Reactivation of Chagas disease after autologous hematopoietic stem cell transplantation

Abstract

Chagas disease (CD) is a protozoan zoonosis caused by Trypanosoma cruzi . Reactivation of CD occurs via drug-induced immunosuppression before and during transplantation. Here, we report the case of a 62-year-old man diagnosed with classic Hodgkin lymphoma who received highly aggressive conditioning chemotherapy before undergoing stem cell transplantation (SCT). The patient tested positive for CD in pre-transplantation evaluation. The patient exhibited persistent fever and elevated C-reactive protein levels before and after SCT, and was treated with antibiotics. Micro-Strout test showed evidence of trypomastigotes and he was treated with benznidazole until tested negative. Post-transplantation seropositive patients should be screened for possible reactivation.

HIV and Chagas Disease: An Evaluation of the Use of Real-Time Quantitative Polymerase Chain Reaction to Measure Levels of Trypanosoma cruzi Parasitemia in HIV Patients in Cochabamba, Bolivia

“…The conventional definition of reactivation is the recurrence of visible parasitemia by microscopy. Reactivation occurs only in an immunosuppressed host and has been reported in patients living with HIV, in post-organ transplant and stem cell transplant patients, in cancer patients on chemotherapy, and in patients receiving immunomodulatory agents for systemic lupus erythematosus, rheumatoid arthritis, and similar conditions [5][6][7][8][9] Symptomatic reactivation in patients with HIV is usually associated with severe clinical manifestations with mortality ranging from 64% to 79%. 10,11 Reactivation most often presents with central nervous system involvement (CNS; 74%), such as meningoencephalitis or CNS chagoma, or myocarditis (17%).…”

“…12 There are reports of successful treatment with benznidazole, highlighting the need to identify at-risk patients. 8,11 Infection with T. cruzi and other intracellular protozoan parasites leads to downregulation of T-cell function and apoptosis, which may contribute to a decrease in CD41 counts and increasing parasitemia, as well as the increased mortality seen with HIV-T. cruzi coinfection. 14 Few studies have directly compared this relationship among parasitemia, CD41 counts, and viral loads in patients coinfected with HIV and T. cruzi.…”

Reactivación de la enfermedad de Chagas después de trasplante autólogo de progenitores hematopoyéticos. Reporte de caso y revisión de la literatura

“…Durante la reactivación, las manifestaciones clínicas incluyen síndrome febril agudo, miocarditis, meningoencefalitis y lesiones cutáneas (7,10). Chalela, et al, recientemente describieron el caso de un hombre colombiano de 62 años con diagnóstico de linfoma de Hodgkin clásico, quien había recibido quimioterapia de alta intensidad como esquema terapéutico condicionante antes del trasplante autólogo y después de una primera recaída (16). En la tamización se documentó enfermedad de Chagas.…”

Vector-borne protozoal infections of the CNS: cerebral malaria, sleeping sickness and Chagas disease

“…The recommended duration of treatment varies but should be at least 30–60 days. Reactivation of Chagas disease after autologous bone marrow transplant has been reported [35].…”