Trypanosoma cruzi Meningoencephalitis in a Patient with Acquired Immunodeficiency Syndrome

Yasukawa, Kosuke; Patel, Shital M.; Flash, Charlene A.; Stager, Charles E.; Goodman, J. Clay; Woc-Colburn, Laila

doi:10.4269/ajtmh.14-0058

Cited by 21 publications

(7 citation statements)

References 14 publications

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“…3 , as an example in a murine model), or those co-infected with HIV (for review, Lattes and Lasala, 2014 ). CNS involvement leading to meningoencephalitis is a common outcome in these situations (Cordova et al 2008 ; Diazgranados, et al 2009 ; Yasukawa et al 2014 ).…”

Section: Does Parasite Tropism During Chronic Infections Have Therapementioning

confidence: 99%

Biological factors that impinge on Chagas disease drug development

et al. 2017

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SUMMARYChagas disease is caused by infection with the insect-transmitted protozoan Trypanosoma cruzi, and is the most important parasitic infection in Latin America. The current drugs, benznidazole and nifurtimox, are characterized by limited efficacy and toxic side-effects, and treatment failures are frequently observed. The urgent need for new therapeutic approaches is being met by a combined effort from the academic and commercial sectors, together with major input from not-for-profit drug development consortia. With the disappointing outcomes of recent clinical trials against chronic Chagas disease, it has become clear that an incomplete understanding of parasite biology and disease pathogenesis is impacting negatively on the development of more effective drugs. In addition, technical issues, including difficulties in establishing parasitological cure in both human patients and animal models, have greatly complicated the assessment of drug efficacy. Here, we outline the major questions that need to be addressed and discuss technical innovations that can be exploited to accelerate the drug development pipeline.

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Section: Does Parasite Tropism During Chronic Infections Have Therapementioning

confidence: 99%

Biological factors that impinge on Chagas disease drug development

et al. 2017

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“…The case-fatality rate for CNS reactivation is very high. The presentation is often confused with CNS toxoplasmosis(212,213); T. cruzi should be considered in the differential diagnosis of CNS mass lesions in HIV-infected patients(214,215). Acute reactivated myocarditis is another frequent manifestation and may be obscured by pre-existing chronic cardiomyopathy(216).…”

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confidence: 99%

“…New arrhythmias or conduction system abnormalities, pericardial effusions or cardiac decompensation should prompt testing for reactivation.Subcutaneous nodules resembling erythema nodosum and parasitic invasion of the peritoneum, stomach or intestine can occur but are uncommon(217). Five cases of T. cruzi reactivation in HIV-infected Latin American immigrants have been reported in the United States since 1992; all presented as CNS syndromes and were treated initially as toxoplasmosis(212,213,(218)(219)(220).…”

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confidence: 99%

Chagas Disease in the United States: a Public Health Approach

et al. 2019

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SUMMARY Trypanosoma cruzi is the etiological agent of Chagas disease, usually transmitted by triatomine vectors. An estimated 20 to 30% of infected individuals develop potentially lethal cardiac or gastrointestinal disease. Sylvatic transmission cycles exist in the southern United States, involving 11 triatomine vector species and infected mammals such as rodents, opossums, and dogs. Nevertheless, imported chronic T. cruzi infections in migrants from Latin America vastly outnumber locally acquired human cases. Benznidazole is now FDA approved, and clinical and public health efforts are under way by researchers and health departments in a number of states. Making progress will require efforts to improve awareness among providers and patients, data on diagnostic test performance and expanded availability of confirmatory testing, and evidence-based strategies to improve access to appropriate management of Chagas disease in the United States.

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“…Case series involving other solid organ transplant recipients (mostly renal transplant recipients) describe similar manifestations of CD reactivation [ 16–19 ]. CD reactivation is also known to occur in people with HIV/AIDS, most commonly presenting as meningoencephalitis [ 20 ] and/or brain abscesses (chagomas) [ 3 , 21 ]. CD reactivation has also been described in patients receiving chemotherapy for hematologic and solid malignancies [ 22–25 ] and hematopoietic cell transplant (HCT) recipients [ 26–29 ].…”

Section: Patient Casementioning

confidence: 99%

Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature

Czech

Nayak

Subramanian

et al. 2021

Open Forum Infectious Diseases

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Reactivation of Chagas disease has been described in immunosuppressed patients, but there is a paucity of literature describing reactivation in patients on immunosuppressive therapies for the treatment of autoimmune rheumatic diseases. We describe a case of Chagas disease reactivation in a woman taking azathioprine and prednisone for limited cutaneous systemic sclerosis (lcSSc). Reactivation manifested as indurated and erythematous cutaneous nodules. Sequencing of a skin biopsy specimen confirmed the diagnosis of Chagas disease. She was treated with benznidazole with clinical improvement in the cutaneous lesions. However, her clinical course was complicated and included disseminated CMV disease and subsequent septic shock due to bacteremia. Our case and review of the literature highlight that screening for Chagas disease should be strongly considered for patients who will undergo immunosuppression for treatment of autoimmune disease if epidemiologically indicated.

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Trypanosoma cruzi Meningoencephalitis in a Patient with Acquired Immunodeficiency Syndrome

Cited by 21 publications

References 14 publications

Biological factors that impinge on Chagas disease drug development

Biological factors that impinge on Chagas disease drug development

Chagas Disease in the United States: a Public Health Approach

Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature

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