Ferreira M S, Nishioka S de A, Silvestre M T, Borges A S, Nunes-Araújo F R, Rocha A
Centro de Ciéncias Biomédicas, Universidade Federal de Uberlândia, Brazil.
Clin Infect Dis. 1997 Dec;25(6):1397-400. doi: 10.1086/516130.
Three new cases of reactivation of Chagas' disease in patients with AIDS, with central nervous system and/or cardiac involvement, are reported. One patient had histological evidence of acute esophageal and gastric Trypanosoma cruzi myositis, a previously unrecognized finding in patients with reactivated Chagas' disease. The patients had a low CD4 lymphocyte count and had other AIDS-defining opportunistic infections. One patient's condition improved with benznidazole therapy. Analysis of these three cases and review of the 13 others published in the literature revealed that the central nervous system is the most commonly involved site (75%), followed by the heart (44%). Early diagnosis and treatment with benznidazole or nifurtimox probably improve the survival rate. Long-term secondary prophylaxis should be recommended for patients who respond to therapy, although it is uncertain which drug to use for this purpose. T. cruzi should be included in the list of opportunistic pathogens causing infection in severely immunocompromised patients with AIDS.
报告了3例艾滋病患者查加斯病再激活的新病例，这些患者有中枢神经系统和/或心脏受累情况。1例患者有急性食管和胃克鲁斯锥虫肌炎的组织学证据，这是再激活的查加斯病患者中以前未被认识到的发现。这些患者的CD4淋巴细胞计数较低，并有其他艾滋病界定的机会性感染。1例患者经苯硝唑治疗后病情改善。对这3例病例的分析以及对文献中发表的其他13例病例的回顾显示，中枢神经系统是最常受累的部位（75%），其次是心脏（44%）。早期诊断并用苯硝唑或硝呋替莫治疗可能会提高生存率。对于对治疗有反应的患者，应建议进行长期二级预防，尽管不确定为此目的使用哪种药物。克鲁斯锥虫应列入导致严重免疫功能低下的艾滋病患者感染的机会性病原体名单。
