Thread by @IUIDfellowship

#idboardreview 30 M Paraguay 🇵🇾 living w/ HIV CD4 50 VL 100k presents w/ seizure, no travel/animal contact. Oriented to self, dysarthria, csf (wbc 15 100% lymph, protein80, gluc35). Dx? #medEd #idmedEd #idtwitter

Meningoencephalitis and chagoma, caused by #Trypanosoma cruzi

#Chagas or American #trypanosomiasis parasitic protozoan #Animal Trypanosoma cruzi transmitted by hematophagous “kissing bugs” Reduviidae aka
vinchuca (Argentina 🇧🇴 🇨🇱 🇵🇾
barbeiro (Brazil),
chipo (Venezuela), and
chinche (Central America)

#trypanosoma vectors live in cracks and holes of rustic homes and acquire the trypomastigote forms of the parasite after feeding on blood from infected humans or animals (armadillos, marsupials, domestic animals

#trypanosoma ingested trypomastigotes transform into epimastigotes in triatominae’s midgut➡️multiply➡️metacyclic tripomastigotes. Vector defecates during/after blood meal & fecal material containing metacyclic trypomastigote is inoculated via mucosal membranes or skin breaks

cdc.gov/dpdx/trypanoso… #trypanosoma

Chagas disease transmission can also occur via consumption of contaminated food or drink, transfusion, organ transplant, IDU or transplacental. 5-18 million people infected. Previously endemic in rural areas of Central/South America but now areas of 🇺🇸 & Europe due to migration

acute phase of #Chagas disease infection can be subclinical or nonspecific systemic symptoms (fever, malaise, anorexia) & inflammatory reaction at inoculation site (known as chagoma). Trypomastigotes may be visualized in the blood during 8-12 weeks of acute phase

70% will progress to a chronic “indeterminate” phase: asymptomatic & anti-T. cruzi antibodies can be detected in absence of parasitemia. 30% will develop clinical manifestations of chronic infection such as gastric motility disorder & cardiomyopathy #chagas

Reactivation of chronic T. cruzi infection is rare, but may occur in immunosuppressed: PLWH & chronic T. cruzi, reactivation can lead to ⬆️morbidity & mortality. CD4<200: meningoencephalitis or focal cerebral abscess (chagoma) is most common reported manifestation of reactivation

CNS #chagas differential toxoplasmosis, tuberculous meningitis, cryptococcosis, or neoplastic processes

Diagnosis of #Chagas reactivation is achieved by direct visualization of parasite by microscopy of fresh anticoagulated blood or buffy coat. In cases of meningoencephalitis, trypomastigotes in direct examination of CSF & amastigotes on histological examination of brain tissue

cdc.gov/dpdx/trypanoso…

#chagas in HIV: treatment benznidazole 5 mg/kg daily divided into two doses for 60 days is commonly used as first line treatment. Reported adverse effects include dermatitis, peripheral neuropathy, and bone marrow suppression. Start ART early

#chagas ijidonline.com/article/S1201-…

#chagas academic.oup.com/ofid/article/6…