Trypanosoma cruzi Meningoencephalitis in HIV-Infected Patients

Abstract

Five cases of Trypanosoma cruzi meningoencephalitis in HIV-infected patients are reported. All patients presented with mass lesions on head computed tomographic scan, trypanosomes in the cerebrospinal fluid and failure to respond to antitoxoplasmosis therapy. Benznidazole therapy was associated with clinical improvement in 1 patient. Another 4 patients had T cruzi identified in a peripheral smear. T cruzi needs to be considered in the differential diagnosis of HIV-infected patients with central nervous system mass lesions if they have a history of appropriate exposure.

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] .…”

T cells responding to Trypanosoma cruzi detected by membrane TNF‐α and CD154 in chagasic patients

“…The acute phase of the infection is followed by a chronic phase with the presence of a low level parasitemia. CD4+ and CD8+ T lymphocytes participate in the control but not the elimination of T. cruzi , as consistently demonstrated in animal models and human infection 14, 15, 16. Approximately 30% of chronically infected individuals become symptomatic due to heart or gastrointestinal involvement 17.…”

Trypanosoma cruzi Meningoencephalitis in a Patient with Acquired Immunodeficiency Syndrome

“…Diagnosis is often delayed and mortality is 79-100% despite treatment 1,2 ; to our knowledge, only four cases of T. cruzi meningoencephalitis in human immunodeficiency virus (HIV)-infected patients have been reported in the United States. [3][4][5][6] None of the four patients have survived.…”