Molecular diagnosis and typing of Trypanosoma cruzi populations and lineages in cerebral Chagas disease in a patient with AIDS

Trypanosoma cruzi DNA was amplified from an intracranial biopsy and peripheral blood of an HIV patient with encephalitis; this episode was indicative of AIDS and congenital Chagas disease. The analysis of a micro-satellite locus revealed a multiclonal parasite population at the brain lesion with a m...

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Bibliographic Details
Published in:	The American journal of tropical medicine and hygiene Vol. 73; no. 6; p. 1016
Main Authors:	Burgos, Juan M, Begher, Sandra B, Freitas, Jorge M, Bisio, Margarita, Duffy, Tomas, Altcheh, Jaime, Teijeiro, Ricardo, Lopez Alcoba, Horacio, Deccarlini, Florencia, Freilij, Hector, Levin, Mariano J, Levalle, Jorge, Macedo, Andrea M, Schijman, Alejandro G
Format:	Journal Article
Language:	English
Published:	United States 01-12-2005
Subjects:	Adult AIDS-Related Opportunistic Infections - blood AIDS-Related Opportunistic Infections - complications AIDS-Related Opportunistic Infections - diagnosis AIDS-Related Opportunistic Infections - pathology Animals Chagas Disease - blood Chagas Disease - complications Chagas Disease - diagnosis Chagas Disease - pathology DNA, Kinetoplast - analysis DNA, Protozoan - analysis Encephalitis - complications Encephalitis - diagnosis Encephalitis - pathology Genetic Variation Humans Magnetic Resonance Imaging Male Polymerase Chain Reaction Polymorphism, Restriction Fragment Length Trypanosoma cruzi - classification Trypanosoma cruzi - genetics Trypanosoma cruzi - isolation & purification
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Summary:	Trypanosoma cruzi DNA was amplified from an intracranial biopsy and peripheral blood of an HIV patient with encephalitis; this episode was indicative of AIDS and congenital Chagas disease. The analysis of a micro-satellite locus revealed a multiclonal parasite population at the brain lesion with a more complex minicircle signature than that profiled in blood using restriction fragment length polymorphism (RFLP)-PCR and low stringency single primer (LSSP) PCR. Interestingly, different sublineages of T. cruzi II were detected in blood and brain by means of spliced-leader and 24salpha ribosomal-DNA amplifications. Quantitative-competitive PCR monitored the decrease of parasitic load during treatment and secondary prophylaxis with benznidazole. The synergy between parasiticidal plus anti-retroviral treatments probably allowed the patient a longer survival than usually achieved in similar episodes. This is the first case report demonstrating a differential distribution of natural parasite populations and sublineages in Chagas disease reactivation, showing the proliferation of cerebral variants not detectable in peripheral blood.
ISSN:	0002-9637
DOI:	10.4269/ajtmh.2005.73.1016