Subject(s)
Adult , Humans , Male , AIDS-Related Opportunistic Infections/cerebrospinal fluid , Central Nervous System Protozoal Infections/cerebrospinal fluid , Chagas Disease/cerebrospinal fluid , Diagnostic Errors , Trypanosoma cruzi/isolation & purification , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/parasitology , Antibodies, Protozoan/blood , Argentina/epidemiology , Central Nervous System Protozoal Infections/diagnosis , Central Nervous System Protozoal Infections/parasitology , Cerebrospinal Fluid/parasitology , Chagas Disease/diagnosis , Chagas Disease/epidemiology , Chagas Disease/parasitology , Diagnosis, Differential , Endemic Diseases , Recurrence , Toxoplasmosis, Cerebral/diagnosis , Trypanosoma cruzi/immunologyABSTRACT
La reactivación de la enfermedad de Chagas (ECH) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) puede causar lesiones cerebrales ocupantes. Considerando que el diseño de un algoritmo para el diagnóstico precoz podría reducir la mortalidad, deben considerarse diversos escenarios: 1) ¿Cuándo debe indicarse el examen parasitológico (EP) del frotis de sangre periférica y líquido cefalorraquídeo (LCR)? 2) ¿debe realizarse aún en aquellos pacientes con serología negativa para Trypanosoma cruzi?, 3) ¿en qué casos el tratamiento para la encefalitis por T. gondii puede interrumpirse?
Reactivation of Chagas disease (CHD) in patients infected with Human Immunodeficiency Virus (HIV) can cause brain mass lesions. As the design of an algorithm for early diagnosis could reduce mortality, different secenarios should be considered:1) when the parasitologic examination (PE) of peripheral blood smears and cerebrospinal fluid(CSF) should be indicated? 2) should it de performed even in patients with negative serology for Trypanosoma cruzi? 3) in which cases the treatment for T. gondii encephalitis can be discontinued?
Subject(s)
Humans , Chagas Disease/diagnosis , Chagas Disease/cerebrospinal fluid , Chagas Disease/pathology , Chagas Disease/blood , HIV Infections/diagnosis , HIV Infections/pathology , Parasitology , Serologic TestsABSTRACT
A case of Chagas' meningoencephalitis in a 47 year-old patient with AIDS is presented. The diagnosis was established by examination of the cerebrospinal fluid which showed the presence of Trypanosoma cruzi. CT-scan revealed multiple cerebral lesions which only became evident by contrast administration. A second CT after 13 days showed a severe evolution with displacement of the midline structures leading to the patient's death. This case, as well as other case reports published, has shown the fulminant evolution of Chagas'meningoencephalitis in AIDS patients and the importance of cerebrospinal fluid examination for the diagnosis.