Cerebral trypanosomiasis and AIDS

Abstract

-A 36 year-old black female, complaining of headache of one month's duration presented with nausea, vomiting, somnolence, short memory problems, loss of weight, and no fever history. Smoker, intravenous drugs abuser, promiscuous lifestyle. Physical examination: left homonimous hemianopsia, left hemiparesis, no papilledema, diffuse hyperreflexia, slowness of movements. Brain CT scan: tumor-like lesion in the splenium of the corpus calosum, measuring 3.5 x 1.4 cm, with heterogeneous enhancing pattern, sugesting a primary CNS tumor. Due to the possibility of CNS infection, a lumbar puncture disclosed an opening pressure of 380 mmH 2 0; 11 white cells (lymphocytes); glucose 18 mg/dl (serum glucose 73 mg/dl); proteins 139 mg/dl; presence of Trypanosoma parasites. Serum Elisa-HIV tests turned out to be positive. Treatment with benznidazole dramatically improved clinical and radiographic picture, but the patient died 6 weeks later because of respiratory failure. T. cruzi infection of the CNS is a rare disease, but we have an increasing number of cases in HIV immunecompromised patients. Diagnosis by direct observation of CSF is uncommon, and most of the cases are diagnosed by pathological examination. It is a highly lethal disease, even when properly diagnosed and treated. This article intends to include cerebral trypanosomiasis in the differential diagnosis of intracranial space-occupying lesions, especially in immunecompromised patients from endemic regions.

Importance of Nonenteric Protozoan Infections in Immunocompromised People

“…In areas of endemicity, reactivated Chagas' disease may be the first presentation of HIV infection (20), and the lethality of T. cruzi-HIV coinfection is high (369). In regions where the disease is endemic, reactivation of latent Chagas' disease not only occurs in patients infected with HIV (118,201,476,496) but also has been reported for those with leukemia (9) or lymphoma (208) and transplant recipients (8,40,216).…”

“…Typically, severe immunosuppression alters the clinical course of Chagas' disease to include central nervous system (CNS) manifestations, which are not usually seen for ICT patients (20). Human immunodeficiency virus-infected patients with Chagas' disease may experience acute meningoencephalitis, fever, headaches, seizures, and vomiting along with myocarditis and other pathologies observed for ICT patients (567).…”

“…In HIV-infected individuals, the diagnosis of Chagasic brain pathologies begins with a computed tomography (CT) scan or magnetic resonance imaging (MRI) (20,174,369,567). Meningoencephalitis and myocarditis as seen for T. cruzi-HIV coinfection may be easily confused with those observed for Toxoplasma-HIV coinfections (20,522).…”

Usefulness of Magnetic Resonance Spectroscopy in the Assessment of Brain Chagas Disease: A Case Report

“…In recent years, a few reports have described HIV-positive patients with CNS lesions due to Chagas disease [7][8][9][10][11]. In these reports, lesions appeared large-sized with lobar location and usually a thick ring enhancement surrounded by severe edema.…”

Human Immunodeficiency Virus and the Central Nervous System

“…Examples of this are the high incidence of tuberculosis [6] schistosomiasis, trypanosomiasis [7][8][9][10][11][12][13][14][15][16][17][18] and some cases of paracoccidioidomycosis [19,20] in the CNS.…”