Successful Treatment of Trypanosoma cruzi Encephalitis in a Patient with Hemophilia and AIDS

Abstract

Although the frequency of infection with the human immunodeficiency virus (HIV) is increasing dramatically in areas where Trypanosoma cruzi is endemic, trypanosomiasis has been rarely reported in persons with HIV infection or AIDS. Persons with hemophilia who receive multiple blood product transfusions from blood banks with little or no screening for infectious agents are at particularly high risk for infections with both HIV and T. cruzi. We describe the case of a person with hemophilia who was infected by blood transfusion with HIV and T. cruzi and in whom a multifocal, necrotic trypanosomal encephalitis was demonstrated by brain biopsy and electron microscopy. Treatment with benznidazole followed by that with itraconazole and fluconazole was associated with significant clinical and radiographic improvement.

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

“…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 .…”

“…Therefore, Chagas' disease, which is a dormant infection in most patients 5 , may reactivate if the immunological surveillance wanes off as the consequence of the viral insult. Along the last years we 6,7 and others [8][9][10] found patients afflicted by AIDS, who developed brain lesions yielded by the Trypanosoma cruzi.…”

Reactivation of Chagas' disease leading to the diagnosis of acquired immunodeficiency syndrome

“…Patients at especially high risk are those submitted for transplants [5,6], those that have leukemia [2], lymphoma [7], and especially, AIDS [3,4,[8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

“…Some articles have reported clinical improvement with benznidazole plus subsequent itraconazole and fluconazole therapy, the latter with good penetration into the CNS [18,20]. The administration of corticoids should be delayed or avoided because of adverse effects on host responses to infection [19].…”

“…Chagasic meningoencephalitis has a bad prognosis when no specific treatment is initiated or when it is delayed [10,20,24]. A high index of suspiciousness is necessary for early diagnosis and treatment, whenever the patient presents involvement of the CNS, particularly in an area endemic for Chagas' disease [16,21].…”