Rossi Spadafora Marcello Salvatore, Céspedes Ghislaine, Romero Sandra, Fuentes Isabel, Boada-Sucre Alpidio A, Cañavate Carmen, Flores-Chávez María
Unit of Toxoplasmosis and Intestinal Protozoosis, Department of Parasitology, National Centre for Microbiology, Carlos III Health Institute, Carretera de Majadahonda-Pozuelo Km 22, Majadahonda, 28220 Madrid, Spain ; Section of Research on Ultrastructural Pathology and Molecular Biology, José A. O'Daly Institute for Pathology, Faculty of Medicine, Central University of Venezuela, Caracas 1080-A, Venezuela.
Section of Neuropathology, José A. O'Daly Institute for Pathology, Faculty of Medicine, Central University of Venezuela, Caracas 1080-A, Venezuela.
Anal Cell Pathol (Amst). 2014;2014:124795. doi: 10.1155/2014/124795. Epub 2014 Dec 29.
Coinfections with human immunodeficiency virus (HIV) and infectious agents have been recognized since the early 90s. In the central nervous system (CNS) of HIV(+) patients, parasitic protozoans like Toxoplasma gondii have been described as responsible for the space occupying lesions (SOL) developed. However, the involvement of Trypanosoma cruzi is also described but appears to be less frequent in acquired immunodeficiency syndrome (AIDS) and transplant recipients, associated with necrotizing myocarditis and neurological symptoms related to the occurrence of necrotizing pseudotumoral encephalitis (NPE) and meningoencephalitis (NME). The present work aims to present a Venezuelan case of NME associated with the coinfection of HIV and a T. cruzi-like trypanosomatid as well as its evolution and diagnosis by histopathological techniques, electron microscopy, and PCR methods using formalin-fixed- (FF-) and paraffin-embedded- (PE-) tissues. Postmortem cytological studies of leptomeninges imprints reveal the presence of trypomastigotes of Trypanosoma sp. Histopathological and electron microscopy studies allowed us to identify an amastigote stage and to reject the involvement of other opportunistic microorganisms as the etiological agent of the SOL. The definitive confirmation of T. cruzi as the etiological agent was achieved by PCR suggesting that the NME by T. cruzi was due to a reactivation of Chagas' disease.
自20世纪90年代初以来，人们就认识到人类免疫缺陷病毒（HIV）与感染因子的合并感染。在HIV阳性患者的中枢神经系统（CNS）中，已描述了诸如刚地弓形虫等寄生原生动物是导致所出现的占位性病变（SOL）的原因。然而，也有关于克氏锥虫感染的描述，但在获得性免疫缺陷综合征（AIDS）患者和移植受者中似乎较为少见，其与坏死性心肌炎以及与坏死性假瘤性脑炎（NPE）和脑膜脑炎（NME）发生相关的神经症状有关。本研究旨在介绍一例委内瑞拉患者，该患者患有与HIV和一种类克氏锥虫的锥虫样寄生虫合并感染相关的NME，以及通过组织病理学技术、电子显微镜和使用福尔马林固定（FF）和石蜡包埋（PE）组织的PCR方法对其进行的病情演变和诊断。软脑膜印片的尸检细胞学研究揭示了锥虫属锥鞭毛体的存在。组织病理学和电子显微镜研究使我们能够识别无鞭毛体阶段，并排除其他机会性微生物作为SOL病原体的可能性。通过PCR最终确认克氏锥虫为病原体，提示克氏锥虫引起的NME是恰加斯病的重新激活所致。
