Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Zip Code 1282, Ciudad Autónoma de Buenos Aires, Argentina.
Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Zip Code 1282, Ciudad Autónoma de Buenos Aires, Argentina; Departamento de Clínica, Patología y Tratamiento, Instituto Nacional de Parasitología Dr. M. Fatala Chaben, ANLIS Dr. C.G. Malbran, Zip Code 1063, Ciudad Autónoma de Buenos Aires, Argentina.
Int J Infect Dis. 2018 Feb;67:118-121. doi: 10.1016/j.ijid.2017.11.027. Epub 2017 Nov 28.
Trypanosoma cruzi reactivation in HIV patients is considered an opportunistic infection, usually with a fatal outcome. The aim of this study was to describe the epidemiological and clinical features of T. cruzi infection in HIV patients and to compare these findings between patients with and without Chagas disease reactivation.
The medical records of T. cruzi-HIV co-infected patients treated at the Muñiz Infectious Diseases Hospital from January 2005 to December 2014 were reviewed retrospectively. Epidemiological and clinical features were assessed and compared between patients with and without Chagas disease reactivation.
The medical records of 80 T. cruzi-HIV co-infected patients were reviewed. The most likely route of T. cruzi infection was vector-borne (32/80 patients), followed by intravenous drug use (12/80). Nine of 80 patients had reactivation. Patients without reactivation had a significantly higher CD4 T-cell count at diagnosis of T. cruzi infection (144 cells/μl vs. 30 cells/μl, p=0.026). Chagas disease serology was negative in two of nine patients with reactivation.
Serological assays for T. cruzi infection may be negative in severely immunocompromised patients. Direct parasitological techniques should be performed in the diagnosis of patients for whom there is a suspicion of T. cruzi reactivation. HIV patients with a lower CD4 count are at higher risk of reactivation.
克氏锥虫在 HIV 患者中的再激活被认为是一种机会性感染，通常结局致命。本研究旨在描述 HIV 合并克氏锥虫感染患者的流行病学和临床特征，并比较有和无锥虫病再激活患者的这些发现。
回顾性分析了 2005 年 1 月至 2014 年 12 月在 Muñiz 传染病医院治疗的 HIV 合并克氏锥虫感染患者的病历。评估并比较了有和无锥虫病再激活患者的流行病学和临床特征。
共回顾了 80 例 HIV 合并克氏锥虫感染患者的病历。克氏锥虫感染的最可能途径是虫媒传播（32/80 例患者），其次是静脉吸毒（12/80 例）。80 例患者中有 9 例发生了再激活。在诊断克氏锥虫感染时，未再激活患者的 CD4 T 细胞计数明显更高（144 个细胞/μl 比 30 个细胞/μl，p=0.026）。9 例再激活患者中有 2 例锥虫病血清学检查为阴性。
在严重免疫功能低下的患者中，克氏锥虫感染的血清学检测可能为阴性。对于怀疑锥虫再激活的患者，应进行直接寄生虫学技术诊断。CD4 计数较低的 HIV 患者再激活风险更高。
