Skip to main content
SpringerLink
Log in

Chagas Disease in Immunosuppressed Patients

  • Chapter
  • First Online:
Chagas Disease

Part of the book series: Birkhäuser Advances in Infectious Diseases ((BAID))

  • 472 Accesses

Abstract

This chapter is a brief update on immunosuppression and Chagas disease (CD) and refers to the pharmacological immunosuppression in solid organ transplantation and hematopoietic stem cell transplantation and to the biological immunosuppression induced by the human immunodeficiency virus (HIV).

In transplantation a review is made of historical and current immunosuppressive drugs and of the keys in the diagnosis for recipients and donors with Chagas disease and their management during the follow-up after transplantation. Likewise, the main events published in the different heart, kidney, liver, and bone marrow transplants in Chagas disease in endemic and non-endemic countries are described. The events corresponding to non-endemic countries have been published, due to the intense migratory flow from the endemic countries to the non-endemic (developed) countries in Europe, Canada, Australia, and the United States. This chapter also covers published reports of the main transplants, key situations in the diagnosis, as well as conclusions.

In HIV and Chagas, a historical review is made since the appearance of AIDS in the world and its characterization as a pandemic. The great and rapid advances in the research of AIDS are a paradigm on how to make progress in order to control a disease. The appearance of new treatments meant a change in the clinical profile and a change in the life expectancy of AIDS patients. With respect to Chagas disease and AIDS, the reactivation of CD in AIDS patients constitutes an AIDS-defining event. This chapter presents different clinical CD-AIDS scenarios, the diagnosis and treatment, as well as a vision of the future.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kuschnir E, Sgammini H, Castro R, Evequoz C, Ledesma R, Brunetto J. Evaluation of cardiac function by radioisotopic angiography, in patients with chronic Chagas cardiopathy. Arq Bras Cardiol. 1985;45(4):249–56.

    CAS  PubMed  Google Scholar 

  2. Schmunis GA, Yadon ZE. Chagas disease: a Latin American health problem becoming a world health problem. Acta Trop. 2010;115(1–2):14–21.

    Article  PubMed  Google Scholar 

  3. Fiorelli AI, Santos RHB, Oliveira JL Jr, Lourenço-Filho DD, Dias RR, Oliveira AS, et al. Heart transplantation in 107 cases of Chagas’ disease. Transplant Proc. 2011;43(1):220–4.

    Article  CAS  PubMed  Google Scholar 

  4. Martinez-Perez A, Norman FF, Monge-Maillo B, Perez-Molina JA, Lopez-Velez R. An approach to the management of Trypanosoma cruzi infection (Chagas’ disease) in immunocompromised patients. Expert Rev Anti-Infect Ther. 2014;12(3):357–73.

    Article  CAS  PubMed  Google Scholar 

  5. Pinazo MJ, Espinosa G, Cortes-Lletget C, Posada EJ, Aldasoro E, Oliveira I, et al. Immunosuppression and Chagas disease: a management challenge. PLoS Negl Trop Dis. 2013;7(1):e1965. https://doi.org/10.1371/journal.pntd.0001965.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Bacal F, Bocchi EA. Trasplante cardíaco para la enfermedad de Chagas. Rev Insuf Cardiac. 2008;3(2):88–90.

    Google Scholar 

  7. Jordán R, Valledor A. Guías de recomendaciones de prevención de infecciones en pacientes que reciben modificadores de la respuesta biológica. Rev Arg Reumatol. 2014;25(2):08–26.

    Google Scholar 

  8. González-Ramos J, Alonso-Pacheco ML, Mora-Rillo M, Herranz-Pinto P. Need to screen for Chagas disease and Strongyloides infestation in non-endemic countries prior to treatment with biologics. Actas Dermosifiliogr. 2017;108(4):373–5. https://doi.org/10.1016/j.ad.2016.10.013.30.

    Article  PubMed  Google Scholar 

  9. Navarrete-Dechent C, Majerson D, Torres M, Armijo D, Patel M, Menter A, et al. Use of tumor necrosis factor alpha (TNF α) antagonists in a patient with psoriasis and Chagas disease. Ann Bras Dermatol. 2015;90(3 Suppl 1):S171–4. https://doi.org/10.1590/abd1806-4841.20153538.

    Article  Google Scholar 

  10. Garzón MI, Sánchez AG, Goy MC, Alvarellos T, Zarate AH, Basquiera AL, et al. Reactivation of Chagas disease in a patient with follicular lymphoma diagnosed by means of quantitative real-time polymerase chain reaction. Open Forum Infect Dis. 2015;30(2):ofv060. https://doi.org/10.1093/ofid/ofv060.

    Article  Google Scholar 

  11. Fontes Rezende RE, Lescano MA, Zambelli Ramalho LN, de Castro Figueiredo JF, Oliveira Dantas R, Garzella Meneghelli U, et al. Reactivation of Chagas’ disease in a patient with non-Hodgkin’s lymphoma: gastric, oesophageal and laryngeal involvement. Trans R Soc Trop Med Hyg. 2006;100(1):74–8.

