Reactivation of Chagas disease with central nervous system involvement in HIV-infected patients in Argentina, 1992-2007.
OBJECTIVE
The objective of this study was to evaluate clinical and microbiological characteristics of Chagas disease (ChD) with central nervous system (CNS) involvement in AIDS patients.


METHODS
This was a retrospective study of clinical and laboratory findings of HIV-infected patients with a confirmed diagnosis of ChD involving the CNS during the period 1992-2007 at the "Francisco J. Muñiz" Infectious Diseases Hospital, Buenos Aires, Argentina.


RESULTS
Of a total of 15 patients, 14 were male and the median age was 33 years (range 25-54 years). Seven out of nine had lived in a Chagas endemic area and 7/10 were intravenous drug users (IDUs). The disease was reactivated during corticosteroid therapy in three patients. Clinical manifestations were: headache (11/15), focal neurological deficits (9/15), fever (9/15), meningismus (7/15), seizures (7/15), altered mental status (5/15), and cardiac involvement (3/10). The median CD4 T-cell count at the time of reactivation was 64cells/microl (range 1-240). Twelve of 14 had positive serology for Trypanosoma cruzi; the two negative were IDUs. Cerebrospinal fluid (CSF) findings (median (range)): cell count 5/mm(3) (2-90), protein level 0.68g/l (0.1-1.84), and glucose level 0.45g/l (0.13-0.73). CSF direct examination for T. cruzi was positive in 11/13. Neuroimaging findings showed a single hypodense lesion in 7/14 and normal images in 2/14. Twelve patients were treated with benznidazole. The global mortality was 79% (11/14).


CONCLUSIONS
ChD reactivation should be considered as a differential diagnosis of meningoencephalitis in HIV patients with low CD4 T-cell counts, previous residency in an endemic area, and/or IDUs. Whenever possible, lumbar puncture should be performed because of the high accuracy for early diagnosis.
Cordova
Ezequiel
E
Francisco J. Muñiz Infectious Diseases Hospital, Uspallata 2262, Buenos Aires, Argentina. dr_ecordova@hotmail.com
Boschi
Analia
A
Ambrosioni
Juan
J
Cudos
Carolina
C
Corti
Marcelo
M
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology; D000328:Adult; D000818:Animals; D001118:Argentina / Q000453:epidemiology; D001921:Brain / Q000000981:diagnostic imaging / Q000469:parasitology; D020808:Central Nervous System Protozoal Infections / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000469:parasitology; D014355:Chagas Disease / Q000469:parasitology / Q000473:pathology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008590:Meningoencephalitis / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology; D008875:Middle Aged; D011859:Radiography; D014349:Trypanosoma cruzi / Q000302:isolation & purification / Q000472:pathogenicity*