Chagasic encephalitis in HIV patients: common presentation of an evolving epidemiological and clinical association

• Published in: The Lancet infectious diseases 2009-05, Vol.9 (5), p.324-330
• Main Authors: DiazGranados, Carlos A, MD, Saavedra-Trujillo, Carlos H, MD, Mantilla, Monica, MD, Valderrama, Sandra L, MD, Alquichire, Carlos, MD, Franco-Paredes, Carlos, MD
• Format: Article
• Language: English
• Subjects: Adult; Anticonvulsants - therapeutic use; Antiretroviral agents; Antiretroviral Therapy, Highly Active; Biological and medical sciences; Chagas Disease - drug therapy; Chagas Disease - immunology; Chagas Disease - parasitology; Female; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - parasitology; Human protozoal diseases; Human viral diseases; Humans; Immunocompromised Host; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious Disease; Infectious diseases; Medical sciences; Meningoencephalitis - drug therapy; Meningoencephalitis - immunology; Meningoencephalitis - parasitology; Nitroimidazoles - therapeutic use; Parasitic diseases; Prophylaxis; Protozoal diseases; Seizures - drug therapy; Seizures - parasitology; Trypanocidal Agents - therapeutic use; Trypanosomiasis; Vector-borne diseases; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(09)70088-X

Summary We present a case of chagasic meningoencephalitis reactivation in an HIV-infected woman with advanced immunosuppression. Prolonged survival was attained with antiparasitic therapy and secondary prophylaxis, in conjunction with the use of highly-active antiretroviral therapy. The geographic expansion of the HIV epidemic around the world coupled with global migration and international travel have created a favourable situation for Trypanosoma cruzi and HIV coinfection. The clinical manifestations of Chagas disease in HIV-positive people usually represent reactivation and not acute infection with T cruzi (coinfection). Symptomatic reactivation of chronic latent T cruzi infection can be triggered by severe immunosuppression associated with HIV infection. In this setting, Chagas disease reactivation often presents as meningoencephalitis resembling toxoplasma encephalitis. We review, in this Grand Round, the clinical manifestations, diagnostic approach, pathogenesis, natural history, treatment, prognosis, and prevention of Chagas disease reactivation among HIV-infected people with an emphasis on CNS manifestations.