Trypanosoma cruziNecrotizing Meningoencephalitis in a Venezuelan HIV⁺-AIDS Patient: Pathological Diagnosis Confirmed by PCR Using Formalin-Fixed- and Paraffin-Embedded-Tissues

Abstract

Coinfections with human immunodeficiency virus (HIV) and infectious agents have been recognized since the early 90s. In the central nervous system (CNS) of HIV+ patients, parasitic protozoans like Toxoplasma gondii have been described as responsible for the space occupying lesions (SOL) developed. However, the involvement of Trypanosoma cruzi is also described but appears to be less frequent in acquired immunodeficiency syndrome (AIDS) and transplant recipients, associated with necrotizing myocarditis and neurological symptoms related to the occurrence of necrotizing pseudotumoral encephalitis (NPE) and meningoencephalitis (NME). The present work aims to present a Venezuelan case of NME associated with the coinfection of HIV and a T. cruzi-like trypanosomatid as well as its evolution and diagnosis by histopathological techniques, electron microscopy, and PCR methods using formalin-fixed- (FF-) and paraffin-embedded- (PE-) tissues. Postmortem cytological studies of leptomeninges imprints reveal the presence of trypomastigotes of Trypanosoma sp. Histopathological and electron microscopy studies allowed us to identify an amastigote stage and to reject the involvement of other opportunistic microorganisms as the etiological agent of the SOL. The definitive confirmation of T. cruzi as the etiological agent was achieved by PCR suggesting that the NME by T. cruzi was due to a reactivation of Chagas' disease.

Diagnosis of Chagasic Encephalitis by Sequencing of 28S rRNA Gene

“…One report described use of molecular testing of cerebrospinal fluid or brain tissue to establish the diagnosis of chagasic encephalitis ( 13 ). Although some laboratories use real-time PCRs for molecular detection of T. cruzi DNA, only this pathogen can be detected in this way, and a negative PCR result for T. cruzi in a tissue sample does not reliably exclude the diagnosis because of low sensitivity ( 14 ).…”

Neuro-toxoplasmosis and fatal necrotizing cerebellitis

“…On the other hand, Trypanosomiasis must be taken into consideration, not only for the corpuscles' morphology, but also for the epidemiological data (patient's South American origin) and for the Trypanosoma capability to cause necrotizing multifocal encephalitis in patients HIV/ AIDS. 5 However, it should be emphasized that CNS Trypanosoma cruzi infection usually requires the presence of amastigotes parasites in the glial and neuronal cells cytoplasms, 4 which were instead histologically absent. PCR examination on paraffinembedded tissue definitively confirmed it to be Toxoplasma.…”

Enfermedades tropicales y embarazo: revisión narrativa

“…En la fase aguda o en reactivación de la enfermedad, el T. cruzi, puede ser observado en frotis de sangre periférica, o en otros tejidos como líquido pericárdico o líquido cefalorraquídeo. Otros métodos utilizados para el diagnóstico son la detección de IgG e IgM por ELISA, RT-PCR, hemaglutinación o inmunofluorescencia, histología, microscopía electrónica (87,88).…”

“…El tamizaje para investigar T. cruzi en toda embarazada residente en zonas de prevalencia de Chagas es mandatorio, el estudio del recién nacido de madres seropositivas al parásito, con el consiguiente seguimiento y realización de pruebas diagnósticas para el descarte de la enfermedad es fundamental, el tratamiento durante el primer año de vida se correlaciona con la curación de la enfermedad casi en el 100 % de los casos (88)(89)(90)(91).…”