title: Chagas disease in the immunosuppressed host.
abstract: OBJECTIVE
  This review examines recent literature on Chagas disease in the immunosuppressed host.
  
  
  RESULTS
  Chagas disease in immunosuppressed patients may represent acute transmission in an organ recipient, or reactivation of chronic infection in an HIV-infected individual or patient receiving cardiac transplantation for Chagas cardiomyopathy. Transplantation of the kidney or liver from an infected donor resulted in transmission in 18-19 and 29%, respectively. Prospective monitoring usually detects acute infection before symptom onset; early treatment is highly effective. In heart transplant patients, reactivation symptoms include fever, myocarditis and skin lesions, and may mimic rejection. Approximately 20% of HIV- Trypanosoma cruzi infected patients experience reactivation; manifestations include meningoencephalitis and/or myocarditis.
  
  
  CONCLUSIONS
  Transplantation of the heart from a T. cruzi-infected donor is contraindicated; use of other organs can be considered. Guidelines recommend prospective monitoring rather than prophylactic treatment in recipients. Posttransplant monitoring for acute infection or reactivation relies on PCR, culture and microscopy of blood specimens regularly for at least 6 months. Treatment employs standard courses of benznidazole or nifurtimox, and immune reconstitution for the HIV-coinfected patient. Case reports suggest some HIV-T. cruzi-infected patients may benefit from secondary prophylaxis, but more data are needed to determine efficacy and specific regimens.
authors.affiliation: Prevention and Public Health Group, Global Health Sciences, Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco, California 94105, USA. Caryn.Bern@UCSF.edu
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
mesh_terms: D000208:Acute Disease; D014355:Chagas Disease / Q000175:diagnosis / Q000635:transmission*; D002908:Chronic Disease; D015658:HIV Infections / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D016377:Organ Transplantation / Q000009:adverse effects*; D014019:Tissue Donors; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014349:Trypanosoma cruzi / Q000302:isolation & purification
chemical_list: D014344:Trypanocidal Agents