Trypanosoma cruzi meningoencephalitis and myocarditis in a patient with acquired immunodeficiency syndrome

Rocha, Ademir; Ferreira, Marcelo Simão; Nishioka, Sergio Andrade; Silva, Marcos; Burgarelli, Marcius K. N.; Silva, Arnaldo M.; Moura, Leandro Pains; Ugrinovich, Reinaldo; Raffin, César N.

doi:10.1590/s0036-46651993000200014

Cited by 26 publications

(17 citation statements)

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“…In relation to the clinical focus of each organ affected, this was nonspecific, ranging to the central nervous system from headache, signs of intracranial hypertension, seizures, motor location and coma, generating diagnostic confusion, mainly with toxoplasmosis and tumors of the central nervous system 37,65,66,75,84 . For the heart, it consists of triggering or exacerbating congestive heart failure, arrhythmias, atrioventricular, heart and fascicular blocks 22,27,34,42 . The fact that the clinical picture presented in the reactivation in the heart, usually occurred in the natural evolution of the chronic chagasic cardiopathy 88,102 making the diagnosis difficult, unlike the central nervous system which does not present exuberant symptomatology in the chronic phase of the disease.…”

Section: Casesmentioning

confidence: 99%

“…The clinical condition is nonspecific for including reactions from the acute phase: fever, poor general condition, disorientation, hepatosplenomegaly, lymphadenopathy, among others 22,23,32,42,81,93 . Specifically, the clinical condition refers to the place of the reactivation.…”

Section: Casesmentioning

confidence: 99%

“…Therefore, the neurological condition draws more the attention 25,52,65,66,87 that in most of the times has toxoplasmosis as the main diagnosis in view to the frequency that this condition happens in HIV infected individuals 33,37,68 . In the heart, the symptomatology and the physical aspects overlap those seen on the natural evolution of the chronic chagasic cardiopathy, hindering the diagnosis 22,27,34,42,88 .…”

Section: Casesmentioning

confidence: 99%

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Co-infection Trypanosoma cruzi/HIV: systematic review (1980 - 2010)

Almeida

Ramos

Correia

et al. 2011

Rev. Soc. Bras. Med. Trop.

114

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Introduction:The co-infection Trypanosoma cruzi/HIV has been described as a clinical event of great relevance. The objective of this study was to describe clinical and epidemiological aspects published in literature. Methods: It is a systematic review of a descriptive nature from the databases Medline, Lilacs, SciELO, Scopus, from 1980 to 2010. Results: There were 83 articles (2.8 articles/year) with a total of 291 cases. The co-infection was described in 1980 and this situation has become the defining AIDS clinical event in Brazil. This is the country with the highest number of publication (51.8%) followed by Argentina (27.7%). The majority of cases are amongst adult men (65.3%) native or from endemic regions with serological diagnosis in the chronic stage (97.9%) and indeterminate form (50.8%). Both diseases follow the normal course, but in 41% the reactivation of the Chagas disease occurs. The most severe form is the meningoencephalitis, with 100% of mortality without specific and early treatment of the T. cruzi. The medication of choice was the benznidazole on doses and duration normally used for the acute phase. The high parasitemia detected by direct or indirect quantitative methods indicated reactivation and its elevation is the most important predictive factor. The lower survival rate was related to the reactivation of the Chagas disease and the natural complications of both diseases. The role of the antiretroviral treatment on the co-infection cannot yet be defined by the knowledge currently existent. Conclusions: Despite the relevance of this clinical event there are still gaps to be filled.

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Section: Casesmentioning

confidence: 99%

Section: Casesmentioning

confidence: 99%

Section: Casesmentioning

confidence: 99%

See 1 more Smart Citation

Co-infection Trypanosoma cruzi/HIV: systematic review (1980 - 2010)

Almeida

Ramos

Correia

et al. 2011

Rev. Soc. Bras. Med. Trop.

