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Analytical Cellular Pathology
Volume 2014 (2014), Article ID 124795, 8 pages
http://dx.doi.org/10.1155/2014/124795
Research Article

Trypanosoma cruzi Necrotizing Meningoencephalitis in a Venezuelan HIV+-AIDS Patient: Pathological Diagnosis Confirmed by PCR Using Formalin-Fixed- and Paraffin-Embedded-Tissues

1Unit of Toxoplasmosis and Intestinal Protozoosis, Department of Parasitology, National Centre for Microbiology, Carlos III Health Institute, Carretera de Majadahonda-Pozuelo Km 22, Majadahonda, 28220 Madrid, Spain
2Section of Research on Ultrastructural Pathology and Molecular Biology, José A. O’Daly Institute for Pathology, Faculty of Medicine, Central University of Venezuela, Caracas 1080-A, Venezuela
3Section of Neuropathology, José A. O’Daly Institute for Pathology, Faculty of Medicine, Central University of Venezuela, Caracas 1080-A, Venezuela
4Section of Nephropathology, José A. O’Daly Institute for Pathology, Faculty of Medicine, Central University of Venezuela, Caracas 1080-A, Venezuela
5Laboratory of Electron Microscopy, Institute of Scientific and Technological Studies, Simón Rodríguez University, Caracas 1041-A, Venezuela
6Unit of Leishmaniasis and Chagas Disease Diagnosis, Department of Parasitology, National Centre for Microbiology, Carlos III Health Institute, Carretera de Majadahonda-Pozuelo Km 22, Majadahonda, 28220 Madrid, Spain

Received 28 September 2014; Revised 11 December 2014; Accepted 12 December 2014

Copyright © 2014 Marcello Salvatore Rossi Spadafora et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Coinfections with human immunodeficiency virus (HIV) and infectious agents have been recognized since the early 90s. In the central nervous system (CNS) of HIV+ patients, parasitic protozoans like Toxoplasma gondii have been described as responsible for the space occupying lesions (SOL) developed. However, the involvement of Trypanosoma cruzi is also described but appears to be less frequent in acquired immunodeficiency syndrome (AIDS) and transplant recipients, associated with necrotizing myocarditis and neurological symptoms related to the occurrence of necrotizing pseudotumoral encephalitis (NPE) and meningoencephalitis (NME). The present work aims to present a Venezuelan case of NME associated with the coinfection of HIV and a T. cruzi-like trypanosomatid as well as its evolution and diagnosis by histopathological techniques, electron microscopy, and PCR methods using formalin-fixed- (FF-) and paraffin-embedded- (PE-) tissues. Postmortem cytological studies of leptomeninges imprints reveal the presence of trypomastigotes of Trypanosoma sp. Histopathological and electron microscopy studies allowed us to identify an amastigote stage and to reject the involvement of other opportunistic microorganisms as the etiological agent of the SOL. The definitive confirmation of T. cruzi as the etiological agent was achieved by PCR suggesting that the NME by T. cruzi was due to a reactivation of Chagas’ disease.