Trypanosoma cruzi parasitemia observed in immunocompromised patients: the importance of the artificial xenodiagnosis

Braz, Lúcia Maria Almeida; Neto, Vicente Amato; Carignani, F L; Marchi, Cassiano

doi:10.1590/s0036-46652001000200012

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…Nevertheless, treatment with benznidazole or nifurtimox should be initiated as soon as any symptoms of T. cruzi infection reactivation are noted, even in the absence of an increase in parasitemia [7], [15], [31], [48]. Direct microscopic examination of blood and cerebrospinal fluid may reveal the presence of T. cruzi trypomastigotes, which usually, but not always, precedes clinical manifestations [49]. Parasitological and/or PCR follow-up are thus mandatory in patients with HIV infection [50].…”

Section: Resultsmentioning

confidence: 99%

Immunosuppression and Chagas Disease: A Management Challenge

et al. 2013

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Immunosuppression, which has become an increasingly relevant clinical condition in the last 50 years, modifies the natural history of Trypanosoma cruzi infection in most patients with Chagas disease. The main goal in this setting is to prevent the consequences of reactivation of T. cruzi infection by close monitoring. We analyze the relationship between Chagas disease and three immunosuppressant conditions, including a description of clinical cases seen at our center, a brief review of the literature, and recommendations for the management of these patients based on our experience and on the data in the literature. T. cruzi infection is considered an opportunistic parasitic infection indicative of AIDS, and clinical manifestations of reactivation are more severe than in acute Chagas disease. Parasitemia is the most important defining feature of reactivation. Treatment with benznidazole and/or nifurtimox is strongly recommended in such cases. It seems reasonable to administer trypanocidal treatment only to asymptomatic immunosuppressed patients with detectable parasitemia, and/or patients with clinically defined reactivation. Specific treatment for Chagas disease does not appear to be related to a higher incidence of neoplasms, and a direct role of T. cruzi in the etiology of neoplastic disease has not been confirmed. Systemic immunosuppressive diseases or immunosuppressants can modify the natural course of T. cruzi infection. Immunosuppressive doses of corticosteroids have not been associated with higher rates of reactivation of Chagas disease. Despite a lack of evidence-based data, treatment with benznidazole or nifurtimox should be initiated before immunosuppression where possible to reduce the risk of reactivation. Timely antiparasitic treatment with benznidazole and nifurtimox (or with posaconazole in cases of therapeutic failure) has proven to be highly effective in preventing Chagas disease reactivation, even if such treatment has not been formally incorporated into management protocols for immunosuppressed patients. International consensus guidelines based on expert opinion would greatly contribute to standardizing the management of immunosuppressed patients with Chagas disease.

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Section: Resultsmentioning

confidence: 99%

Immunosuppression and Chagas Disease: A Management Challenge

et al. 2013

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“…Esses achados são similares aos observados em humanos e em primatas não-humanos (BRAZ at al., 2001;CARVALHO et al, 2003) e pode estar associado à escassez do T. cruzi no sangue periférico devido à provável forma crônica da doença.…”

Section: Resultsunclassified

Aspectos clínico-laboratoriais da infecção natural por Trypanosoma cruzi em cães de Mato Grosso do Sul

et al. 2008

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“…The level of parasitemia observed in HIV infected individuals with symptoms of Chagas' disease is useful in diagnosis [2,20]. Direct microscopic examination of blood and cerebrospinal fluid may reveal T. cruzi trypomastigotes [20].…”

Section: Chagas' Disease and Aidsmentioning

confidence: 99%

“…Direct microscopic examination of blood and cerebrospinal fluid may reveal T. cruzi trypomastigotes [20]. This finding may precede the clinical manifestations of disease or it may be discovered with the onset of symptoms.…”

Section: Chagas' Disease and Aidsmentioning

confidence: 99%

Chagas' disease and AIDS

Vaidian

Weiss

Tanowitz

2004

Kinetoplastid Biol Dis

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Chagas' disease caused by Trypanosoma cruzi is an opportunistic infection in the setting of HIV/ AIDS. Some individuals with HIV and chronic T. cruzi infection may experience a reactivation, which is most commonly manifested by meningoencephalitis. A reactivation myocarditis is the second most common manifestation. These presentations may be difficult to distinguish from toxoplasmosis in individuals with HIV/AIDS. The overlap of HIV and Trypanosoma cruzi infection occurs not only in endemic areas but also in non-endemic areas of North America and Europe where the diagnosis may be even more difficult. The pathological features, diagnosis and the role of cytokines in the pathogenesis of the disease are discussed.

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Trypanosoma cruzi parasitemia observed in immunocompromised patients: the importance of the artificial xenodiagnosis

Cited by 8 publications

References 5 publications

Immunosuppression and Chagas Disease: A Management Challenge

Immunosuppression and Chagas Disease: A Management Challenge

Aspectos clínico-laboratoriais da infecção natural por Trypanosoma cruzi em cães de Mato Grosso do Sul

Chagas' disease and AIDS

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