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MOLECULAR DIAGNOSIS AND TYPING OF TRYPANOSOMA CRUZI POPULATIONS AND LINEAGES IN CEREBRAL CHAGAS DISEASE IN A PATIENT WITH AIDS

Trypanosoma cruzi DNA was amplified from an intracranial biopsy and peripheral blood of an HIV patient with encephalitis; this episode was indicative of AIDS and congenital Chagas disease. The analysis of a micro-satellite locus revealed a multiclonal parasite population at the brain lesion with a more complex minicircle signature than that profiled in blood using restriction fragment length polymorphism (RFLP)-PCR and low stringency single primer (LSSP) PCR. Interestingly, different sublineages of T. cruzi II were detected in blood and brain by means of spliced-leader and 24s ribosomal-DNA amplifications. Quantitative-competitive PCR monitored the decrease of parasitic load during treatment and secondary prophylaxis with benznidazole. The synergy between parasiticidal plus anti-retroviral treatments probably allowed the patient a longer survival than usually achieved in similar episodes. This is the first case report demonstrating a differential distribution of natural parasite populations and sublineages in Chagas disease reactivation, showing the proliferation of cerebral variants not detectable in peripheral blood.

Received June 9, 2005. Accepted for publication July 8, 2005.

Acknowledgments: We are indebted to the work of Dr. Gustavo Rolando and Alejandro Seoane. This work was supported by grants from the World Health Organization-Tropical Diseases Research projects (ID 20285 and 990893) and Bunge & Born Private Foundation of Argentina (to A.G.S.), CONICET (PEI 2000), University of Buenos Aires, FONCyT BID 802/OC-AR PICT 01421, PICT 02030, and PRONEX FAPEMIG/CNPQ. The work of Dr. M.J. Levin is partially supported by an International Research Scholar grant from the Howard Hughes Medical Institute (Chevy Chase, MD). M.J.L. and A.G.S. are members of the National Research Council (CONICET) Research Career Program. J.A. and H.F. are members of the research career of Buenos Aires city Government.

^* Address correspondence to Alejandro G. Schijman, Ph.D., Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina. E-mail: schijman{at}dna.uba.ar

Authors’ addresses: Juan M. Burgos, Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina and Departamento de Fisiología y Biología Molecular y Celular, FCEyN, UBA, Buenos Aires, Argentina. Margarita Bisio, Tomas Duffy, Mariano J. Levin, and Alejandro G. Schijman, Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Invesigaciones en Ingeniería Genética y Biología Molecular (INGEBI-CONICET), Buenos Aires, Argentina. Sandra B. Begher, Ricardo Teijeiro, Horacio Lopez Alcoba, Florencia Deccarlini, and Jorge LeValle. Unidad 2 Clínica Médica e Infectología, Hospital Ignacio Pirovano, Gobierno de la Ciudad de Buenos Aires, Buenos, Aires, Argentina. Jorge M. Freitas and Andrea M. Macedo, Departamento de Bioquímica e Imunología, ICB/UFMG, Belo Horizonte, Brazil. Jaime Altcheh and Hector Freilij, Laboratorio de Parasitología y Enfermedad de Chagas, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina.

Reprint requests: Alejandro G. Schijman, Ph.D., Vuelta de Obligado 2490, 2nd floor, Buenos Aires 1428, Argentina, Telephone: 05411-4783-2871, Fax: 05411-4786-8578, E-mail: schijman{at}dna.uba.ar.

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