Tumour-like chagasic encephalitis in AIDS patients: an atypical presentation in one of them and outcome in a small series of cases

Sica, R. E. P.; Gargiullo, Gisella; Papayanis, C.

doi:10.1590/s0004-282x2008000600021

Cited by 12 publications

(6 citation statements)

References 11 publications

(14 reference statements)

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“…CNS infection by T. cruzi is more common than myocardial damage in HIV-immunosuppressed patients [6], [7], [15], [16]. Space-occupying lesions in the white matter of the brain are the most common clinical finding, but meningitis and meningoencephalitis may also occur [31]. CNS involvement was reported in 75%–80% of patients with concomitant T. cruzi and HIV infection between 1990 (when del Castillo et al [19] described the first case of a young man with HIV infection and a lesion in the right frontal lobe with inflammatory perivascular infiltrates and clusters of T. cruzi amastigotes) and 2007 [13], [26], [32]–[40].…”

Section: Resultsmentioning

confidence: 99%

“…Nevertheless, treatment with benznidazole or nifurtimox should be initiated as soon as any symptoms of T. cruzi infection reactivation are noted, even in the absence of an increase in parasitemia [7], [15], [31], [48]. Direct microscopic examination of blood and cerebrospinal fluid may reveal the presence of T. cruzi trypomastigotes, which usually, but not always, precedes clinical manifestations [49].…”

Section: Resultsmentioning

confidence: 99%

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Immunosuppression and Chagas Disease: A Management Challenge

et al. 2013

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Immunosuppression, which has become an increasingly relevant clinical condition in the last 50 years, modifies the natural history of Trypanosoma cruzi infection in most patients with Chagas disease. The main goal in this setting is to prevent the consequences of reactivation of T. cruzi infection by close monitoring. We analyze the relationship between Chagas disease and three immunosuppressant conditions, including a description of clinical cases seen at our center, a brief review of the literature, and recommendations for the management of these patients based on our experience and on the data in the literature. T. cruzi infection is considered an opportunistic parasitic infection indicative of AIDS, and clinical manifestations of reactivation are more severe than in acute Chagas disease. Parasitemia is the most important defining feature of reactivation. Treatment with benznidazole and/or nifurtimox is strongly recommended in such cases. It seems reasonable to administer trypanocidal treatment only to asymptomatic immunosuppressed patients with detectable parasitemia, and/or patients with clinically defined reactivation. Specific treatment for Chagas disease does not appear to be related to a higher incidence of neoplasms, and a direct role of T. cruzi in the etiology of neoplastic disease has not been confirmed. Systemic immunosuppressive diseases or immunosuppressants can modify the natural course of T. cruzi infection. Immunosuppressive doses of corticosteroids have not been associated with higher rates of reactivation of Chagas disease. Despite a lack of evidence-based data, treatment with benznidazole or nifurtimox should be initiated before immunosuppression where possible to reduce the risk of reactivation. Timely antiparasitic treatment with benznidazole and nifurtimox (or with posaconazole in cases of therapeutic failure) has proven to be highly effective in preventing Chagas disease reactivation, even if such treatment has not been formally incorporated into management protocols for immunosuppressed patients. International consensus guidelines based on expert opinion would greatly contribute to standardizing the management of immunosuppressed patients with Chagas disease.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Immunosuppression and Chagas Disease: A Management Challenge

et al. 2013

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“…This dual infection occurs because of the secondary reactivation of chronic (latent) T. cruzi infection triggered by immunosuppression in HIV-infected patients98. In regions where Chagas’ disease is endemic, the reactivation of this parasitic infection may be the first presentation of patients with HIV infection99100 and it can cause a high mortality rate among these coinfected patients101. HIV-related immunosuppression changes the clinical manifestations of Chagas’ disease including the central nervous system involvement102.…”

Section: Diseases Due To Tissue Parasites In Hiv/aids Patientsmentioning

confidence: 99%

Parasitic infections in HIV infected individuals: Diagnostic & therapeutic challenges