    Article  PubMed  Google Scholar 

  12. Vicco MH, César LI, Musacchio HM, Bar DO, Marcipar IS, Bottasso OA. Chagas disease reactivation in a patient non-Hodgkin’s lymphoma. Rev Clin Esp. 2014;214(7):e83–5. https://doi.org/10.1016/j.rce.2014.04.006.

    Article  CAS  PubMed  Google Scholar 

  13. Altclas J, Sinagra A, Dictar M, Luna C, Verón MT, de Rissio AM, et al. Chagas disease in bone marrow transplantation: an approach to preemptive therapy. Bone Marrow Transplant. 2005;36:123–9. https://doi.org/10.1038/sj.bmt.1705006.

    Article  CAS  PubMed  Google Scholar 

  14. Dictar M, Sinagra A, Verón MT, Luna C, Dengra C, de Rissio A, et al. Recipients and donors of bone marrow transplants suffering from Chagas’ disease: management and preemptive therapy of parasitemia. Bone Marrow Transplant. 1998;21:391–3. https://doi.org/10.1038/sj.bmt.1701107.

    Article  CAS  PubMed  Google Scholar 

  15. Guiang KMU, Cantey P, Montgomery SP, Ailawadhi S, Qvarnstrom Y, Price T, et al. Reactivation of Chagas disease in a bone marrow transplant patient: case report and review of screening and management. Transpl Infect Dis. 2013;15(6):E264–7.

    Article  CAS  PubMed  Google Scholar 

  16. WHO. Consultation on international biological reference. Geneva: WHO; 2007.

    Google Scholar 

  17. Strout R. A method for concentrating hemoflagellate. J Parasitol. 1962;48:100–1.

    Article  CAS  PubMed  Google Scholar 

  18. Ministerio de Salud de la Nación. Argentina. Guías Para La Atencion Al Paciente Infectado Con Trypanosoma cruzi Enfermedad De Chagas. Agosto de 2012. Revisión Noviembre 2011 – Julio 2012 (Resolución Ministerial 1337/14).

    Google Scholar 

  19. Chin-Honga PV, Schwartz BS, Bern C, Montgomery SP, Kontak S, Kubak B, et al. Screening and treatment of Chagas disease in organ transplant recipients in the United States: recommendations from the Chagas in transplant working group. Am J Transplant. 2011;11:672–80.

    Article  Google Scholar 

  20. The Chagas’ Disease Argentine Collaborative Transplant Consortium et al. Chagas’ disease and solid organ transplantation. Transplant Proc. 2010;42:3354–9.

    Article  Google Scholar 

  21. Schijman AG, Vigliano C, Burgos J, Favaloro R, Perrone S, Laguens R, et al. Early diagnosis of recurrence of Trypanosoma cruzi infection by polymerase chain reaction after heart transplantation of a chronic chagas heart disease patient. Heart Lung Transplant. 2000;19(11):1114–7.

    Article  CAS  Google Scholar 

  22. Diez M, Favaloro L, Bertolotti A, Burgos JM, Vigliano C, Lastra MP, et al. Usefulness of PCR strategies for early diagnosis of Chagas’ disease reactivation and treatment follow-up in heart transplantation. Am J Transplant. 2007;7:1633–40.

    Article  CAS  PubMed  Google Scholar 

  23. Schijman AG, Bisio M, Orellana L, Sued M, Duffy T, Mejia Jaramillo AM, et al. International study to evaluate PCR methods for detection of Trypanosoma cruzi DNA in blood samples from Chagas disease patients. PLoS Negl Trop Dis. 2011;5(1):e931. https://doi.org/10.1371/journal.pntd.0000931.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Qvarnstrom Y, Schijman AG, Veron V, Aznar C, Steurer F, da Silva AJ. Sensitive and specific detection of Trypanosoma cruzi DNA in clinical specimens using a multi-target real-time PCR approach. PLoS Negl Trop Dis. 2012;6(7):e1689. https://doi.org/10.1371/journal.pntd.0001689.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Cura CI, Lattes R, Nagel C, Gimenez MJ, Blanes M, Calabuig E, et al. Early molecular diagnosis after transplantation with donors from Trypanosoma cruzi-infected donors. Am J Transplant. 2013;13(12):3253–61.

    Article  CAS  PubMed  Google Scholar 

  26. Ramírez JC, Cura CI, da Cruz MO, Lages-Silva E, Juiz N, Velázquez E, et al. Analytical validation of quantitative real-time PCR methods for quantification of Trypanosoma cruzi DNA in blood samples from Chagas disease patients. J Mol Diagn. 2015;17(5):605–15. https://doi.org/10.1016/j.jmoldx.2015.04.010.

