Chagasic encephalitis in HIV patients: common presentation of an evolving epidemiological and clinical association
Chagasic encephalitis in HIV patients: common presentation of an evolving epidemiological and clinical association
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DOI：
10.1016/s1473-3099(09)70088-x
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发表时间：
2009-05-01
影响因子：
56.3
通讯作者：
Franco-Paredes, Carlos
中科院分区：
文献类型：
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作者：
DiazGranados, Carlos A.;Saavedra-Trujillo, Carlos H.;Franco-Paredes, Carlos
我们提出了一个病例的chaghills脑膜脑炎再激活的艾滋病毒感染的妇女与先进的免疫抑制。通过抗寄生虫治疗和二级预防，结合使用高效抗逆转录病毒治疗，延长了生存期。艾滋病毒流行病在世界各地的地理范围扩大，加上全球移徙和国际旅行，为克氏锥虫和艾滋病毒合并感染创造了有利条件。查加斯病在HIV阳性人群中的临床表现通常表现为再激活，而不是急性克氏锥虫感染（合并感染）。慢性潜伏性克氏锥虫感染的症状再激活可由与HIV感染相关的严重免疫抑制触发。在这种情况下，恰加斯病的复发通常表现为类似弓形虫脑炎的脑膜脑炎。我们回顾，在这一轮，临床表现，诊断方法，发病机制，自然史，治疗，预后和预防南美锥虫病的艾滋病毒感染者的再激活，重点是中枢神经系统的表现。
We present a case of chagasic meningoencephalitis reactivation in an HIV-infected woman with advanced immunosuppression. Prolonged survival was attained with antiparasitic therapy and secondary prophylaxis, in conjunction with the use of highly-active antiretroviral therapy. The geographic expansion of the HIV epidemic around the world coupled with global migration and international travel have created a favourable situation for Trypanosoma cruzi and HIV coinfection. The clinical manifestations of Chagas disease in HIV positive people usually represent reactivation and not acute infection with T cruzi (coinfection). Symptomatic reactivation of chronic latent T cruzi infection can be triggered by severe immunosuppression associated with HIV infection. In this setting, Chagas disease reactivation often presents as meningoencephalitis resembling toxoplasma encephalitis. We review, in this Grand Round, the clinical manifestations, diagnostic approach, pathogenesis, natural history, treatment, prognosis, and prevention of Chagas disease reactivation among HIV infected people with an emphasis on CNS manifestations.