Nissapatorn¹,

Sawangjaroen²

2011

Indian J Med Res

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After 30 years of the human immunodeficiency virus (HIV) epidemic, parasites have been one of the most common opportunistic infections (OIs) and one of the most frequent causes of morbidity and mortality associated with HIV-infected patients. Due to severe immunosuppression, enteric parasitic pathogens in general are emerging and are OIs capable of causing diarrhoeal disease associated with HIV. Of these, Cryptosporidium parvum and Isospora belli are the two most common intestinal protozoan parasites and pose a public health problem in acquired immunodeficiency syndrome (AIDS) patients. These are the only two enteric protozoan parasites that remain in the case definition of AIDS till today. Leismaniasis, strongyloidiasis and toxoplasmosis are the three main opportunistic causes of systemic involvements reported in HIV-infected patients. Of these, toxoplasmosis is the most important parasitic infection associated with the central nervous system. Due to its complexity in nature, toxoplasmosis is the only parasitic disease capable of not only causing focal but also disseminated forms and it has been included in AIDS-defining illnesses (ADI) ever since. With the introduction of highly active anti-retroviral therapy (HAART), cryptosporidiosis, leishmaniasis, schistosomiasis, strongyloidiasis, and toxoplasmosis are among parasitic diseases reported in association with immune reconstitution inflammatory syndrome (IRIS). This review addresses various aspects of parasitic infections in term of clinical, diagnostic and therapeutic challenges associated with HIV-infection.

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“…In them, a more severe clinical presentation (e.g., central nervous system involvement and severe myocarditis) is observed compared to immunocompetent patients with acute Chagas disease (Pinazo et al, 2013 ). Mass lesions in the white matter of the brain are the most frequent clinical findings, but meningitis and meningoencephalitis may also occur (Sica et al, 2008 ; Pinazo et al, 2013 ). This CNS involvement was reported in 75–80% of patients coinfected with T. cruzi and HIV, being more frequent than myocardial damage (Sartori et al, 1995 , 2007 ; Cordova et al, 2008 ).…”

Section: Discussionmentioning

confidence: 99%

Astrocyte Apoptosis and HIV Replication Are Modulated in Host Cells Coinfected with Trypanosoma cruzi

Urquiza

Burgos

Ojeda

et al. 2017

Front. Cell. Infect. Microbiol.

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The protozoan Trypanosoma cruzi is the etiological agent of Chagas disease. In immunosuppressed individuals, as it occurs in the coinfection with human immunodeficiency virus (HIV), the central nervous system may be affected. In this regard, reactivation of Chagas disease is severe and often lethal, and it accounts for meningoencephalitis. Astrocytes play a crucial role in the environment maintenance of healthy neurons; however, they can host HIV and T. cruzi. In this report, human astrocytes were infected in vitro with both genetically modified-pathogens to express alternative fluorophore. As evidenced by fluorescence microscopy and flow cytometry, HIV and T. cruzi coexist in the same astrocyte, likely favoring reciprocal interactions. In this context, lower rates of cell death were observed in both T. cruzi monoinfected-astrocytes and HIV-T. cruzi coinfection in comparison with those infected only with HIV. The level of HIV replication is significantly diminished under T. cruzi coinfection, but without affecting the infectivity of the HIV progeny. This interference with viral replication appears to be related to the T. cruzi multiplication rate or its increased intracellular presence but does not require their intracellular cohabitation or infected cell-to-cell contact. Among several Th1/Th2/Th17 profile-related cytokines, only IL-6 was overexpressed in HIV-T. cruzi coinfection exhibiting its cytoprotective role. This study demonstrates that T. cruzi and HIV are able to coinfect astrocytes thus altering viral replication and apoptosis.

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Tumour-like chagasic encephalitis in AIDS patients: an atypical presentation in one of them and outcome in a small series of cases

Abstract: enCefaliTiS ChagáSiCa pSeuDoTumoral en paCienTeS Con SiDa: preSenTaCión aTípiCa en uno De elloS e hiSToria De la enfermeDaD en una pequeña Serie De CaSoS

Cited by 12 publications

References 11 publications

Immunosuppression and Chagas Disease: A Management Challenge

Immunosuppression and Chagas Disease: A Management Challenge

Parasitic infections in HIV infected individuals: Diagnostic & therapeutic challenges

Astrocyte Apoptosis and HIV Replication Are Modulated in Host Cells Coinfected with Trypanosoma cruzi

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