Trypanosoma cruzi meningoencephalitis in AIDS mimicking cerebral metastases: case report

Pimentel, Pedro Camilo A.; Handfas, Benjamin Wolf; Carmignani, Márcia

doi:10.1590/s0004-282x1996000100017

Cited by 18 publications

(11 citation statements)

References 15 publications

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“…Other authors utilized the PCR for lineage specifications of the parasite isolated by other methods 62,64,73 . The study of the parasite on a direct way took as reference, mainly, the peripheral blood and liquor. However, the utilized method was not specified in some articles 29,30,32,70 . Yet, the research between slide and cover slip of fresh material, thick smear with May-GrunwaldGiemsa coloration, Strout, microhematocrit and buffy-coat was reported in several studies in order to increase the sensitivity when verifying the presence of the protozoa 23,33,39,42,45,46,63,68,81 , not having, however, in any of those reference to the superiority of this methods compared to the study of the parasite directly on fresh material.…”

Section: Casesmentioning

confidence: 99%

Co-infection Trypanosoma cruzi/HIV: systematic review (1980 - 2010)

Almeida

Ramos

Correia

et al. 2011

Rev. Soc. Bras. Med. Trop.

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Introduction:The co-infection Trypanosoma cruzi/HIV has been described as a clinical event of great relevance. The objective of this study was to describe clinical and epidemiological aspects published in literature. Methods: It is a systematic review of a descriptive nature from the databases Medline, Lilacs, SciELO, Scopus, from 1980 to 2010. Results: There were 83 articles (2.8 articles/year) with a total of 291 cases. The co-infection was described in 1980 and this situation has become the defining AIDS clinical event in Brazil. This is the country with the highest number of publication (51.8%) followed by Argentina (27.7%). The majority of cases are amongst adult men (65.3%) native or from endemic regions with serological diagnosis in the chronic stage (97.9%) and indeterminate form (50.8%). Both diseases follow the normal course, but in 41% the reactivation of the Chagas disease occurs. The most severe form is the meningoencephalitis, with 100% of mortality without specific and early treatment of the T. cruzi. The medication of choice was the benznidazole on doses and duration normally used for the acute phase. The high parasitemia detected by direct or indirect quantitative methods indicated reactivation and its elevation is the most important predictive factor. The lower survival rate was related to the reactivation of the Chagas disease and the natural complications of both diseases. The role of the antiretroviral treatment on the co-infection cannot yet be defined by the knowledge currently existent. Conclusions: Despite the relevance of this clinical event there are still gaps to be filled.

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Section: Casesmentioning

confidence: 99%

Co-infection Trypanosoma cruzi/HIV: systematic review (1980 - 2010)

Almeida

Ramos

Correia

et al. 2011

Rev. Soc. Bras. Med. Trop.

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“…Este perfil puede simular un tumor del SNC 13,15,16,23,24 . El riesgo de reactivación en pacientes con infección chagásica y VIH es de 15 a 21% en estudios de seguimiento y está asociado al nivel de inmunosupresión 25 .…”

Section: Discussionunclassified

Enfermedad de Chagas del sistema nervioso central en un paciente con SIDA demostrada por métodos cuantitativos moleculares

Fíca

Salinas

Jercic

et al. 2017

Rev. chil. infectol.

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Although infrequent, Trypanosoma cruzi reactivation is possible among patients with HIV/AIDS infection that develop a tumor-like or granulomatous lesion in the CNS. We report the case of a 60 years old male patient with HIV /AIDS and low CD4 lymphocytes count with cerebellar symptoms and mild paresis, associated to supra and infratentorial hypodense lesions and positive serology tests both to T. gondii and Trypanosoma cruzi. Empirical therapy against toxoplasmosis was prescribed together with antiretroviral therapy but without a favorable response. Brain Chagas disease was confirmed by quantitative PCR in the CSF but he died despite nifurtimox treatment. Despite its rare occurrence, Chagas disease affecting the CNS is possible among patients with HIV/AIDS infection. Epidemiological exposure, a positive Chagas serological test and the image pattern of brain lesions support the suspicion. Diagnosis can be confirmed by molecular test in CSF samples, including new quantitative methods. Despite an adverse prognosis, specific therapy can be attempted besides antiretroviral treatment.

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“…Only 35% of patients show symptoms 4 like: fever, general malaise, headache, edema, lymphadenopathy and hepatosplenomegaly 5 . Myocarditis, mos- tly seen as an EKG alteration, may happen.…”

Section: Discussionmentioning

confidence: 99%

1621 Cerebral trypanosomiasis and aids

2005

Journal of the Neurological Sciences

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-A 36 year-old black female, complaining of headache of one month's duration presented with nausea, vomiting, somnolence, short memory problems, loss of weight, and no fever history. Smoker, intravenous drugs abuser, promiscuous lifestyle. Physical examination: left homonimous hemianopsia, left hemiparesis, no papilledema, diffuse hyperreflexia, slowness of movements. Brain CT scan: tumor-like lesion in the splenium of the corpus calosum, measuring 3.5 x 1.4 cm, with heterogeneous enhancing pattern, sugesting a primary CNS tumor. Due to the possibility of CNS infection, a lumbar puncture disclosed an opening pressure of 380 mmH 2 0; 11 white cells (lymphocytes); glucose 18 mg/dl (serum glucose 73 mg/dl); proteins 139 mg/dl; presence of Trypanosoma parasites. Serum Elisa-HIV tests turned out to be positive. Treatment with benznidazole dramatically improved clinical and radiographic picture, but the patient died 6 weeks later because of respiratory failure. T. cruzi infection of the CNS is a rare disease, but we have an increasing number of cases in HIV immunecompromised patients. Diagnosis by direct observation of CSF is uncommon, and most of the cases are diagnosed by pathological examination. It is a highly lethal disease, even when properly diagnosed and treated. This article intends to include cerebral trypanosomiasis in the differential diagnosis of intracranial space-occupying lesions, especially in immunecompromised patients from endemic regions.

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Trypanosoma cruzi meningoencephalitis in AIDS mimicking cerebral metastases: case report

Cited by 18 publications

References 15 publications

Co-infection Trypanosoma cruzi/HIV: systematic review (1980 - 2010)

Co-infection Trypanosoma cruzi/HIV: systematic review (1980 - 2010)

Enfermedad de Chagas del sistema nervioso central en un paciente con SIDA demostrada por métodos cuantitativos moleculares

1621 Cerebral trypanosomiasis and aids

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