Cerebral tumor-like American trypanosomiasis in acquired immunodeficiency syndrome

Abstract

Cerebral tumor‐like American trypanosomiasis (CTLAT) is an uncommon complication of Chagas' disease, observed only in immunosuppressed patients. We assessed 10 human immunodeficiency virus–positive patients with Chagas' disease who presented with CTLAT. All patients had neurological involvement and 6 developed intracranial hypertension. Neuroimaging studies showed supratentorial lesions in 9 patients, being single in 8. One case had infratentorial and supratentorial lesions. Low CD4+ cell counts were observed in all the cases and in 6 of them CTLAT was the first manifestation of acquired immunodeficiency syndrome. Serological tests for Chagas' disease were positive in 6 of 8 patients. Trypanosoma cruzi was identified in all brain specimens and in three cerebrospinal fluid samples. CTLAT should be considered in the differential diagnosis of intracranial mass lesions in human immunodeficiency virus–positive patients and should be added to the list of acquired immunodeficiency syndrome–defining illnesses. Ann Neurol 1999;45:403–406

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

“…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. The peripheral blood was the site where the parasite was most searched, but the liquor was where the largest proportion of positivity on the T. cruzi research (78%) occurred, which shows that it is indispensable the use of this evaluation during the investigation of cerebral impairment in patients with the co-infection, considering the feasibility of the exam.…”

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

“…In regards to the first two patients, they behaved as most of the other patients described in the literature 6,7,12,16,17 with a very poor outcome in spite of specific treatment, and like most of them, died shortly after diagnosis.…”

“…It is noteworthy that the parasites are able to reach the central nervous system at the time of their first contact with its host 11,12 and, thence, most probably, lodge in neurones and/or glia cells 13,14 . In normal conditions, the surveillance of the immune system takes control of them, but if for any reason the immune system fails, they will be allowed to reproduce and leave the host cell [5][6][7][8][9] . This sort of behaviour has been noted in patients whose immune system has been weakened by the employment of citotoxic drugs 14,15 .…”

“…In a previous communication 7 we described 10 patients who had Chagas' disease and were asymptomatic until they were infected by the HIV virus. All of them developed cerebral tumour-like (pseudotumours) lesions when they had less than 126 CD4+ cells/mm 3 .…”

Human Immunodeficiency Virus and the Central Nervous System

“…Examples of this are the high incidence of tuberculosis [6] schistosomiasis, trypanosomiasis [7][8][9][10][11][12][13][14][15][16][17][18] and some cases of paracoccidioidomycosis [19,20] in the CNS.…”