Reactivation of Chagas disease with central nervous system involvement in HIV-infected patients in Argentina, 1992-2007

Int J Infect Dis. 2008 Nov;12(6):587-92. doi: 10.1016/j.ijid.2007.12.007. Epub 2008 Mar 11.


Objectives: The objective of this study was to evaluate clinical and microbiological characteristics of Chagas disease (ChD) with central nervous system (CNS) involvement in AIDS patients.

Methods: This was a retrospective study of clinical and laboratory findings of HIV-infected patients with a confirmed diagnosis of ChD involving the CNS during the period 1992-2007 at the "Francisco J. Muñiz" Infectious Diseases Hospital, Buenos Aires, Argentina.

Results: Of a total of 15 patients, 14 were male and the median age was 33 years (range 25-54 years). Seven out of nine had lived in a Chagas endemic area and 7/10 were intravenous drug users (IDUs). The disease was reactivated during corticosteroid therapy in three patients. Clinical manifestations were: headache (11/15), focal neurological deficits (9/15), fever (9/15), meningismus (7/15), seizures (7/15), altered mental status (5/15), and cardiac involvement (3/10). The median CD4 T-cell count at the time of reactivation was 64cells/microl (range 1-240). Twelve of 14 had positive serology for Trypanosoma cruzi; the two negative were IDUs. Cerebrospinal fluid (CSF) findings (median (range)): cell count 5/mm(3) (2-90), protein level 0.68g/l (0.1-1.84), and glucose level 0.45g/l (0.13-0.73). CSF direct examination for T. cruzi was positive in 11/13. Neuroimaging findings showed a single hypodense lesion in 7/14 and normal images in 2/14. Twelve patients were treated with benznidazole. The global mortality was 79% (11/14).

Conclusions: ChD reactivation should be considered as a differential diagnosis of meningoencephalitis in HIV patients with low CD4 T-cell counts, previous residency in an endemic area, and/or IDUs. Whenever possible, lumbar puncture should be performed because of the high accuracy for early diagnosis.

MeSH terms

  • AIDS-Related Opportunistic Infections* / epidemiology
  • AIDS-Related Opportunistic Infections* / parasitology
  • AIDS-Related Opportunistic Infections* / pathology
  • Adult
  • Animals
  • Argentina / epidemiology
  • Brain / diagnostic imaging
  • Brain / parasitology
  • Central Nervous System Protozoal Infections / epidemiology
  • Central Nervous System Protozoal Infections / parasitology
  • Central Nervous System Protozoal Infections / pathology
  • Cerebrospinal Fluid / parasitology
  • Chagas Disease / parasitology
  • Chagas Disease / pathology*
  • Female
  • HIV Infections / complications*
  • Humans
  • Male
  • Meningoencephalitis / epidemiology
  • Meningoencephalitis / parasitology
  • Meningoencephalitis / pathology
  • Middle Aged
  • Radiography
  • Trypanosoma cruzi / isolation & purification
  • Trypanosoma cruzi / pathogenicity*