Central nervous system involvement in Chagas' disease: an updating

Abstract

A review was made of the available literature on central nervous system (CNS) involvement in Chagas' disease. Thirty-one works concerning the acute nervous form and 17 others dealing with the chronic nervous form, all presenting neuropathologic studies, were critically analysed. Based on this analysis, an attempt was made to establish the possible natural history of CNS involvement in Chagas' disease. Among others, the following facts stand out: 1) the initial, acute phase of Trypanosoma cruzi infection is usually asymptomatic and subclinical; 2) only a small percentage of cases develop encephalitis in the acute phase of Chagas' disease; 3) the symptomatic acute forms accompanied by chagasic encephalitis are grave, with death ensuing in virtually all cases as a result of the brain lesions per se or of acute chagasic myocarditis, this being usually intense and always present; 4) individuals with the asymptomatic acute form and with the mild symptomatic acute form probably have no CNS infection or, in some cases, they may have discrete encephalitis in sparse foci. In the latter case, regression of the lesions may be total, or residual inflammatory nodules of relative insignificance may persist. Thus, no anatomical basis exists that might characterize the existence of a chronic nervous form of Chagas' disease; 5) reactivation of the CNS infection in the chronic form of Chagas' disease is uncommon and occurs only in immunosuppressed patients.

Chagas' Disease and HIV Co-infection: Genotypic Characterization of the Trypanosoma cruzi Strain

“…It is also possible that the cerebral lesions are indeed related to reactivation instead of being present prior to the immunosuppression. According to Pittella (1993), symptomatic acute forms accompanied by chagasic encephalitis are grave with death in virtually all cases and reactivation of the CNS infection in the chronic form of Chagas' disease occurs only in immunosuppressed patients. The parasite kDNA restriction pattern detected can be used as a marker for further comparisons with other T. cruzi strains from immunosuppressed and immunocompetent patients from the same and other endemic areas (Pacheco et al unpublished results).…”

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

“…Specifically, the clinical condition refers to the place of the reactivation. Therefore, the neurological condition draws more the attention 25,52,65,66,87 that in most of the times has toxoplasmosis as the main diagnosis in view to the frequency that this condition happens in HIV infected individuals 33,37,68 . In the heart, the symptomatology and the physical aspects overlap those seen on the natural evolution of the chronic chagasic cardiopathy, hindering the diagnosis 22,27,34,42,88 .…”

Parasite Genotypically Related to a Monoxenous Trypanosomatid of Dog's Flea Causing Opportunistic Infection in an HIV Positive Patient

“…Particularly in cases of HIV co-infection the clinical symptoms are frequently peculiar. Cases of central nervous system tumor-like lesions (Ferreira et al 1991, Pittella 1993, Rocha et al 1994) and cutaneous lesions manifestations (Amato et al 1997) related to the reactivation of Chagas' disease have been reported in association with immunosuppression. Distinct Leishmania isoenzymatic patterns and specific dermotropic zymodemes have also been found causing visceral leishmaniasis (Campino et al 1994, Jimenez et al 1995, Alvar et al 1997.…”