, endemic countries. All children born to seropositive mothers should be tested not only within the first month of life but also at ~6 months and ~12 months of age. The diagnosis is made by identification of the parasite in blood before the age of 6 months and by identification of the parasite in blood and/or positive serology after 10 months of age. Follow up for a year is essential as a significant proportion of cases are initially negative and are only detected at a later stage. If the condition is diagnosed and treated early, the clinical response is excellent and the majority of cases are cured.
    Full-text · Article · May 2014 · BioMed Research International
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    • "In the case of absent or controlled reactivation, survival is directly related to the complications of Chagas disease and of HIV/AIDS infection. In the case of central nervous system involvement, delay in diagnosis of Chagas neurological damage and late introduction of specific therapy against T. cruzi increases case fatality [3, 8]. However, predictive factors for reactivation of Chagas disease are not yet fully understood [7, 14]. "
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    ABSTRACT: Chagas disease in patients with HIV infection represents a potentially serious event with high case fatality rates. This study describes epidemiological and clinical aspects of deaths related to Chagas disease and HIV/AIDS coinfection in Brazil, 1999–2007. We performed a descriptive study based on mortality data from the nationwide Mortality Information System. Of a total of about 9 million deaths, Chagas disease and HIV/AIDS were mentioned in the same death certificate in 74 cases. AIDS was an underlying cause in 77.0% (57) and Chagas disease in 17.6% (13). Males (51.4%), white skin color (50%), age group 40–49 years (29.7%), and residents in the Southeast region (75.7%) were most common. Mean age at death was significantly lower in the coinfected (47.1 years [SD ± 14.6]), as compared to Chagas disease deaths (64.1 years [SD ± 14.7], P < 0.001 ). Considering the lack of data on morbidity related to Chagas disease and AIDS coinfection, the use of mortality data may be an appropriate sentinel approach to monitor the occurrence of this association. Due to the epidemiological transition in Brazil, chronic Chagas disease and HIV/AIDS coinfection will be further complicated and require the development of evidence-based preventive control measures.
    Full-text · Article · Aug 2012 · Journal of Tropical Medicine
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