    Article  CAS  PubMed  Google Scholar 

  27. Bocchi EA, Bellotti G, Mocelin AO, Uip D, Bacal F, Higuchi ML, et al. Heart transplantation for chronic Chagas’ heart disease. Ann Thorac Surg. 1996;61:1727–33.

    Article  CAS  PubMed  Google Scholar 

  28. Bacal F, Pereira Silva C, Bocchi EA, Vieira Pires P, Moreira LFP, Issa S, et al. Mychophenolate mofetil increased Chagas disease reactivation in heart transplanted patients: comparison between two different protocols. Am J Transplant. 2005;5:2017–21.

    Article  CAS  PubMed  Google Scholar 

  29. Riarte A, Luna C, Sabatiello R, Sinagra A, Schiavelli R, de Rissio A, et al. Chagas’ disease in patients with kidney transplants: 7 years of experience 1989–1996. Clin Infect Dis. 1999;29:561–7.

    Article  CAS  PubMed  Google Scholar 

  30. Cicora F, Escurra V, Silguero S, Gonzalez IM, Roberti JE. Use of kidneys from Trypanosoma cruzi infected donors in naive transplant recipients without prophylactic therapy: the experience in a high-risk area. Transplantation. 2014;97(1):e3–4. https://doi.org/10.1097/01.TP.0000437673.86339.82.

    Article  PubMed  Google Scholar 

  31. Huprikar S, Bosserman E, Patel G, Moore A, Pinney S, Anyanwu A, et al. Donor-derived Trypanosoma cruzi infection in solid organ recipients in the United States, 2001-2011. Am J Transplant. 2013;3:2418–25.

    Article  Google Scholar 

  32. Barcan L, Luna C, Clara L, Sinagra A, Valledor A, de Rissio AM, et al. Liver transplantation from deceased donors serologically positive for Chagas disease. Liver Transpl. 2005;11:1112–6.

    Article  PubMed  Google Scholar 

  33. Albuquerque LACD, Gonzalez AM, Filho HLVN, Copstein JLM, Larrea FIS, Mansero JMP, et al. Liver transplantation from deceased donors serologically positive for Chagas disease. Am J Transplant. 2007;7:680–4.

    Article  PubMed  Google Scholar 

  34. Salvador F, Len O, Molina I, Sulleiro E, Sauleda S, Bilbao I, et al. Safety of liver transplantation with Chagas disease-seropositive donors for seronegative recipients. Liver Transpl. 2011;17:1304–8.

    Article  PubMed  Google Scholar 

  35. McCormack L, Quinonez E, Goldaracena N, Anders M, Rodrıguez V, Orozco F, et al. Liver transplantation using Chagas-infected donors in uninfected recipients: a single-center experience without prophylactic therapy. Am J Transplant. 2012;12:2832–7.

    Article  CAS  PubMed  Google Scholar 

  36. Nishioka SA. Benznidazol na quimioprofilaxia primária da reativação de doença de Chagas em chagásicos crônicos em uso de corticosteróides em dose imunodepressoras: há evidência suficiente para a recomendação do seu uso? Rev Soc Bras Med Trop. 2000;33(1):83–5.

    Article  Google Scholar 

  37. Lattes R, Lasala MB. Chagas disease in the immunosuppressed patient. Clin Microbiol Infect. 2014;20(4):300–9. https://doi.org/10.1111/1469-0691.12585.

    Article  CAS  PubMed  Google Scholar 

  38. UNAIDS. World AIDS Day report, 2017. Geneva: UNAIDS; 2017. http://www.unaids.org/en/resources/fact-sheet. Accessed 18 Feb 2018

    Google Scholar 

  39. CDC. Pneumocystis pneumonia—Los Angeles. MMWR. 1981;30(21). https://www.cdc.gov/mmwr/hiv_aids20.html

  40. Gottlieb MS, Schroff R, Schanker HM, Weisman JD, Fan PT, Wolf RA, et al. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency. N Engl J Med. 1981;305(24):1425–31.

    Article  CAS  PubMed  Google Scholar 

  41. Barré-Sinoussi F, Chermann JC, Rey F, Nugeyre MT, Chamaret S, Gruest J, et al. Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science. 1983;220(4599):868–71.

    Article  PubMed  Google Scholar 

  42. Brun-Vezinet F, Rouzioux C, Barre-Sinoussi F, Klatzmann D, Saimot AG, Rozenbaum W, et al. Detection of IgG antibodies to lymphadenopathy-associated virus in patients with AIDS or lymphadenopathy syndrome. Lancet. 1984;1(8389):1253–6.

    Article  CAS  PubMed  Google Scholar 

  43. Dalgleish AG, Beverley PC, Clapham PR, Crawford DH, Greaves MF, Weiss RA. The CD4 (T4) antigen is an essential component of the receptor for the AIDS retrovirus. Nature. 1984;312(5996):763–7.

