Anticorpos a Trypanosoma cruzi no líquido cefalorraqueano: pesquisa pelas reações de fixação do complemento e de imunofluorescência

Spina-França, A.; Livramento, José Antônio; Machado, L. R.; Yasuda, N.

doi:10.1590/s0004-282x1988000400006

Cited by 28 publications

(5 citation statements)

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“…The first case of T . cruzi -HIV co-infection was reported in 1990 [ 7 ], but CDR has been already cited in 1988, in a patient with AIDS [ 8 ]. Considering the worldwide estimated 38 million people living with HIV in 2019, a sustained risk of T .…”

Section: Introductionmentioning

confidence: 99%

Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the “Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions”

et al. 2021

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Objective Chagas disease (CD) globalization facilitated the co-infection with Human Immunodeficiency Virus (HIV) in endemic and non-endemic areas. Considering the underestimation of Trypanosoma cruzi (T. cruzi)-HIV co-infection and the risk of life-threatening Chagas Disease Reactivation (CDR), this study aimed to analyze the major co-infection clinical characteristics and its mortality rates. Methods This is a cross-sectional retrospective multicenter study of patients with CD confirmed by two serological or one parasitological tests, and HIV infection confirmed by immunoblot. CDR was diagnosed by direct microscopy with detection of trypomastigote forms in the blood or other biological fluids and/or amastigote forms in inflammatory lesions. Results Out of 241 patients with co-infection, 86.7% were from Brazil, 47.5% had <200 CD4+ T cells/μL and median viral load was 17,000 copies/μL. Sixty CDR cases were observed. Death was more frequent in patients with reactivation and was mainly caused by CDR. Other causes of death unrelated to CDR were the manifestation of opportunistic infections in those with Acquired Immunodeficiency Syndrome. The time between the co-infection diagnosis to death was shorter in patients with CDR. Lower CD4+ cells count at co-infection diagnosis was independently associated with reactivation. Similarly, lower CD4+ cells numbers at co-infection diagnosis and male sex were associated with higher lethality in CDR. Additionally, CD4+ cells were lower in meningoencephalitis than in myocarditis and milder forms. Conclusion This study showed major features on T. cruzi-HIV co-infection and highlighted the prognostic role of CD4+ cells for reactivation and mortality. Since lethality was high in meningoencephalitis and all untreated patients died shortly after the diagnosis, early diagnosis, immediate antiparasitic treatment, patient follow-up and epidemiological surveillance are essentials in T. cruzi/HIV co-infection and CDR managements.

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Section: Introductionmentioning

confidence: 99%

Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the “Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions”

et al. 2021

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“…A reativação da doença de Chagas foi registrada inicialmente em pacientes imunodeprimidos por neoplasias hematológicas; 176 no final da década de 1980, e a partir de 1990, começaram a ser relatados casos de reativação da doença de Chagas em pessoas infectadas por HIV. 159,175,177,[178][179][180] No maior estudo prospectivo em coinfecção, a taxa observada em 53 pacientes foi de 20,8%; 175 considerando-se apenas os pacientes em seguimento com coinfecção (excluídos os internados com diagnóstico de reativação), este valor foi de aproximadamente 10%. 175 Em transplantes de rim, são registradas taxas de transmissão por doador infectado de 18,7%, e de reativação em pacientes crônicos submetidos a transplante taxas de 21,7%.…”

Section: Reativação Da Doença De Chagasunclassified

II Consenso Brasileiro em Doença de Chagas, 2015

Dias¹,

Ramos²,

Gontijo³

et al. 2016

Epidemiol. Serv. Saúde

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A doença de Chagas é uma condição crônica negligenciada com elevada carga de morbimortalidade e impacto dos pontos de vista psicológico, social e econômico. Representa um importante problema de saúde pública no Brasil, com diferentes cenários regionais. Este documento traduz a sistematização das evidências que compõe o Consenso Brasileiro de Doença de Chagas. O objetivo foi sistematizar estratégias de diagnóstico, tratamento, prevenção e controle da doença de Chagas no país, de modo a refletir as evidências científicas disponíveis. Sua construção fundamentou-se na articulação e contribuição estratégica de especialistas brasileiros com conhecimento, experiência e atualização sobre diferentes aspectos da doença. Representa o resultado da estreita colaboração entre a Sociedade Brasileira de Medicina Tropical e o Ministério da Saúde. Espera-se com este documento fortalecer o desenvolvimento de ações integradas para enfrentamento da doença no país com foco em epidemiologia, gestão, atenção integral (incluindo famílias e comunidades), comunicação, informação, educação e pesquisas.

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“…Others have described reactivation disease in patients post-solid organ transplant [ 40 ]. After the arrival of HIV to T. cruzi -endemic regions, Del Castillo et al published the first recognized case of reactivated T. cruzi infection in a PWH in 1990 [ 41 ] (though a Brazilian group had reported T. cruzi antibodies in the CSF of PWH in 1988 [ 42 ] and T. cruzi trypomastigotes in the CSF of two PWH in 1989 [ 43 ]). Nearly all of the published cases of T. cruzi reactivation describe PWH naïve to ART; however, no studies evaluating risk of reactivation in PWH taking versus not taking ART exist.…”

Section: Presentationsmentioning

confidence: 99%

Chagas Disease in People with HIV: A Narrative Review

Clark

Bern

2021

TropicalMed

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Many questions remain unanswered regarding the epidemiology, pathophysiology, diagnosis, treatment, and monitoring of Trypanosoma cruzi infection in people with HIV (PWH). The reported prevalence of T. cruzi infection in PWH living in endemic countries ranges from 1–28% and is likely similar in at-risk US populations. While classic cardiac and gastrointestinal presentations of chronic Chagas disease occur in PWH, PWH are additionally at risk for a severe and often fatal form of T. cruzi-mediated disease called reactivation disease. T. cruzi reactivation typically occurs in PWH with low CD4 counts and poor virologic control. National HIV guidelines in several endemic South American countries recommend that all PWH be screened for T. cruzi infection at the time of HIV diagnosis; however, this recommendation is not widely implemented. The early detection of T. cruzi infection in PWH is critical as the sequelae of Chagas disease, including T. cruzi reactivation, may be preventable through the restoration of robust cellular immunity via the initiation of antiretroviral therapy and the appropriate use of antitrypanosomal therapy.

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Anticorpos a Trypanosoma cruzi no líquido cefalorraqueano: pesquisa pelas reações de fixação do complemento e de imunofluorescência

Cited by 28 publications

References 10 publications

Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the “Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions”

Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the “Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions”

II Consenso Brasileiro em Doença de Chagas, 2015

Chagas Disease in People with HIV: A Narrative Review

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