Fatal Evolution Of Chagas'disease/aids Co-infection: Diagnostic Difficulties Between Myocarditis Reactivation And Chronic Chagasic Myocardiopathy [evolução Fatal Da Co-infecção Doença De Chagas/aids: Dificuldades Diagnósticas Entre A Reagudização Da Miocardite E A Miocardiopatia Chagásica Crônica]

Chagas disease is a type of parasitosis caused by the protozoan Trypanosoma cruzi, and it is transmitted by triatomine insects. This disease is found between the southern United States to Argentina and approximately 14 million people in Latin America are believed to be infected, predominantly with the chronic form of the disease. Reactivation of Chagas disease can occur among immunosuppressed patients, as has been observed among AIDS patients. In one such case, we observed cardiac decompensation with severe ventricular dysfunction and arrhythmias. This case was thought to be reactivation of Chagas disease in the myocardium, since the xenodiagnosis was positive. Specific treatment for Trypanosoma cruzi was administered, consisting of benznidazole, but the course of treatment was not completed because the patient died due to cardiopathic complications. The necropsy showed the usual stigmas of chronic Chagas cardiopathy, such as fibrosing myocarditis and a decreased number of neurons in the digestive system. There were no amastigote forms of Trypanosoma cruzi in any of the tissue samples studied. Therefore, reactivation of Chagas disease was not demonstrated but, rather, the natural evolution of chronic Chagas cardiopathy was demonstrated.422199202Akhavan, D., (2000) Análise de Custo-efetividade Do Programa de Controle Da Doença de Chagas No Brasil. Relatório Final, p. 271. , Organização Pan-Americana da Saúde, BrasíliaCastro, J.A., Mecca, M.M., Bartel, L.C., Toxic effects of drugs used to treat Chagas'disease (American trypanosomiasis) (2006) Human Experimental Toxicology, 25, pp. 471-479Consenso Brasileiro em Doença de Chagas (2005) Revista Da Sociedade Brasileira de Medicina Tropical, 38 (SUPPL. III), pp. 7-29Cordova, E., Boschi, A., Ambrosioni, J., Cudos, C., Corti, M., Reactivation of Chagas' disease with central nervous involvement in HIV-infected patients in Argentina, 1992-2007 (2008) International Journal of Infectious Disease, 12, pp. 587-592Corti, M., AIDS and Chagas'disease (2000) AIDS Patient Care and STDs, 14, pp. 581-588Del Castillo, M., Mendoza, G., Oviedo, J., Bianco, R.P.P., Anselmo, A.E., Silva, M., AIDS and Chagas' disease with central nervous system tumor-like lesion (1990) American Journal of Medicine, 88 (6), pp. 693-694. , DOI 10.1016/0002-9343(90)90544-NFerreira, M.S., Nishioka, A.S., Rocha, A., Silva, A.M., Doença de Chagas e imunossupressão (1997) Clínica e Terapêutica Da Doença de Chagas, 1 a Edição, pp. 365-379. , Dias JCP, Coura JR (eds), Fundação Osvaldo CruzSantos, E.O., Reis Canela, J., Gomes Monção, H.C., Guedes Roque, M.J., Reactivation of Chagas'disease leading to the diagnosis of acquired immunodeficiency syndrome (2002) Brazilian Journal of Infectious Disease, 6, pp. 317-321Pereira, J.B., Willcox, H.P.P., Marcondes, C.B., Coura, J.R., Parasitemia em pacientes chagásicos crônicos avaliados pelo índice de triatomíneos infectados no xenodiagnóstico (1989) Revista Da Sociedade Brasileira de Medicina Tropical, 22, pp. 39-44Rassi Jr., A., Rassi, A., Little, W.C., Chagas' heart disease (2000) Clinical Cardiology, 23, pp. 883-889Recommendations for diagnosis, treatment and follow-up of the Trypanosoma cruzi - Human immunodeficiency virus co-infection. Thecnical Report of Health Ministery of Brazil 2006 (2006) Revista Da Sociedade Brasileira de Medicina Tropical, 39, pp. 392-1341Sartori, A.M.C., Ibrahim, K.Y., Nunes Westphalen, E.V., Braz, L.M.A., Oliveira Jr., O.C., Gakiya, E., Lopes, M.H., Shikanai-Yasuda, M.A., Manifestations of Chagas disease (American trypanosomiasis) in patients with HIV/AID S (2007) Annals of Tropical Medicine and Parasitology, 101 (1), pp. 31-50. , DOI 10.1179/136485907X154629Sartori, A.M.C., Eluf Neto, J., Nunes, E.V., Braz, L.M.A., Caiaffa-Filho, H.H., Oliveira Jr., O.C., Amato Neto, V., Shikanai-Yassuda, M.A., Trypanosoma cruzi parasitemia in chronic Chagas' disease: Comparison between Human Immunodeficiency Virus (HIV)-Positive and HIV-Negative patients (2002) The Journal of Infectious Diseases, 186, pp. 872-875Sartori, A.M., Shikanai-Yasuda, M.A., Amato Neto, V., Lopes, M.H., Follow-up of 18 patients with human immunodeficiency vírus infection and chronic Chagas'disease with reactivation of Chagas'disease causing cardiac disease in three patients (1998) Clinical of Infectious Disease, 26, pp. 177-17