    Article  CAS  PubMed  Google Scholar 

  44. Klatzmann D, Champagne E, Chamaret S, Gruest J, Guetard D, Hercend T, et al. T lymphocyte T4 molecule behaves as the receptor for human retrovirus LAV. Nature. 1984;312(5996):767–8.

    Article  CAS  PubMed  Google Scholar 

  45. Maddon PJ, Dalgleish AG, McDougal JS, Clapham PR, Weiss RA, Axel R. The T4 gene encodes the AIDS virus receptor and is expressed in the immune system and the brain. Cell. 1986;47(3):333–48.

    Article  CAS  PubMed  Google Scholar 

  46. Fahey JL, Prince H, Weaver M, Groopman J, Visscher B, Schwartz K, et al. Quantitative changes in T helper or T suppressor/cytotoxic lymphocyte subsets that distinguish acquired immune deficiency syndrome from other immune subset disorders. Am J Med. 1984;76(1):95–100.

    Article  CAS  PubMed  Google Scholar 

  47. Piatak M Jr, Saag MS, Yang LC, Clark SJ, Kappes JC, Luk KC, et al. High levels of HIV-1 in plasma during all stages of infection determined by competitive PCR. Science. 1993;259(5102):1749–54.

    Article  CAS  PubMed  Google Scholar 

  48. Pantaleo G, Graziosi C, Demarest JF, Butini L, Montroni M, Fox CH, et al. HIV infection is active and progressive in lymphoid tissue during the clinically latent stage of disease. Nature. 1993;362(6418):355–8.

    Article  CAS  PubMed  Google Scholar 

  49. Mellors JW, Rinaldo CR Jr, Gupta P, White RM, Todd JA, Kingsley LA. Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science. 1996;272(5265):1167–70.

    Article  CAS  PubMed  Google Scholar 

  50. Murray JS, Elashoff MR, Iacono-Connors LC, Cvetkovich TA, Struble KA. The use of plasma HIV RNA as a study endpoint in efficacy trials of antiretroviral drugs. AIDS. 1999;13(7):797–804.

    Article  CAS  PubMed  Google Scholar 

  51. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. Department of Health and Human Services. http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescent. Accessed 18 Feb 2018.

  52. Walensky RP, Paltiel AD, Losina E, Mercincavage LM, Schackman BR, Sax PE, et al. The survival benefits of AIDS treatment in the United States. J Infect Dis. 2006;194(1):11–9.

    Article  PubMed  Google Scholar 

  53. Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient Study Investigators. N Engl J Med. 1998;338(13):853–60.

    Article  PubMed  Google Scholar 

  54. Detels R, Muñoz A, McFarlane G, Kingsley LA, Margolick JB, Giorgi J, et al. Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators. JAMA. 1998;280(17):1497–503.

    Article  CAS  PubMed  Google Scholar 

  55. Jones JL, Hanson DL, Dworkin MS, Alderton DL, Fleming PL, Kaplan JE, et al. Surveillance for AIDS-defining opportunistic illnesses, 1992–1997. MMWR CDC Surveill Summ. 1999;48(2):1–22.

    PubMed  Google Scholar 

  56. Mocroft A, Vella S, Benfield TL, Chiesi A, Miller V, Gargalianos P, et al. Changing patterns of mortality across Europe in patients infected with HIV-1. EuroSIDA Study Group. Lancet. 1998;352(9142):1725–30.

    Article  CAS  PubMed  Google Scholar 

  57. AD MN, Hanson DL, Jones JL, Dworkin MS, Ward JW. Effects of antiretroviral therapy and opportunistic illness primary chemoprophylaxis on survival after AIDS diagnosis Adult/Adolescent Spectrum of Disease Group. AIDS. 1999;13(13):1687–95.

    Article  Google Scholar 

  58. Dore GJ, Li Y, McDonald A, Ree H, Kaldor JM, National HIV Surveillance Committee. Impact of highly active antiretroviral therapy on individual AIDS-defining illness incidence and survival in Australia. J Acquir Immune Defic Syndr. 2002;29(4):388–95.

    Article  PubMed  Google Scholar 

  59. Centers for Disease Control and Prevention. Vital signs: HIV prevention through care and treatment—United States. MMWR Morb Mortal Wkly Rep. 2011;60(47):1618–23.

    Google Scholar 

  60. Campsmith ML, Rhodes PH, Hall HI, Green TA. Undiagnosed HIV prevalence among adults and adolescents in the United States at the end of 2006. J Acquir Immune Defic Syndr. 2010;53(5):619–24. https://doi.org/10.1097/QAI.0b013e3181bf1c45.

    Article  PubMed  Google Scholar 

  61. Perbost I, Malafronte B, Pradier C, Santo LD, Dunais B, Counillon E, et al. In the era of highly active antiretroviral therapy, why are HIV-infected patients still admitted to hospital for an inaugural opportunistic infection? HIV Med. 2005;6(4):232–9.

