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      Prevalencia de Toxoplasmosis y Chagas en pacientes con VIH/SIDA Translated title: Prevalence of toxoplasmosis and Chagas disease in patients with HIV / AIDS

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          Abstract

          En la actualidad más de dos millones de personas viviendo con VIH/SIDA (PVVS) en América Latina, y cien mil fallecidos por causas relacionadas con esta enfermedad, lo cual convierte a la región en la tercera del mundo con mayor índice de mortalidad relacionada con esta enfermedad. El presente estudio es observacional, prospectivo y de corte transversal con elementos analíticos. Muestreo no probabilístico de casos no consecutivos, en el que se incluyeron pacientes mayores de 16 años con VIH/SIDA que accedan a la realización del dosaje de anticuerpos, para Toxoplasmosis y Enfermedad de Chagas. De una muestra de 53 PVVS, 56,6% fueron del sexo masculino, edad promedio 37,83 ± 10,02 años. 36 personas fueron pacientes ambulatorios y 17 pacientes internados. Los resultados obtenidos nos llevan a pensar que un screening buscando anticuerpos IgG para Chagas en pacientes con VIH está justificado ya que de cada 10 pacientes que tengamos, uno resulta positivo. El método de ELISA un método barato, rápido y con una efectividad aceptable puede ser usado en el screening tanto de Toxoplasmosis como de Chagas. Las posibles complicaciones, ya mencionadas, justifican la utilización de estos métodos auxiliares del diagnóstico en todos nuestros pacientes PVVS.

          Translated abstract

          At present more than two million people living with HIV / AIDS (PLWA) in Latin America, and a hundred thousand deaths from causes related to this disease, which makes the region the world's third highest rate of mortality related to this disease. This study was observational, prospective, cross sectional analytical elements. Nonprobabilit sampling of consecutive cases, which included patients over 16 years with HIV / AIDS who access the realization of the dosage of antibodies to toxoplasmosis and Chagas disease. In a sample of 53 PLWA, 56,6% were male, mean age 37,83 ± 10,02 years. 36 people were outpatients and 17 inpatients. The results obtained suggest that a screening for antibodies to Chagas IgG in HIV patients is justified because 10 patients we have, one is positive. The ELISA method an inexpensive, fast and with an acceptable effectiveness can be used in screening both toxoplasmosis and Chagas. Possible complications, mentioned above, justify the use of these ancillary methods of diagnosis in all our patients PLWA.

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          Most cited references10

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          Parasitic central nervous system infections in immunocompromised hosts: malaria, microsporidiosis, leishmaniasis, and African trypanosomiasis.

          Immunosuppression associated with HIV infection or following transplantation increases susceptibility to central nervous system (CNS) infections. Because of increasing international travel, parasites that were previously limited to tropical regions pose an increasing infectious threat to populations at risk for acquiring opportunistic infection, especially people with HIV infection or individuals who have received a solid organ or bone marrow transplant. Although long-term immunosuppression caused by medications such as prednisone likely also increases the risk for acquiring infection and for developing CNS manifestations, little published information is available to support this hypothesis. In an earlier article published in Clinical Infectious Diseases, we described the neurologic manifestations of some of the more common parasitic CNS infections. This review will discuss the presentation, diagnosis, and treatment of the following additional parasitic CNS infections: malaria, microsporidiosis, leishmaniasis, and African trypanosomiasis.
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            Cerebral trypanosomiasis and AIDS

            A 36 year-old black female, complaining of headache of one month's duration presented with nausea, vomiting, somnolence, short memory problems, loss of weight, and no fever history. Smoker, intravenous drugs abuser, promiscuous lifestyle. Physical examination: left homonimous hemianopsia, left hemiparesis, no papilledema, diffuse hyperreflexia, slowness of movements. Brain CT scan: tumor-like lesion in the splenium of the corpus calosum, measuring 3.5 x 1.4 cm, with heterogeneous enhancing pattern, sugesting a primary CNS tumor. Due to the possibility of CNS infection, a lumbar puncture disclosed an opening pressure of 380 mmH(2)0; 11 white cells (lymphocytes); glucose 18 mg/dl (serum glucose 73 mg/dl); proteins 139 mg/dl; presence of Trypanosoma parasites. Serum Elisa-HIV tests turned out to be positive. Treatment with benznidazole dramatically improved clinical and radiographic picture, but the patient died 6 weeks later because of respiratory failure. T. cruzi infection of the CNS is a rare disease, but we have an increasing number of cases in HIV immunecompromised patients. Diagnosis by direct observation of CSF is uncommon, and most of the cases are diagnosed by pathological examination. It is a highly lethal disease, even when properly diagnosed and treated. This article intends to include cerebral trypanosomiasis in the differential diagnosis of intracranial space-occupying lesions, especially in immunecompromised patients from endemic regions.
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              Toxoplasma encephalitis in AIDS patients in São Paulo during 1988 and 1991. A comparative retrospective analysis

              We conducted a retrospective analysis of Toxoplasma encephalitis patients from Instituto de Infectologia Emílio Ribas, the main AIDS hospital of São Paulo, Brazil, during two different stages of the HIV epidemics, in 1988 (38 patients) and 1991 (33 patients). There were AIDS-related demographic differences, but the clinical presentation and diagnostic efficiency were similar, usually based on tomography and clinical response to therapy, with a clear distinction from other CNS infections, based on clinical and laboratory findings. Specific serologic studies were performed less often in 1991, with a high frequency of therapy change. The direct acute death rate from Toxoplasma encephalitis was high during both periods, i.e. 8/38 in 1988 and 10/33 in 1991. The direct acute death rate for the patients from the two periods as a whole was 25.4% (18/71), related to the time of HIV infection, absence of fever and presence of meningeal irritation at presentation, blood leukocytes higher than 10,000/mm³ and blood lymphocytes lower than 350/mm³. Toxoplasma encephalitis is a preventable disease when adequate prophylactic therapy is used and is relatively easy to treat in diagnosed HIV patients. Unfortunately, this severe and deadly disorder is the HIV diagnostic disease in several patients, and our data support the need for careful management of these patients, especially in those countries with a high toxoplasmosis prevalence where AIDS is concurrent with economic and public health problems.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                imt
                Revista del Instituto de Medicina Tropical
                Rev. Inst. Med. Trop.
                Instituto de Medicina Tropical (Asunción, , Paraguay )
                1996-3696
                December 2010
                : 5
                : 2
                : 10-15
                Affiliations
                [01] orgnameUniversidad Nacional de Asuncion orgdiv1Universidad de Ciencias Médicas
                [02] orgnameLaboratorio Central de Salud Pública
                Article
                S1996-36962010000200003
                8933332a-3124-4287-b73a-e8fa2287c01d

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 12, Pages: 6
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                SciELO Paraguay

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                Articulos Originales

                tropical infection,Infecciones tropicales,Laboratorio,PVVS,laboratory,PLWA

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