title: [Chagas disease affecting the central nervous system in a patient with AIDS demonstrated by quantitative molecular methods].
abstract: Although infrequent, Trypanosoma cruzi reactivation is possible among patients with HIV/AIDS infection that develop a tumor-like or granulomatous lesion in the CNS. We report the case of a 60 years old male patient with HIV/AIDS and low CD4 lymphocytes count with cerebellar symptoms and mild paresis, associated to supra and infratentorial hypodense lesions and positive serology tests both to T. gondii and Trypanosoma cruzi. Empirical therapy against toxoplasmosis was prescribed together with antiretroviral therapy but without a favorable response. Brain Chagas disease was confirmed by quantitative PCR in the CSF but he died despite nifurtimox treatment. Despite its rare occurrence, Chagas disease affecting the CNS is possible among patients with HIV/AIDS infection. Epidemiological exposure, a positive Chagas serological test and the image pattern of brain lesions support the suspicion. Diagnosis can be confirmed by molecular test in CSF samples, including new quantitative methods. Despite an adverse prognosis, specific therapy can be attempted besides antiretroviral treatment.
authors.affiliation: Servicio de Infectología, Hospital Militar, Santiago, Chile.
authors.forename: Alberto
authors.initials: A
authors.lastname: Fica
authors.affiliation: Servicio de Imagenología, Hospital Militar, Santiago, Chile.
authors.forename: Marcia
authors.initials: M
authors.lastname: Salinas
authors.affiliation: Sección Parasitología, Instituto de Salud Pública, Chile.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Jercic
authors.affiliation: Servicio de Infectología, Hospital Militar, Santiago, Chile.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Dabanch
authors.affiliation: Servicio de Infectología, Hospital Militar, Santiago, Chile.
authors.forename: Andrés
authors.initials: A
authors.lastname: Soto
authors.affiliation: Servicio de Neurología, Hospital Militar, Santiago, Chile.
authors.forename: Sergio
authors.initials: S
authors.lastname: Quintanilla
authors.affiliation: Servicio de Neurología, Hospital Militar, Santiago, Chile.
authors.forename: Carlos
authors.initials: C
authors.lastname: Flores
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000469:parasitology; D018791:CD4 Lymphocyte Count; D020808:Central Nervous System Protozoal Infections / Q000175:diagnosis* / Q000469:parasitology; D002555:Cerebrospinal Fluid / Q000469:parasitology; D014355:Chagas Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D014349:Trypanosoma cruzi / Q000235:genetics* / Q000302:isolation & purification; D019562:Viral Load