Chagas'disease and HIV co-infection: genotypic characterization of the Trypanosoma cruzi strain

In the past few years, new aspects of the immunopathology of Chagas' disease have been described in immunosuppressed patients, such as fatal central system lesions related to the reactivation of the parasite. This article is the first description of the genotypic characterization, at the strain level, of Trypanosoma cruzi isolated from a patient with Chagas' disease/AIDS co-infection. The presence of four hypodense lesions was observed in the cranial compute tomographic scan. The diagnosis of AIDS was assessed by the detection of anti-HIV antibodies using enzyme-linked immunosorbent assay (ELISA) and Western blot techniques. The CD4+ lymphocyte counts were maintained under 200 cells/mm cube number during one year demonstrating the severity of the state of immunosuppression. Chagas' disease was confirmed by serological and parasitological methods. Trypomastigote forms were visualized in a thick blood smear. The parasite isolated is genotypically similar to the CL strain. The paper reinforces that cerebral Chagas' disease can be considered as another potencial opportunistic infection in AIDS resulting from the reactivation of a dormant T. cruzi infection acquired years earlier.

Casos de leishmaniose tegumentar americana por Leishmania (Viannia) braziliensis nos Municípios de Cosmópolis e Indaiatuba-regiäo de Campinas, Estado de Säo Paulo, Brasil / Cases of mucocutaneous leishmaniasis due to Leishmania (Viannia) braziliensis from Cosmópolis and Indaituba municipalities - Campinas region, State of Säo Paulo, Brazil

A study was carried out to identify Leishmania species involved in skin lesions of patients from Cosmópolis and Indaiatuba, State of Säo Paulo, Brazil. The epidemiological data of cutaneous leishmaniasis in two cities suggested a epidemic situation in 1994. The lesions were clinically characteristic of cutaneous leishmaniasis and five out six patients responded positively to Montenegro's intradermal test. The histopathology of skin lesions were characterized by two patterns: exudative-cellular reaction and exudative granulomatous reaction. The clinical and histopathological parameters suggested Leishmania (Viannia) braziliensis as the possible etiologic agent. In agreement, it was difficult to isolate and maintain the parasite in the laboratory. Characterization by in situ hybridization with kDNA amastigotes from lesions fragments confirmed that Leishmania (Viannia) braziliensis was the parasite responsible for the studied cutaneous lesions.