Coinfección SIDA / Enfermedad de Chagas. Presentación de caso y revisión de la bibliografía
9 CO-INFECTION AIDS / CHAGA’S DISEASE. REPORT OF A CASE AND LITERATURE REVISION
Prensa méd. argent; 103 (9), 2017
Publication year: 2017
Chagas’ disease caused by “Trypanosoma
cruzi” (T. cruzi), is well recognized as an
opportunistic infection in the setting of HIV
/ AIDS. More patients with Chagas’ disease, live in countries of Central and South
America, That’s why, it is also called “American Trypanosomiasis “. T. cruzi is mainly
transmitted by vectors (“Triatoma infestans” in Argentina) specially in the “endemic american area” and secondarily, by blood
transfusion, not only in America, but also in
the rest of the world. Many people have migrated from the endemic area of America to
others countries around the world. Perhaps,
some of them were asyntomatic “chagasic”
patients and may have transmitted T. cruzi
by blood transfusions in those non-endemic areas.. So that, Chagas’ disease should be
considered nowadays, as a “global pathology”. In severely inmunocompromissed patients with AIDS, chronic Chagas’ disease
may have reactivated, affecting central nervous system (CNS) with brain mass lesions
(called “chagomas”), similar to others necrotizing encephalitis like Toxoplasmosis.. We
report a 32 year-old woman assisted in the
Rawson Hospital of Córdoba City (Argentina), with AIDS and reactivation of Chagas’ disease. Patient coming from Catamarca (north-western region of Argentina) with
severe headache, unisocoria, desorientation
in time and space, fine tremor, nistagmus,
clonus, hiperreflexia and fascial-braquial-crural hemiparesia. Patient was afebrile
and the rest of physical examination was
normal. She had low count of CD4 cells and
high HIV-viral load. Magnetic resonance
imagin (MRI) showed: several enhanced
rounded lesions surrounded by edema along
the whole brain. Treatment with sulfadiacina + Pyrimethamine and Dexametasone,
for a presuntive cerebral toxoplasmosis was
implemented but, patient did not improve.
So, cerebral biopsie was performed and it
showed: intra and extracellular “ AMASTIGOTES” of T. cruzi..Treatment with
Benznidazol was prescribed, but in a few
days, patient died.