AIDS and Chagas' disease БТЛ
M. Corti and M.F. Villafane
Infectious Diseases Hospital "F. J. Muniz," Buenos Aires, Argentina
Chapter Outline
Introduction 731
Epidemiology of Chagas' disease in Latin America and Argentina 732 Natural history of Chagas' disease 732
Pathogenic mechanisms of Chagas' disease reactivation in AIDS patients 734
AIDS and Chagas' disease 734
Clinical aspects 735
Laboratory diagnosis 737
Diagnosis of chagasic meningoencephalitis 739
Diagnosis of chagasic tumor-like lesions 739
Diagnosis of heart compromise 741
Differential diagnosis 742
Treatment 742
Conclusion 744
Glossary of specialized terms of this chapter 744 References 745
Introduction
Chagas’ disease or American Trypanosomiasis is a zoonotic disease caused by the flagellated protozoan Trypanosoma cruzi, which was first identified by Carlos Chagas in 1909 in Minas Gerais, Brazil. Generally, this zoonotic disease is transmitted to humans and animals by Triatoma infestans (vectors) known as “vinchu- cas” in Argentina and “barbeiros” in Brazil. Less frequently, T. cruzi can be transmitted by transfusion of infected blood, via the transplacental route and organ transplantation from an infected donor. Sharing intravenous needles with an infected person with parasitemia is another possible source of infection.1 Rarely, the oral route including breast milk and laboratory accidents can be an alternative source of infection.2
Several authors have observed the occurrence of severe forms of Chagas’ disease, such as meningoencephalitis and myocarditis in patients with severe immuno- depression. The majority of cases have been described in Brazil and in the other countries in which this parasitosis is endemic. Generally, the clinical manifestations of the reactivation of T. cruzi infection in immunosupressed patients result in the
American Trypanosomiasis Chagas Disease. DOI: http://dx.doi.org/10.1016/B978-0-12-801029-7.00031-9
Copyright © 2017 Elsevier Inc. All rights reserved.
reactivation of chronic and previously asymptomatic or oligosymptomatic disease.3 Chagasic patients infected with the human immunodeficiency virus (HIV) present episodes of reactivation of the T. cruzi infection. Acute exacerbation of chronic Chagas’ disease is more frequent in AIDS than in other immunocompromised patients. Reactivation of Chagas’ disease in AIDS is possible in those patients with a CD4 T cell count less than 200 cell/^L and the highest risk occurs with a CD4 T cell count less than 50 cell/^L.
