Molecular evaluation of Chagas disease reactivation and treatment follow-up in HIV coinfected patient

MARISA FERNANDEZ; LATINI V; CORTI M; SUSANA BESUSCHIO; BIONDI ML; ALEJANDRO G. SCHIJMAN; DIEGO NICITA; GARCIA J; JUAN M. BURGOS

Congreso; 18 th International Congress on Infectious Diseases; 2018

Background: Chagas disease reactivation is an AIDS defined ill-ness that usually affects Central Nervous System. Gold-Standarddiagnosis for T.cruzi reactivation is based on microscopical obser-vation methods.Methods & Materials: Seven patients with HIV/AIDS diagnosis,T.cruzi serological findings, neurological disorders, and suspectedof Chagas disease reactivation were included between 2015?2017from two health centers of Buenos Aires, Argentina. Real-time PCRs(qPCR) against T.cruzi satellite DNA were carried out from cere-brospinal fluid (CSF) and peripheral blood samples (BS) for parasiteload quantification. Molecular parasite characterization was basedon amplification of spliced leader intergenic region, 24 srDNA, andA10 polymorphic sequences.Results: Patients were aged from 41 to 69 years old, 43% werewomen, CD4+ T cell counts were between 7 and 53 cell/mm3. Allof them received tripanocidal treatment (TrypT).Five CSFs were withdrawn before TrypT starting. Two hadmicroscopical detection of trypomastigote forms (MDTryp) andquantification over 500 p.e/mL by qPCR. The other 3 CSF sam-ples were non-detectable by both methods. The remaining twopatients CSF were obtained after starting TrypT with MDTryp neg-ative findings but qPCR positive results with parasite burden below13 p.e/mL.Among the 3 patients with negative CSF findings, 2 had positiveMDTryp on BS with 119 and 3512 p.e/mL. The third was negativeby MDTryp and had 2 p.e/mL before TrypT.All patients had qPCR positive findings on BS (2 -1426 p.e/mL)and decreased their parasitic loads during TrypT.All characterized parasites from BS and CSF samples belonged toDTU (Discrete Typing Unit) II, V or VI, frequently found in SouthernCone region.Out of this small series, 4 patients died: 2 because of brain?Chagoma?, 1 due to status epilepticus and 1 due to acute abdomen.Two of the 3 survivors were those with negative CSF findings forboth methods.Conclusion: Chagas disease reactivation occurred on deepinmunosupressed HIV people. Its diagnosis by MDTryp and qPCRis complementary. qPCR detected T.cruzi DNA on negative MDTrypfindings even during treatment. TrypT always reduces T.cruzi DNAloads. qPCR might be an useful therapeutical marker.