Trypanosoma cruzi infection associated with atypical clinical manifestation during the acute phase of the Chagas disease

Abstract

BackgroundChagas disease (CD) is caused by the protozoan parasite Trypanosoma cruzi and is transmitted by triatomine insects. Clinical manifestations vary according to the phase of the disease. Cutaneous manifestations are usually observed in the acute phase (chagoma and Romaña’s sign) or after reactivation of the chronic phase by immunosuppression; however, a disseminated infection in the acute phase without immunosuppression has not been reported for CD. Here, we report an unusual case of disseminated cutaneous infection during the acute phase of CD in a Mexican woman.MethodsEvaluation of the patient included a complete clinical history, a physical exam, and an exhaustive evaluation by laboratory tests, including ELISA, Western blot and PCR.ResultsSkin biopsies of a 50-year-old female revealed intracellular parasites affecting the lower extremities with lymphangitic spread in both legs. The PCR tests evaluated biopsy samples obtained from the lesions and blood samples, which showed a positive diagnosis for T. cruzi. Partial sequencing of the small subunit ribosomal DNA correlated with the genetic variant DTU II; however, serological tests were negative.ConclusionsWe present a case of CD with disseminated skin lesions that was detected by PCR and showed negative serological results. In Mexico, an endemic CD area, there are no records of this type of manifestation, which demonstrates the ability of the parasite to initiate and maintain infections in atypical tissues.

Parasites causing cutaneous wounds: Theory and practice from a dermatological point of view

“…Schizotrypanides is a diffuse morbilliform eruption observed in a minority of cases (Hemmige et al, 2012). An atypical manifestation in the acute phase has been reported with multiple nodules, some of which have been characterized by central necrosis, and subsequent non-healing ulceration, in an immunocompetent patient (Rangel-Gamboa et al, 2019). In reactivation cases, cutaneous lesions reflect the hypodermal involvement and usually present as painful, erythematous nodules or plaques (Ferraresso et al, 2018;Hemmige et al, 2012).…”

Prevalence and Epitope Recognition of Anti-Trypanosoma cruzi Antibodies in Two Procyonid Species: Implications for Host Resistance

“…Controls were run in each plate and used to obtain the cut off (CO) absorbance according the equation CO = m + 2.5δ, where m = the average absorbance of the negative samples tested in triplicate and δ = standard deviation. In all assays, negative control sera showed constant optical density (OD) values [44]. From ELISA-positive samples, patterns of protein recognition were analyzed between host species by Western blot (WB) using two strains of T. cruzi with different genetic background (DTU-I and DTU-II).…”

Accuracy of the diagnostic tests for the detection of Chagas disease: a systematic review and meta-analysis

“…The infection has two distinct clinical phases separated by an indeterminate period [12] In the acute phase, the disease is characterized by high parasitemia; usually asymptomatic or oligosymptomatic; and patients can exhibit fever, anorexia, tachycardia, and cutaneous manifestations, such as Chagoma’s and Romaña’s signs [13]. ; In the chronic phase, the infection can manifest as neurological, cardiac, digestive, and cardio-digestive alterations [14].…”