Trypanosoma cruzi (DTU TcI) in a fatal case of meningoencephalitis due to Chagas disease reactivation in a patient coinfected with human immunodeficiency virus: case report

The reactivation of Chagas disease (RCD) by human immunodeficiency virus (HIV) is associated with high mortality and is a relevant public health problem in areas endemic for the causative agent of CD, Trypanosoma cruzi (T. cruzi). Here, we report a fatal case of meningoencephalitis caused by RCD involving the discrete typing unit (DTU) of T. cruzi I (TcI) in an HIV-coinfected patient from Paraná, Brazil. Based on computed tomography findings, a 55-year-old man initially underwent empirical treatment for neurotoxoplasmosis. However, Giemsa-stained cerebrospinal fluid and blood smears revealed T. cruzi trypomastigotes on direct microscopic examination. Protozoa were detected by fresh blood examination and blood culture. Additionally, anti-T. cruzi immunoglobulin G antibodies were detected in serum using a chemiluminescent immunoassay. Blood culture sequencing of cytochrome oxidase II confirmed the DTU TcI infection. Benznidazole therapy was administered for 76 d; however, the patient showed no clinical improvement and died nearly 7 months after hospital admission. The fatal outcome was likely related to delayed diagnosis and treatment, severe immunosuppression (CD4 = 39 cells/mm³), high viral load (94,638 copies/mL), and the involvement of TcI, which has been consistently associated with fatal RCD-related meningoencephalitis.