[Fatal evolution of Chagas'disease/Aids co-infection: diagnostic difficulties between myocarditis reactivation and chronic chagasic myocardiopathy].
Chagas disease is a type of parasitosis caused by the protozoan Trypanosoma cruzi, and it is transmitted by triatomine insects. This disease is found between the southern United States to Argentina and approximately 14 million people in Latin America are believed to be infected, predominantly with the chronic form of the disease. Reactivation of Chagas disease can occur among immunosuppressed patients, as has been observed among AIDS patients. In one such case, we observed cardiac decompensation with severe ventricular dysfunction and arrhythmias. This case was thought to be reactivation of Chagas disease in the myocardium, since the xenodiagnosis was positive. Specific treatment for Trypanosoma cruzi was administered, consisting of benznidazole, but the course of treatment was not completed because the patient died due to cardiopathic complications. The necropsy showed the usual stigmas of chronic Chagas cardiopathy, such as fibrosing myocarditis and a decreased number of neurons in the digestive system. There were no amastigote forms of Trypanosoma cruzi in any of the tissue samples studied. Therefore, reactivation of Chagas disease was not demonstrated but, rather, the natural evolution of chronic Chagas cardiopathy was demonstrated.
Almeida
Eros Antonio de
EA
Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP. eros@fcm.unicamp.br
Silva
Eliane Lages
EL
Guariento
Maria Elena
ME
Souza
Milton Lopes de
ML
Aoki
Francisco Hideo
FH
Pedro
Rogério de Jesus
Rde J
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000208:Acute Disease; D000328:Adult; D002598:Chagas Cardiomyopathy / Q000150:complications / Q000175:diagnosis*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000175:diagnosis*; D009593:Nitroimidazoles / Q000627:therapeutic use; D014344:Trypanocidal Agents / Q000627:therapeutic use
D009593:Nitroimidazoles; D014344:Trypanocidal Agents; C009999:benzonidazole