Reactivation of Chagas disease with central nervous system involvement in HIV-infected patients in Argentina, 1992–2007

Summary Objectives The objective of this study was to evaluate clinical and microbiological characteristics of Chagas disease (ChD) with central nervous system (CNS) involvement in AIDS patients. Methods This was a retrospective study of clinical and laboratory findings of HIV-infected patients with a confirmed diagnosis of ChD involving the CNS during the period 1992–2007 at the "Francisco J. Muniz" Infectious Diseases Hospital, Buenos Aires, Argentina. Results Of a total of 15 patients, 14 were male and the median age was 33 years (range 25–54 years). Seven out of nine had lived in a Chagas endemic area and 7/10 were intravenous drug users (IDUs). The disease was reactivated during corticosteroid therapy in three patients. Clinical manifestations were: headache (11/15), focal neurological deficits (9/15), fever (9/15), meningismus (7/15), seizures (7/15), altered mental status (5/15), and cardiac involvement (3/10). The median CD4 T-cell count at the time of reactivation was 64cells/μl (range 1–240). Twelve of 14 had positive serology for Trypanosoma cruzi ; the two negative were IDUs. Cerebrospinal fluid (CSF) findings (median (range)): cell count 5/mm 3 (2–90), protein level 0.68g/l (0.1–1.84), and glucose level 0.45g/l (0.13–0.73). CSF direct examination for T. cruzi was positive in 11/13. Neuroimaging findings showed a single hypodense lesion in 7/14 and normal images in 2/14. Twelve patients were treated with benznidazole. The global mortality was 79% (11/14). Conclusions ChD reactivation should be considered as a differential diagnosis of meningoencephalitis in HIV patients with low CD4 T-cell counts, previous residency in an endemic area, and/or IDUs. Whenever possible, lumbar puncture should be performed because of the high accuracy for early diagnosis.