CHAGASIC MENINGOENCEPHALITIS IN AN HIV INFECTED PATIENT WITH MODERATE IMMUNOSUPPRESSION: PROLONGED SURVIVAL AND CHALLENGES IN THE HAART ERA

Rev Inst Med Trop Sao Paulo. 2015 Dec;57(6):531-5. doi: 10.1590/S0036-46652015000600014.

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.

A reativação da doença de Chagas em pacientes com a infecção pelo HIV apresenta uma alta morbidade e mortalidade. Neste relato, apresentamos caso confirmado de meningoencefalite chagásica, como doença definidora de aids, em paciente com 318 linfócitos T-CD4+/mm3. Após 2 meses de tratamento seguido de um ano de profilaxia secundária com benzonidazol e início precoce de terapia antirretroviral (HAART), a paciente apresentou boa evolução clínica, parasitológica e radiológica. Utilizamos a reação em cadeia da polimerase qualitativa do T. cruzi, para monitorização da parasitemia por T. cruzi durante e após o tratamento. Ressaltamos o valor potencial das técnicas moleculares associadas aos parâmetros clínicos e radiológicos nos pacientes com doença de Chagas e infecção pelo HIV. A introdução precoce da terapia antirretroviral, a terapia antiparasitária prolongada, manutenção e descontinuação da mesma, são desafios atuais, embora possíveis, no manejo da reativação da doença de Chagas na era das terapias antirretrovirais de alta eficácia.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections* / complications
  • AIDS-Related Opportunistic Infections* / drug therapy
  • AIDS-Related Opportunistic Infections* / parasitology
  • Acquired Immunodeficiency Syndrome / complications
  • Acquired Immunodeficiency Syndrome / drug therapy
  • Acquired Immunodeficiency Syndrome / parasitology
  • Adult
  • Antiretroviral Therapy, Highly Active
  • CD4 Lymphocyte Count
  • Chagas Disease / complications*
  • Chagas Disease / virology
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Meningoencephalitis* / diagnostic imaging
  • Meningoencephalitis* / drug therapy
  • Meningoencephalitis* / parasitology
  • Meningoencephalitis* / virology
  • Nitroimidazoles / therapeutic use*
  • Secondary Prevention / methods
  • Survival Rate
  • Time Factors
  • Trypanocidal Agents / therapeutic use
  • Ultrasonography

Substances

  • Immunosuppressive Agents
  • Nitroimidazoles
  • Trypanocidal Agents
  • benzonidazole

Grants and funding

This study was partially supported by the Centro de Estudos Emílio Ribas, Instituto de Infectologia Emílio Ribas and the Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP, Proc. FAPESP 12/50273-0.