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Am. J. Trop. Med. Hyg., 50(3), 1994, pp. 261-268
Copyright © 1994 by The American Society of Tropical Medicine and Hygiene

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Pathology of Patients with Chagas' Disease and Acquired Immunodeficiency Syndrome

Ademir Rocha, Antonio Carlos Oliveira de Meneses, Oliveira De Meneses, Arnaldo Moreira da Silva, Marcelo Simao Ferreira, Sergio Andrade Nishioka, Marcius K. N. Burgarelli, Eros Almeida, Gilberto Turcato, Jr, Konradin Metze AND Edison Reis Lopes
Centro de Ciencias Biomedicas, Universidade Federal de Uberlandia, Uberlandia, Minas Gerais, Brazil; Universidade de Campinas (UNICAMP), Campinas, SP, Brazil; Escola Paulista de Medicina, Disciplina de Doengas Infecciosas e Parasitarias, Sao Paulo, SP, Brazil; Faculdade de Medicina do Triangulo Mineiro, Uberaba, Minas Gerais, Brazil

The main pathologic findings in 23 patients with acquired immunodeficiency syndrome (AIDS) and Chagas' disease are reviewed; five are from our own experience and 18 from the literature. The presence of Trypanosoma cruzi parasites and/or T. cruzi antibodies in blood and cerebrospinal fluid was recorded and computerized tomograms of the brain were evaluated. Twenty (87%) of the 23 subjects developed severe, multifocal or diffuse meningoencephalitis with necrosis and hemorrhage associated with numerous tissue parasites. The second most severely affected site was the heart. Seven (30.4%) of the 23 cases had myocarditis on pathologic examination. It was acute in four patients, chronic in two, and simultaneously acute and chronic in one. Acute myocarditis and meningoencephalitis are interpreted as being caused by relapses of chronic T. cruzi infections. An AIDS permissive role is suggested for these conditions since immunologic defense against T. cruzi is mediated mainly by T lymphocytes, whose CD4 subpopulation is depleted in patients with this disease. Consequently, AIDS is a factor that may favor the reactivation of T. cruzi infections. The lesions reported in the association of Chagas' disease with AIDS were compared with those reported from patients without AIDS having fatal, acute, vector-transmitted infections, contaminated blood transfusions, or accidental exposures in the laboratory. For the latter three, meningoencephalitis is uncommon. Only immunosuppressed cases of Chagas' disease have been described as having a pseudotumoral presentation that shows expanding lesions with a mass effect in the cranial cavity that causes intracranial hypertension and simulates neoplasms (tumors such as gliomas, lymphomas, metastases, etc.).




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Copyright © 1994 by the American Society of Tropical Medicine and Hygiene.