    Article  CAS  PubMed  Google Scholar 

  62. Palacios R, Hidalgo A, Reina C, de la Torre M, Márquez M, Santos J. Effect of antiretroviral therapy on admissions of HIV-infected patients to an intensive care unit. HIV Med. 2006;7(3):193–6.

    Article  CAS  PubMed  Google Scholar 

  63. Ramos AN Jr. Inclusion of Chagas’ disease reactivation as a condition for AIDS case definition to epidemiological surveillance in Brazil [Article in Portuguese]. Rev Soc Bras Med Trop. 2004;37(2):192–3.

    Article  PubMed  Google Scholar 

  64. Rubin R. Collaboration and conflict: looking back at the 30-year history of the AIDS clinical trials group. JAMA. 2015;314(24):2604–6. https://doi.org/10.1001/jama.2015.14848.

    Article  CAS  PubMed  Google Scholar 

  65. Fischl MA, Richman DD, Grieco MH, Gottlieb MS, Volberding PA, Laskin OL, et al. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial. N Engl J Med. 1987;317(4):185–91.

    Article  CAS  PubMed  Google Scholar 

  66. Volberding PA, Lagakos SW, Koch MA, Pettinelli C, Myers MW, Booth DK, et al. Zidovudine in asymptomatic human immunodeficiency virus infection. A controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. The AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases. N Engl J Med. 1990;322(14):941–9.

    Article  CAS  PubMed  Google Scholar 

  67. Mitsuya H, Weinhold KJ, Furman PA, St Clair MH, Lehrman SN, Gallo RC, et al. 3′ Azido 3′ deoxythymidine (BW A509U): an antiviral agent that inhibits the infectivity and cytopathic effect of human T lymphotropic virus type III/lymphadenopathy-associated virus in vitro. Proc Natl Acad Sci U S A. 1985;82(20):7096–100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O’Sullivan MJ, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med. 1994;331(18):1173–80.

    Article  CAS  PubMed  Google Scholar 

  69. Ho DD. Time to hit HIV, early and hard. N Engl J Med. 1995;333(7):450–1.

    Article  CAS  PubMed  Google Scholar 

  70. Hammer SM, Squires KE, Hughes MD, Grimes JM, Demeter LM, Currier JS, et al. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. N Engl J Med. 1997;337(11):725–33.

    Article  CAS  PubMed  Google Scholar 

  71. Ho DD, Neumann AU, Perelson AS, Chen W, Leonard JM, Markowitz M. Rapid turnover of plasma virions and CD4 lymphocytes in HIV 1 infection. Nature. 1995;373(6510):123–6.

    Article  CAS  PubMed  Google Scholar 

  72. Collier AC, Coombs RW, Schoenfeld DA, Bassett RL, Timpone J, Baruch A, et al. Treatment of human immunodeficiency virus infection with saquinavir, zidovudine and zalcitabine. N Engl J Med. 1996;334(16):1011–7.

    Article  CAS  PubMed  Google Scholar 

  73. Staszewski S, Morales-Ramirez J, Tashima KT, Rachlis A, Skiest D, Stanford J, et al. Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. N Engl J Med. 1999;341(25):1865–73.

    Article  CAS  PubMed  Google Scholar 

  74. The Antiretroviral Therapy Cohort Collaboration. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008;372(9635):293–9.

    Article  PubMed Central  Google Scholar 

  75. Egger M, Hirschel B, Francioli P, Sudre P, Wirz M, Flepp M, et al. Impact of new antiretroviral combination therapies in HIV infected patients in Switzerland: prospective multicentre study. BMJ. 1997;315(7117):1194–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Barré-Sinoussi F, Ross AL, Delfraissy JF. Past, present and future: 30 years of HIV research. Nat Rev Microbiol. 2013;11(12):877–83.

    Article  PubMed  CAS  Google Scholar 

  77. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2014. HIV surveillance supplemental report 21. Atlanta, GA: Centers for Disease Control and Prevention. p. 2016. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-reportvol-21-4.pdf

  79. Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–22.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  80. Chun TW, Finzi D, Margolick J, Chadwick K, Schwartz D, Siliciano RF. In vivo fate of HIV 1 infected T cells: quantitative analysis of the transition to stable latency. Nat Med. 1995;1(12):1284–90.

    Article  CAS  PubMed  Google Scholar 

  81. Chun TW, Stuyver L, Mizell SB, Ehler LA, Mican JA, Baseler M, et al. Presence of an inducible HIV 1 latent reservoir during highly active antiretroviral therapy. Proc Natl Acad Sci U S A. 1997;94(24):13193–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Finzi D, Hermankova M, Pierson T, Carruth LM, Buck C, Chaisson RE, et al. Identification of a reservoir for HIV 1 in patients on highly active antiretroviral therapy. Science. 1997;278(5341):1295–300.

