[Chagas disease and immunodeficiency: HIV infection and transplantation].
In the immunocompromised patients, the main features of Chagas disease are severe clinical manifestations during the acute phase and reactivations occurring during the chronic phase. Reactivation is defined by a demonstration of trypomastigots on microscopic examination of blood or the identification of amastigots on biopsy samples and/or acute clinical manifestations during the chronic phase. In HIV patients, meningo-encephalitis and myocarditis are the major clinical syndromes of reactivation. In transplanted patients, cutaneous lesions often reveal the reactivation. A parasiticidal treatment (nifurtimox or benznidazole) should be initiated immediately. A secondary prophylaxis is indicated for HIV patients with CD4 cells count < 200/mm3. In the near future, quantitative PCR could allow to diagnose early reactivation, to initiate preemptive therapy and to closely monitor the therapeutic response. Due to the severe manifestations and prognosis of Chagas disease in the immunocompromised host, two serologic tests must be performed in the patient with an history of residency in endemic countries.
Service des maladies infectieuses et tropicales, clinique du voyage et des maladies tropicales, hôpital Tenon, AP-HP, Paris, France. guillaume.le-loup@tnn.aphp.fr
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D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D014355:Chagas Disease / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000635:transmission*; D005602:France; D015658:HIV Infections / Q000150:complications / Q000635:transmission*; D006801:Humans; D008590:Meningoencephalitis / Q000469:parasitology / Q000517:prevention & control; D009547:Nifurtimox / Q000627:therapeutic use; D009593:Nitroimidazoles / Q000627:therapeutic use; D014180:Transplantation / Q000009:adverse effects*; D014344:Trypanocidal Agents / Q000009:adverse effects / Q000627:therapeutic use
D019380:Anti-HIV Agents; D009593:Nitroimidazoles; D014344:Trypanocidal Agents; D009547:Nifurtimox; C009999:benzonidazole