Molecular diagnosis and typing of Trypanosoma cruzi populations and lineages in cerebral Chagas disease in a patient with AIDS
Burgos, J.M.; Begher, S.B.; Freitas, J.M.; Bisio, M.; Duffy, T.; Altcheh, J.; Teijeiro, R.; Lopez Alcoba, H.; Deccarlini, F.; Freilij, H.; Levin, M.J.; Levalle, J.; Macedo, A.M.; Schijman, A.G.
American Journal of Tropical Medicine and Hygiene 73(6): 1016-1018
2005
ISSN/ISBN: 0002-9637 PMID: 16354804 Document Number: 259221
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 24s alpha 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.