    Article  CAS  PubMed  Google Scholar 

  83. Wong JK, Hezareh M, Günthard HF, Havlir DV, Ignacio CC, Spina CA, et al. Recovery of replication-competent HIV despite prolonged suppression of plasma viremia. Science. 1997;278(5341):1291–5.

    Article  CAS  PubMed  Google Scholar 

  84. van der Kuy AC, Bakker M, Jurriaans S, Back NK, Pasternak AO, Cornelissen M, et al. Translational HIV-1 research: from routine diagnostics to new virology insights in Amsterdam, the Netherlands during 1983–2013. Retrovirology. 2013;10:93. https://doi.org/10.1186/1742-4690-10-93.

    Article  Google Scholar 

  85. World Health Organization. Chagas disease in Latin America: an epidemiological update based on 2010 estimates. Wkly Epidemiol Rec. 2015;90(6):33–43.

    Google Scholar 

  86. Coura JR, Dias JC. Epidemiology, control and surveillance of Chagas disease: 100 years after its discovery. Mem Inst Oswaldo Cruz. 2009;104(Suppl 1):31–40.

    Article  PubMed  Google Scholar 

  87. Schmunis GA. Epidemiology of Chagas disease in non-endemic countries: the role of international migration. Mem Inst Oswaldo Cruz. 2007;102(Suppl 1):75–85.

    Article  PubMed  Google Scholar 

  88. Balasso V, Almeida E, Molina I, Campis M, et al. A coinfeccao T cruzi/HIV em regioes nao endemicas para doenca de chagas. Libro: Epidemiologia e clinica da coinfeccao Trypanosoma cruzi e virus da imunofediciencia adquirida. Campinas, SP: Editorial Unicamp; 2015. p. 215–36.

    Google Scholar 

  89. Yasukawa K, Patel SM, Flash CA, Stager CE, Goodman JC, Woc-Colburn L. Trypanosoma cruzi meningoencephalitis in a patient with acquired immunodeficiency syndrome. Am J Trop Med Hyg. 2014;91(1):84–5.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Pinto A, Pett S, Jackson Y. Identifying Chagas disease in Australia: an emerging challenge for general practitioners. Aust Fam Physician. 2014;43(7):440–2.

    PubMed  Google Scholar 

  91. Antinori S, Galimberti L, Bianco R, Grande R, Galli M, Corbellino M. Chagas disease in Europe: a review for the internist in the globalized world. Eur J Intern Med. 2017;43:6–15. https://doi.org/10.1016/j.ejim.2017.05.001.

    Article  PubMed  Google Scholar 

  92. Satoh F, Tachibana H, Hasegawa I, Osawa M. Case report sudden death caused by chronic Chagas disease in a non-endemic country: autopsy report. Pathol Int. 2010;60(3):235–40. https://doi.org/10.1111/j.1440-1827.2009.02503.x.

    Article  CAS  PubMed  Google Scholar 

  93. Dirección de Sida y ETS, Ministerio de Salud de la Nación, Argentina. Boletín sobre el VIH, SIDA e ITS en la Argentina n°34. 2017.

    Google Scholar 

  94. Benetucci J, Bissio E, Bologna R, Bruno M, et al. Guía para el manejo de los pacientes adultos con infección por VIH 2013. http://www.msal.gob.ar/images/stories/bes/graficos/0000000109cnt-2013-05_guia-manejo-pacientes-adultos.pdf

    Google Scholar 

  95. Benchetrit A, Andreani G, Avila MM, Rossi D, de Rissio AM, Weissenbacher M, et al. High HIV-Trypanosoma cruzi coinfection levels in vulnerable populations in Buenos Aires, Argentina. AIDS Res Hum Retroviruses. 2017;33(4):330–1.

    Article  PubMed  Google Scholar 

  96. Diez M, Nocito I, Frade RA, Cappello S, et al. Evidencia serologica de infecciones por citomegalovirus, hepatitis b y c, vírus de Ebstein Barr, Toxoplasma gondii, Trypanosoma cruzi y Treponema pallidum en infectados por HIV. Medicina (B Aires). 2001;61(4):376–80.

    Google Scholar 

  97. Dolcini G, Ambrosioni J, Andreani G, Pando MA, Martínez Peralta L, Benetucci J. Prevalencia de la coinfeccion virus e la inmunodeficiencia humana (VIH)-Trypanosoma cruzi e impacto del abuso de drogas inyectables en un centro de salud de la ciudad de Buenos Aires. Rev Argent Microbiol. 2008;40(3):164–6.

    CAS  PubMed  Google Scholar 

  98. Arias L. Enfermedad de chagas: coinfección con VIH. Congreso Argentino de Parasitología 2012. Rev Arg Parasitol. 2012;1:117–8.