114

View full text Add to dashboard Cite

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“…Patients at especially high risk are those submitted for transplants [5,6], those that have leukemia [2], lymphoma [7], and especially, AIDS [3,4,[8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…Myocarditis may occur associated with the CNS picture, or rarely as the sole manifestation [1,8,9,22]. A literature review showed CNS disease in 75% and cardiac involvement in 44% of cases [10].…”

Section: Discussionmentioning

confidence: 99%

Reactivation of Chagas' disease leading to the diagnosis of acquired immunodeficiency syndrome

Santos¹,

Canela²,

Monção³

et al. 2002

Braz J Infect Dis

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Reactivation of chronic Chagas' disease is a rare condition and occurs only in immunosuppressed patients. We report a case of a patient with a rapid and fatal reactivation of Chagas' disease, manifested by meningoencephalitis, which lead to a diagnosis of acquired immunodeficiency syndrome (AIDS). We believe there is sufficient evidence to include the reactivation of Chagas' disease among the diagnostic criteria of AIDS in Human Immunodeficiency Virus (HIV) infection.

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The impairment in the NLRP3-induced NO secretion renders astrocytes highly permissive to T. cruzi replication

Pacheco

Vicentini

Matteucci

et al. 2019

Journal of Leukocyte Biology

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Trypanossoma cruzi (T. cruzi), the causative protozoan of Chagas disease (CD) invades many cell types, including central nervous system (CNS) cells triggering local lesions and neurological impact. Previous work from our group described NLRP3 inflammasomes as central effectors for the parasite control by macrophages. Recent evidences demonstrate that NLRP3 can be activated in CNS cells with controversial consequences to the control of infections and inflammatory pathologies. However, the relative contribution of NLRP3 in different cell types remains to be elucidated. In this article, we described an effector response mediated by NLRP3 that works on microglia but not on astrocytes to control T. cruzi infection. Despite T. cruzi ability to invade astrocytes and microglia, astrocytes were clearly more permissive to parasite replication. Moreover, the absence of NLRP3 renders microglia but not astrocytes more permissive to T. cruzi replication. In fact, microglia but not astrocytes were able to secrete NLRP3-dependent IL-1 and NO in response to T. cruzi. Importantly, the pharmacological inhibition of iNOS with aminoguanidine resulted in a significant increase in the numbers of amastigotes found in microglia from wild-type but not from NLRP3 −/− mice, indicating the importance of NLRP3-mediated NO secretion to the infection control by these cells. Taken together, our findings revealed that T. cruzi differentially activates NLRP3 inflammasomes in astrocytes and microglia and established a role for these platforms in the control of a protozoan infection by glial cells from CNS. K E Y W O R D S NLRP3, T. cruzi, astrocytes, microglia, nitric oxide associated molecular patterns (DAMPs) (revised by Kigerl et al. 3 ). Inflammasomes are cytosolic complexes composed by multiple proteins that assemble in cell cytoplasm after DAMPs or PAMPs stimulation. 4-6 The stimulation is sensed by cytosolic receptors such as 202 PACHECO ET AL.the NOD-leucin rich repeats (LRR)-containing receptors (NLRs), which oligomerize and start the formation of cytoplasmatic complexes resulting in the recruitment and activation of caspase-1. Active caspase-1 cleaves pro-IL-1 , pro-IL-18, leading to the secretion of mature IL-1 and IL-18. Caspase-1 and caspase-11 also cleave gasdermin-D (GsmD), the effector protein of an inflammatory process of cell death named pyroptosis. 7,8 In addition to the maturation and secretion of IL-1 and IL-18 and induction of pyroptosis, inflammasomes also activate other microbicidal responses (reviewed in refs. 9,10). In this sense, our group demonstrated that the induction of NO through NLRC4 11,12 and NLRP3 13 inflammasomes is involved in the clearance of pathogens by macrophages.The role of inflammasomes in neuroinflamation has been described in many situations from sterile spinal cord injury (SCI), Alzheimer Disease (AD), multiple sclerosis (MS), and others 14 to bacterial and viral infections such as Legionella pneumophila, 15 Brucella abortus, 16 Staphylococcus aureus,17,18 Zika virus, 19 and many others. For each cont...

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Trypanosoma cruzi meningoencephalitis and myocarditis in a patient with acquired immunodeficiency syndrome

Cited by 26 publications

References 10 publications

Co-infection Trypanosoma cruzi/HIV: systematic review (1980 - 2010)

Co-infection Trypanosoma cruzi/HIV: systematic review (1980 - 2010)

Reactivation of Chagas' disease leading to the diagnosis of acquired immunodeficiency syndrome

The impairment in the NLRP3-induced NO secretion renders astrocytes highly permissive to T. cruzi replication

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