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Abstract
Chagas disease neurological involvement and HIV infection in Argentina (1992-2006)
Cordova E.1, Boschi A.1, Ambrosioni Czyrko J.1, Cudos C.1, Corti M.1
Objectives: To evaluate clinical and microbiological characteristics of Chagas disease (ChD) with CNS involvement, one of the most severe neurological complications in AIDS patients.
Methods: Retrospective study of clinical and laboratory findings of HIV-infected patients with confirmed diagnosis of ChD involving CNS.
Results: Male sex: 13/14; average age: 35 years (range 25-54). Nine of fourteen knew their HIV positive status and 6/14 had a concomitant opportunistic infection (OI) at admission. None of them were receiving HAART. Seven of nine had lived in Chagas endemic area and only 4/14 knew about their Trypanosoma cruzi infection. Seven of ten were intravenous drug users (IDUs). Two patients reactivated their disease while they were receiving corticosteroid therapy for another OI. Clinical manifestations included: headache (11/14), fever (9/14), focal neurological abnormalities (8/14), meningismus (6/14), seizures (6/14), altered mental status (4/14) and concomitant cardiac involvement (3/10). Median of CD4 T cell count: 58 cells/µL (1-240). Eleven of thirteen had positive serology for T. cruzi infection; the two negative were IDUs. Cerebrospinal fluid (CSF) findings were: median cell count 5/mm3 (2-90); protein level: median 0,66g/l (0,1-1,84); glucose level: median 0,4g/l (0,13-0,73). CSF direct examination for T. cruzi was positive in 10/12 and in 1/6 from blood. The most frequent finding in neuroimages was a single lesion compatible with abscess (7/14). Two patients had normal images. The median time between clinical manifestations and diagnosis was 18 days (1-60). All patients were treated with Benznidazole; 10/13 died (77%) with a median time of survival of 21 days.
Conclusions: ChD reactivation is associated with a high mortality rate in patients with AIDS, probably related with the delayed diagnosis. It should be considered in patients with previous residency in endemic area and/or IDUs. Corticosteroids should be used with caution in these patients. Whenever possible, lumbar puncture should be performed because of the high accuracy for early diagnosis.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
Abstract no.
MOPEB074
Suggested Citation
"CordovaE., et al.
Chagas disease neurological involvement and HIV infection in Argentina (1992-2006).
Poster exhibition:
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention:
Abstract no.
MOPEB074"
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