title: Trypanosoma cruzi necrotizing meningoencephalitis in a Venezuelan HIV⁺-AIDS patient: pathological diagnosis confirmed by PCR using formalin-fixed- and paraffin-embedded-tissues.
abstract: Coinfections with human immunodeficiency virus (HIV) and infectious agents have been recognized since the early 90s. In the central nervous system (CNS) of HIV(+) patients, parasitic protozoans like Toxoplasma gondii have been described as responsible for the space occupying lesions (SOL) developed. However, the involvement of Trypanosoma cruzi is also described but appears to be less frequent in acquired immunodeficiency syndrome (AIDS) and transplant recipients, associated with necrotizing myocarditis and neurological symptoms related to the occurrence of necrotizing pseudotumoral encephalitis (NPE) and meningoencephalitis (NME). The present work aims to present a Venezuelan case of NME associated with the coinfection of HIV and a T. cruzi-like trypanosomatid as well as its evolution and diagnosis by histopathological techniques, electron microscopy, and PCR methods using formalin-fixed- (FF-) and paraffin-embedded- (PE-) tissues. Postmortem cytological studies of leptomeninges imprints reveal the presence of trypomastigotes of Trypanosoma sp. Histopathological and electron microscopy studies allowed us to identify an amastigote stage and to reject the involvement of other opportunistic microorganisms as the etiological agent of the SOL. The definitive confirmation of T. cruzi as the etiological agent was achieved by PCR suggesting that the NME by T. cruzi was due to a reactivation of Chagas' disease.
authors.affiliation: Unit of Toxoplasmosis and Intestinal Protozoosis, Department of Parasitology, National Centre for Microbiology, Carlos III Health Institute, Carretera de Majadahonda-Pozuelo Km 22, Majadahonda, 28220 Madrid, Spain ; Section of Research on Ultrastructural Pathology and Molecular Biology, José A. O'Daly Institute for Pathology, Faculty of Medicine, Central University of Venezuela, Caracas 1080-A, Venezuela.
authors.forename: Marcello Salvatore
authors.initials: MS
authors.lastname: Rossi Spadafora
authors.affiliation: Section of Neuropathology, José A. O'Daly Institute for Pathology, Faculty of Medicine, Central University of Venezuela, Caracas 1080-A, Venezuela.
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Céspedes
authors.affiliation: Section of Nephropathology, José A. O'Daly Institute for Pathology, Faculty of Medicine, Central University of Venezuela, Caracas 1080-A, Venezuela.
authors.forename: Sandra
authors.initials: S
authors.lastname: Romero
authors.affiliation: Unit of Toxoplasmosis and Intestinal Protozoosis, Department of Parasitology, National Centre for Microbiology, Carlos III Health Institute, Carretera de Majadahonda-Pozuelo Km 22, Majadahonda, 28220 Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Fuentes
authors.affiliation: Laboratory of Electron Microscopy, Institute of Scientific and Technological Studies, Simón Rodríguez University, Caracas 1041-A, Venezuela.
authors.forename: Alpidio A
authors.initials: AA
authors.lastname: Boada-Sucre
authors.affiliation: Unit of Leishmaniasis and Chagas Disease Diagnosis, Department of Parasitology, National Centre for Microbiology, Carlos III Health Institute, Carretera de Majadahonda-Pozuelo Km 22, Majadahonda, 28220 Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Cañavate
authors.affiliation: Unit of Leishmaniasis and Chagas Disease Diagnosis, Department of Parasitology, National Centre for Microbiology, Carlos III Health Institute, Carretera de Majadahonda-Pozuelo Km 22, Majadahonda, 28220 Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Flores-Chávez
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D014355:Chagas Disease / Q000150:complications* / Q000175:diagnosis*; D005557:Formaldehyde; D006801:Humans; D008297:Male; D008590:Meningoencephalitis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D016612:Paraffin Embedding; D016133:Polymerase Chain Reaction; D016707:Tissue Fixation; D014349:Trypanosoma cruzi; D014687:Venezuela
chemical_list: D005557:Formaldehyde