Diagnosis of Chagasic Encephalitis by Sequencing of 28S rRNA Gene

Multani, Ashrit; Meer, Aabed; Smith, Dave; Kheraj, Malika N; Plowey, Edward D.; Blackburn, Brian G.

doi:10.3201/eid2507.180285

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…Additionally, advances in cancer treatment, autoimmune disease management and organ transplants have resulted in an increased number of individuals with compromised immune systems. This, in turn, increases the risk and prevalence of patients experiencing reactivation of Chagas disease in the CNS, particularly in Chagas-endemic countries (Multani et al ., 2019).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of patients in Chagas disease of the central nervous system: a systematic review

Shelton,

Gonzalez

2023

Parasitology

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Chagas disease is a parasitic infection caused by the protozoan Trypanosoma cruzi. One of the complications of the disease is the infection of the central nervous system (CNS), as it can result from either the acute phase or by reactivation during the chronic phase, exhibiting high mortality in immunocompromised patients. This systematic review aimed to determine clinical and paraclinical characteristics of patients with Chagas disease in the CNS. Articles were searched from PubMed, Scopus and LILACS until January 2023. From 2325 articles, 59 case reports and 13 case series of patients with Chagas in the CNS were retrieved from which 138 patients were identified. In this population, 77% of the patients were male, with a median age of 35 years old, from which most of them came from Argentina and Brazil. Most of the individuals were immunocompromised from which 89% were HIV-positive, and 54 patients had an average of 48 cells per mm3 CD4+ T cells. Motor deficits and seizures were the most common manifestation of CNS compromise. Furthermore, 90 patients had a documented CNS lesion by imaging from which 89% were supratentorial and 86% were in the anterior/middle cranial fossa. The overall mortality was of 74%. Among patients who were empirically treated with anti-toxoplasma drugs, 70% died. This review shows how Chagas disease in the CNS is a devastating complication requiring prompt diagnosis and treatment to improve patients’ outcomes.

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Section: Discussionmentioning

confidence: 99%

Outcomes of patients in Chagas disease of the central nervous system: a systematic review

Shelton,

Gonzalez

2023

Parasitology

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“…Of 31 PWH with positive T. cruzi serologic tests, Chunap detected 100% (7/7) of PWH with reactivation, 91.7% (11/12) of PWH with moderate parasitemia, and 41.7% (5/12) of PWH with negative parasitemia. Finally, for PWH who are suspected of having reactivation disease and who are being evaluated in high-resource settings, clinicians can consider tissue sample evaluation via the sequencing of the internal transcribed spacer 2 and D2 regions of the 28S rRNA gene, particularly in PWH with an unrevealing microscopic evaluation of blood and CSF specimens [ 66 ]. The D2 primers used in 28S rRNA gene sequencing react with multiple protozoa and fungi and therefore can detect not only T. cruzi but also other pathogens that share the D2 subunit and are often involved in the differential diagnosis of meningoencephalitis in PWH, such as Toxoplasma gondii , Cryptococcus spp., Histoplasma spp., and Leishmania spp.…”

Section: Screening and Diagnosismentioning

confidence: 99%

Chagas Disease in People with HIV: A Narrative Review

Clark

Bern

2021

TropicalMed

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Many questions remain unanswered regarding the epidemiology, pathophysiology, diagnosis, treatment, and monitoring of Trypanosoma cruzi infection in people with HIV (PWH). The reported prevalence of T. cruzi infection in PWH living in endemic countries ranges from 1–28% and is likely similar in at-risk US populations. While classic cardiac and gastrointestinal presentations of chronic Chagas disease occur in PWH, PWH are additionally at risk for a severe and often fatal form of T. cruzi-mediated disease called reactivation disease. T. cruzi reactivation typically occurs in PWH with low CD4 counts and poor virologic control. National HIV guidelines in several endemic South American countries recommend that all PWH be screened for T. cruzi infection at the time of HIV diagnosis; however, this recommendation is not widely implemented. The early detection of T. cruzi infection in PWH is critical as the sequelae of Chagas disease, including T. cruzi reactivation, may be preventable through the restoration of robust cellular immunity via the initiation of antiretroviral therapy and the appropriate use of antitrypanosomal therapy.

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“…Case series involving other solid organ transplant recipients (mostly renal transplant recipients) describe similar manifestations of CD reactivation [ 16–19 ]. CD reactivation is also known to occur in people with HIV/AIDS, most commonly presenting as meningoencephalitis [ 20 ] and/or brain abscesses (chagomas) [ 3 , 21 ]. CD reactivation has also been described in patients receiving chemotherapy for hematologic and solid malignancies [ 22–25 ] and hematopoietic cell transplant (HCT) recipients [ 26–29 ].…”

Section: Patient Casementioning

confidence: 99%

Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature

Czech

Nayak

Subramanian

et al. 2021

Open Forum Infectious Diseases

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Reactivation of Chagas disease has been described in immunosuppressed patients, but there is a paucity of literature describing reactivation in patients on immunosuppressive therapies for the treatment of autoimmune rheumatic diseases. We describe a case of Chagas disease reactivation in a woman taking azathioprine and prednisone for limited cutaneous systemic sclerosis (lcSSc). Reactivation manifested as indurated and erythematous cutaneous nodules. Sequencing of a skin biopsy specimen confirmed the diagnosis of Chagas disease. She was treated with benznidazole with clinical improvement in the cutaneous lesions. However, her clinical course was complicated and included disseminated CMV disease and subsequent septic shock due to bacteremia. Our case and review of the literature highlight that screening for Chagas disease should be strongly considered for patients who will undergo immunosuppression for treatment of autoimmune disease if epidemiologically indicated.

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Diagnosis of Chagasic Encephalitis by Sequencing of 28S rRNA Gene

Cited by 5 publications

References 14 publications

Outcomes of patients in Chagas disease of the central nervous system: a systematic review

Outcomes of patients in Chagas disease of the central nervous system: a systematic review

Chagas Disease in People with HIV: A Narrative Review

Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature

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