    Google Scholar 

  99. Almeida EA, Lima JN, Lages-Silva E, Guariento ME, Aoki FH, Torres-Morales AE, et al. Chagas’ disease and HIV co-infection in patients without effective antiretroviral therapy: prevalence, clinical presentation and natural history. Trans R Soc Trop Med Hyg. 2010;104(7):447–52.

    Article  PubMed  Google Scholar 

  100. Pérez-Molina JA, Rodríguez-Guardado A, Soriano A, Pinazo MJ, Carrilero B, García-Rodríguez M, et al. Guidelines on the treatment of chronic coinfection by Trypanosoma cruzi and HIV Outside Endemic Areas. HIV Clin Trials. 2011;12(6):287–98.

    Article  PubMed  CAS  Google Scholar 

  101. Llenas-García J, Hernando A, Fiorante S, Maseda D, Matarranz M, Salto E, et al. Chagas disease screening among HIV-positive Latin American immigrants: an emerging problem. Eur J Clin Microbiol Infect Dis. 2012;31(8):1991–7.

    Article  PubMed  Google Scholar 

  102. Pinto Dias JC, Coura JR. Epidemiologia da doenca de Chagas. libro: epidemiologia e clinica da coinfeccao Trypanosoma cruzi e virus da imunofediciencia adquirida. Campinas, SP: Editorial Unicamp; 2015.

    Google Scholar 

  103. Salvador F, Molina I, Sulleiro E, Burgos J, Curran A, Van den Eynde E, et al. Tropical diseases screening in immigrant patients with human immunodeficiency virus infection in Spain. Am J Trop Med Hyg. 2013;88(6):1196–202.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  104. Rodríguez-Guardado A, Asensi Alvarez V, Rodríguez Perez M, Mejuto Alvarez P, Flores-Chavez M, Alonso González P, et al. Screening for Chagas’ disease in HIV-positive immigrants from endemic areas. Epidemiol Infect. 2011;139(4):539–43.

    Article  PubMed  Google Scholar 

  105. Departamento de Vigilância Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais (DIAHV), Ministerio da Saude, Brasil. Protocolo Clínico e Diretrizes Terapêuticas para Manejo da Infecção pelo HIV em Adultos. http://www.aids.gov.br/pt-br/pub/2013/protocolo-clinico-e-diretrizes-terapeuticas-para-manejo-da-infeccao-pelo-hiv-em-adultos

  106. Stauffert D, da Silveira MF, Mesenburg MA, Gaspar T, Manta AB, Bicca GL, et al. Serological diagnosis of Chagas disease in HIV-infected patients. Rev Soc Bras Med Trop. 2015;48(3):331–3.

    Article  PubMed  Google Scholar 

  107. PAHO/WHO. Communicable diseases and health analysis neglected infectious diseases: Chagas disease. http://www.paho.org/hq/index.phpoption=com_content&view=article&id=5856&Itemid=41506&lang=es

  108. Almeida E, Ramos A Jr, Correa D, Shikanai Yasuda MA. Coinfeccao T. cruzi/HIV/AIDS: revisão da literatura. Epidemiologia da doenca de Chagas. Epidemiologia e clinica da coinfeccao Trypanosoma cruzi e virus da imunodeficiencia adquirida. Campinas, SP: Editorial Unicamp; 2015.

    Google Scholar 

  109. Almeida EA, Ramos AN Jr, Correia D, Shikanai-Yasuda MA. Co infection Trypanosoma cruzi/HIV: systematic review (1980–2010). Rev Soc Bras Med Trop. 2011;44(6):762–70.

    Article  PubMed  Google Scholar 

  110. Benchetrit AG, Fernández M, Bava AJ, Corti M, Porteiro N, Martínez PL. Clinical and epidemiological features of chronic Trypanosoma cruzi infection in patients with HIV/AIDS in Buenos Aires, Argentina. Int J Infect Dis. 2018;67:118–21. https://doi.org/10.1016/j.ijid.2017.11.027.

    Article  PubMed  Google Scholar 

  111. Cordova E, Boschi A, Ambrosioni J, Cudos C, Corti M. Reactivation of Chagas disease with central nervous system involvement in HIV-infected patients in Argentina, 1992–2007. Int J Infect Dis. 2008;12(6):587–92.

    Article  PubMed  Google Scholar 

  112. Menghi RC, de NC G, Angeleri GA, Rocher CA, Palaoro IL. Trypanosoma cruzi: trypomastigote forms in pleural fluid of a patient with AIDS. Rev Chil Infectol. 2011;28(6):597–8.

    Article  Google Scholar 

  113. Nisida IV, Amato Neto V, Braz LM, Duarte MI, Umezawa ES. A survey of congenital Chagas’ disease, carried out at three health institutions in Sao Paulo City, Brazil. Rev Inst Med Trop Sao Paulo. 1999;41(5):305–11.

