Long-term follow-up of co-infected HIV and Trypanosoma cruzi Brazilian patients

Da‐Cruz, Alda Maria; Igreja, Ricardo Pereira; Dantas, Waldomiro; Junqueira, Ângela Cristina Veríssimo; Pacheco, Raquel S.; Silva-Gonçalves, Antônio José da; Pirmez, Claude

doi:10.1016/j.trstmh.2004.01.010

Cited by 23 publications

(9 citation statements)

References 22 publications

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“…The clinical manifestations of the megacolon syndrome occur when the loss (depopulation) of neurons exceeds 55% of the overall intramural parasympathetic units (211,212). The suggestion of a T. cruzi-secreted neurotoxin is refuted by data from experimental studies (17,18,88,386). The death of the neuron is credited to lymphocyte-mediated lysis, exactly as described above for the minimal rejection unit in the heart of chagasic patients.…”

Section: Clinical and Pathological Presentations Of Chagas' Diseasementioning

confidence: 95%

“…The important modifying factor is represented mainly by HIV and T. cruzi coinfections mutually affecting each other (168). HIV infection profoundly affects some T. cruzi-infected individuals, sometimes presenting a long silent clinical course and other times presenting an overwhelming recrudescence of the myocarditis and/or meningoencephalitis (88,433). A growing concern is our understanding of these coinfections, which demand further investigations in regions of the world where this disease is both endemic and not endemic (410).…”

Section: Immunosuppressionmentioning

confidence: 99%

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Pathogenesis of Chagas' Disease: Parasite Persistence and Autoimmunity

et al. 2011

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SUMMARY Acute Trypanosoma cruzi infections can be asymptomatic, but chronically infected individuals can die of Chagas' disease. The transfer of the parasite mitochondrial kinetoplast DNA (kDNA) minicircle to the genome of chagasic patients can explain the pathogenesis of the disease; in cases of Chagas' disease with evident cardiomyopathy, the kDNA minicircles integrate mainly into retrotransposons at several chromosomes, but the minicircles are also detected in coding regions of genes that regulate cell growth, differentiation, and immune responses. An accurate evaluation of the role played by the genotype alterations in the autoimmune rejection of self-tissues in Chagas' disease is achieved with the cross-kingdom chicken model system, which is refractory to T. cruzi infections. The inoculation of T. cruzi into embryonated eggs prior to incubation generates parasite-free chicks, which retain the kDNA minicircle sequence mainly in the macrochromosome coding genes. Crossbreeding transfers the kDNA mutations to the chicken progeny. The kDNA-mutated chickens develop severe cardiomyopathy in adult life and die of heart failure. The phenotyping of the lesions revealed that cytotoxic CD45, CD8 + γδ, and CD8α + T lymphocytes carry out the rejection of the chicken heart. These results suggest that the inflammatory cardiomyopathy of Chagas' disease is a genetically driven autoimmune disease.

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Section: Clinical and Pathological Presentations Of Chagas' Diseasementioning

confidence: 95%

Section: Immunosuppressionmentioning

confidence: 99%

Pathogenesis of Chagas' Disease: Parasite Persistence and Autoimmunity

et al. 2011

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“…60 HIV infection may lead to reactivation of T cruzi infection. 61 The disease in some T cruzi-HIV-infected patients may have a long silent clinical course, whereas in others it may present with meningoencephalitis or myocarditis.…”

Section: Chronic Chagas Diseasementioning

confidence: 99%

Chagas disease

Teixeira

Nitz

Guimaro

et al. 2006

Postgraduate Medical Journal

152

122

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Chagas disease is the clinical condition triggered by infection with the protozoan Trypanosoma cruzi. The infection is transmitted by triatomine insects while blood feeding on a human host. Field studies predict that one third of an estimated 18 million T cruzi-infected humans in Latin America will die of Chagas disease. Acute infections are usually asymptomatic, but the ensuing chronic T cruzi infections have been associated with high ratios of morbidity and mortality: Chagas heart disease leads to unexpected death in 37.5% of patients, 58% develop heart failure and die and megacolon or megaoesophagus has been associated with death in 4.5%. The pathogenesis of Chagas disease appears to be related to a parasite-induced mutation of the vertebrate genome. Currently, treatment is unsatisfactory.

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“…Since then, there have been several reports from Brazil on cases with severe clinical expression of Chagas disease reactivation in patients with HIV/T. cruzi coinfection at an advanced stage of immunodeficiency [4,[11][12][13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

History, Current Issues and Future of the Brazilian Network for Attending and Studying Trypanosoma cruzi/HIV Coinfection

Ramos

Correia

Almeida

et al. 2010

J Infect Dev Ctries

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Introduction: In countries with endemic Chagas disease, coinfection involving Trypanosoma cruzi and HIV is expected to become more frequent. There is a clear need to structure a comprehensive care network aimed at dealing with this situation, with mobilization going from primary care to care at the highest level of technological complexity. The objective of this study was to describe the Brazilian response to the challenges of Chagas disease: the history, current issues, and future of the Brazilian Network for attending and studying T. cruzi/HIV coinfection. Methodology: This descriptive study reviewed technical documents relating to the basis and structuring process of the Brazilian network for attending and studying T. cruzi/HIV coinfection. Results: The process of setting up the network was marked by technical and political debates in technical-scientific meetings going back to the 1990s. This process made it possible to expand and focus on different aspects of comprehensive care for Chagas disease in Brazil, regardless of the associated immunosuppressive conditions. These meetings produced a structure of national technical guidelines and standards, health care and research protocols and research priorities, along with mobilization and awareness-raising among HIV/AIDS reference centers regarding occurrences of coinfection. Conclusions: The creation of the Brazilian network was a milestone for the country in terms of integration of control programs, with the reference point of quality of care and comprehensiveness. The possibility of extending this network to form a Latin American network is seen as a strategy for dealing more effectively with this condition.

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Long-term follow-up of co-infected HIV and Trypanosoma cruzi Brazilian patients

Cited by 23 publications

References 22 publications

Pathogenesis of Chagas' Disease: Parasite Persistence and Autoimmunity

Pathogenesis of Chagas' Disease: Parasite Persistence and Autoimmunity

Chagas disease

History, Current Issues and Future of the Brazilian Network for Attending and Studying Trypanosoma cruzi/HIV Coinfection

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