CNS chagoma

Abstract

A 39-year-old woman was admitted with dysarthria, left facio-brachio-crural paresis, and increased frontotemporal headache. She had undergone heart transplantation due to end-stage Chagas heart disease 4 months previously and was on immunosuppression therapy. MRI of the brain demonstrated a right cortico-subcortical frontoparietal lesion with mass effect and heterogeneous enhancement with gadolinium (figure 1). Stereotaxic brain biopsy demonstrated nests of amastigotes and assay for Trypanosoma cruzi confirmed the diagnosis (figure 2).1 Therapy with benznidazole was successful. This case illustrates that T cruzi infection reactivation may occur and requires early diagnosis and treatment.

Anxiety, depression, and memory loss in Chagas disease: a puzzle far beyond neuroinflammation to be unpicked and solved*

“… 33 The central participation of T. cruzi in these processes has been confirmed when benznidazole therapy was timely administered, with effective parasite control and brain lesion resolution. 29 , 35 , 111 These data reinforce the accessibility of the CNS through benznidazole therapy. 36 …”

“…(29) Histologically, common findings are haemorrhagic necrotic nodules, tumour-like mass enriched in parasites, moderate focal and scattered inflammatory infiltrates, and parasite-bearing reactive macrophages. (29,33,34,35) Crucially, if timely diagnosed the drug of choice to treat the reactivated infection in the CNS in immunosuppressed patients is benznidazole, which is accessible to the brain tissue, (36) effective in controlling parasitism and parasitaemia, and in improving clinical outcomes and patient life expectancy. (29,35) Chagas proposed that behavioural alterations described in adults, as cognitive deficits, could represent sequelae of the acute phase of infection.…”

“… 29 , 33 , 34 , 35 Crucially, if timely diagnosed the drug of choice to treat the reactivated infection in the CNS in immunosuppressed patients is benznidazole, which is accessible to the brain tissue, 36 effective in controlling parasitism and parasitaemia, and in improving clinical outcomes and patient life expectancy. 29 , 35 …”

“… 99 In a situation of immunosuppression by HIV infection, the CNS is the main target tissue of the reactivation of T. cruzi infection. 29 , 35 Curiously, in vitro experiments revealed that HIV and T. cruzi coexist in the same astrocyte cell, likely favouring reciprocal interactions proposed to be linked to an IL-6-promoted cytoprotective activity. 100 Thus, the presence of IFNγ may promote the infection of astrocytes by both pathogens, a matter to be further mechanistically explored.…”

Chagas Disease Infection Reactivation after Heart Transplant

“…Reactivation episodes may induce clinical acute Chagas disease-like symptoms, including fever, anemia, jaundice, liver function test alterations, myocarditis, and neurologic symptoms, secondary to the parasitic effects on the central nervous system. [ 12 , 29 , 32 ]. However, reactivation episodes may occur without symptoms.…”