title: CHAGASIC MENINGOENCEPHALITIS IN AN HIV INFECTED PATIENT WITH MODERATE IMMUNOSUPPRESSION: PROLONGED SURVIVAL AND CHALLENGES IN THE HAART ERA.
abstract: The reactivation of Chagas disease in HIV infected patients presents high mortality and morbidity. We present the case of a female patient with confirmed Chagasic meningoencephalitis as AIDS-defining illness. Interestingly, her TCD4+ lymphocyte cell count was 318 cells/mm3. After two months of induction therapy, one year of maintenance with benznidazol, and early introduction of highly active antiretroviral therapy (HAART), the patient had good clinical, parasitological and radiological evolution. We used a qualitative polymerase chain reaction for the monitoring of T. cruzi parasitemia during and after the treatment. We emphasize the potential value of molecular techniques along with clinical and radiological parameters in the follow-up of patients with Chagas disease and HIV infection. Early introduction of HAART, prolonged induction and maintenance of antiparasitic therapy, and its discontinuation are feasible, in the current management of reactivation of Chagas disease.
authors.affiliation: Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brasil.
authors.forename: Renata
authors.initials: R
authors.lastname: Buccheri
authors.affiliation: Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brasil.
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Kassab
authors.affiliation: Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Vera Lucia Teixeira de
authors.initials: VL
authors.lastname: Freitas
authors.affiliation: Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Sheila Cristina Vicente da
authors.initials: SC
authors.lastname: Silva
authors.affiliation: Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Rita C
authors.initials: RC
authors.lastname: Bezerra
authors.affiliation: Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brasil.
authors.forename: Zarifa
authors.initials: Z
authors.lastname: Khoury
authors.affiliation: Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Shikanai-Yasuda
authors.affiliation: Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brasil.
authors.forename: José E
authors.initials: JE
authors.lastname: Vidal
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy / Q000469:parasitology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy / Q000469:parasitology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D014355:Chagas Disease / Q000150:complications* / Q000821:virology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008590:Meningoencephalitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000469:parasitology / Q000821:virology; D009593:Nitroimidazoles / Q000627:therapeutic use*; D055502:Secondary Prevention / Q000379:methods; D015996:Survival Rate; D013997:Time Factors; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D007166:Immunosuppressive Agents; D009593:Nitroimidazoles; D014344:Trypanocidal Agents; C009999:benzonidazole