PATHOLOGY OF PATIENTS WITH CHAGAS-DISEASE AND ACQUIRED-IMMUNODEFICIENCY-SYNDROME

The main pathologic findings in 23 patients with acquired immunodefici ency syndrome (AIDS) and Chagas' disease are reviewed; five are from o ur own experience and 18 from the literature. The presence of Trypanos oma cruzi parasites and/or T. cruzi antibodies in blood and cerebrospi nal fluid was recorded and computerized tomograms of the brain were ev aluated. Twenty (87%) of the 23 subjects developed severe, multifocal or diffuse meningoencephalitis with necrosis and hemorrhage associated with numerous tissue parasites. The second most severely affected sit e was the heart. Seven (30.4%) of the 23 cases had myocarditis on path ologic examination. It was acute in four patients, chronic in two, and simultaneously acute and chronic in one. Acute myocarditis and me nin goencephalitis are interpreted as being caused by relapses of chronic T. cruzi infections. An AIDS permissive role is suggested for these co nditions since immunologic defense against T. cruzi is mediated mainly by T lymphocytes, whose CD4 subpopulation is depleted in patients wit h this disease. Consequently, AIDS is a factor that may favor the reac tivation of T. cruzi infections. The lesions reported in the associati on of Chagas' disease with AIDS were compared with those reported from patients without AIDS having fatal, acute, vector-transmitted infecti ons, contaminated blood transfusions, or accidental exposures in the l aboratory. For the latter three, meningoencephalitis is uncommon. Only immunosuppressed cases of Chagas' disease have been described as havi ng a pseudotumoral presentation that shows expanding lesions with a ma ss effect in the cranial cavity that causes intracranial hypertension and simulates neoplasms (tumors such as gliomas, lymphomas, metastases , etc.).