    Article  CAS  PubMed  Google Scholar 

  114. Scapellato PG, Bottaro EG, Rodriguez-Brieschke MT. Mother-child transmission of Chagas disease: could coinfection with human immunodeficiency virus increase the risk? Rev Soc Bras Med Trop. 2009;42(2):107–9.

    Article  PubMed  Google Scholar 

  115. Freilij H, Altcheh J, Muchinik G. Perinatal human immunodeficiency virus infection and congenital Chagas’ disease. Pediatr Infect Dis J. 1995;14(2):161–2.

    Article  CAS  PubMed  Google Scholar 

  116. Sartori AM, Ibrahim KY, Nunes Westphalen EV, Braz LM, Oliveira OC Jr, Gakiya E, et al. Manifestations of Chagas disease (American trypanosomiasis) in patients with HIV/AIDS. Ann Trop Med Parasitol. 2007;101(1):31–50.

    Article  CAS  PubMed  Google Scholar 

  117. Sartori AM, Caiaffa-Filho HH, Bezerra RC, Guilherme SC, Lopes MH, Shikanai-Yasuda MA. Exacerbation of HIV viral load simultaneous with asymptomatic reactivation of chronic Chagas’ disease. Am J Trop Med Hyg. 2002;67(5):521–3.

    Article  PubMed  Google Scholar 

  118. de Freitas VL, da Silva SC, Sartori AM, Bezerra RC, Westphalen EV, Molina TD. Real-time PCR in HIV/Trypanosoma cruzi coinfection with and without Chagas disease reactivation: association with HIV viral load and CD4 level. PLoS Negl Trop Dis. 2011;5(8):e1277. https://doi.org/10.1371/journal.pntd.0001277.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  119. Sartori AM, Shikanai-Yasuda MA, Amato Neto V, Lopes MH. Follow-up of 18 patients with human immunodeficiency virus infection and chronic Chagas’ disease, with reactivation of Chagas’ disease causing cardiac disease in three patients. Clin Infect Dis. 1998;26(1):177–9.

    Article  CAS  PubMed  Google Scholar 

  120. Spina-França A, Livramento JA, Machado LR, Yasuda N. Trypanosoma cruzi antibodies in the cerebrospinal fluid: a search using complement fixation and immunofluorescence reactions. Arq Neuropsiquiatr. 1988;46(4):374–8.

    Article  PubMed  Google Scholar 

  121. Livramento JA, Machado LR, Spina-França A. Cerebrospinal fluid abnormalities in 170 cases of AIDS. Arq Neuropsiquiatr. 1989;47(3):326–31.

    Article  CAS  PubMed  Google Scholar 

  122. Del Castillo M, Mendoza G, Oviedo J, Perez Bianco RP, Anselmo AE, Silva M. AIDS and Chagas’ disease with central nervous system tumor-like lesion. Am J Med. 1990;88(6):693–4.

    Article  PubMed  Google Scholar 

  123. Karp CL, Auwaerter PG. Coinfection with HIV and tropical infectious diseases. I Protozoal pathogens. Clin Infect Dis. 2007;45(9):1208–13.

    Article  PubMed  Google Scholar 

  124. Concetti H, Retegui M, Pérez G, Pérez H. Chagas disease of the cervix uteri in a patient with acquired immunodeficiency syndrome. Hum Pathol. 2000;31(1):120–2.

    Article  CAS  PubMed  Google Scholar 

  125. Iliovich E, Lopez R, Kum M, Uzandizaga G. Spontaneous chagasic peritonitis in a patient with AIDS. Medicina (B Aires). 1998;58(5 Pt 1):507–8.

    CAS  Google Scholar 

  126. Oelemann W, Velásquez JN, Carnevale S, Besasso H, Teixeira MG, Peralta JM. Intestinal Chagas disease in patients with AIDS. AIDS. 2000;14(8):1072–3.

    Article  CAS  PubMed  Google Scholar 

  127. Sartori AM, Sotto MN, Braz LM, Oliveira Júnior Oda C, Patzina RA, Barone AA, et al. Reactivation of Chagas disease manifested by skin lesions in a patient with AIDS. Trans R Soc Trop Med Hyg. 1999;93(6):631–2.

    Article  CAS  PubMed  Google Scholar 

  128. Diazgranados CA, Saavedra-Trujillo CH, Mantilla M, Valderrama SL, Alquichire C, Franco-Paredes C. Chagasic encephalitis in HIV patients: common presentation of an evolving epidemiological and clinical association. Lancet Infect Dis. 2009;9(5):324–30.

    Article  CAS  PubMed  Google Scholar 

  129. Lazo J, Meneses AC, Rocha A, Ferreira MS, Marquez JO, Chapadeiro E, et al. Chagasic meningoencephalitis in the immunodeficient. Arq Neuropsiquiatr. 1998;56(1):93–7.

    Article  CAS  PubMed  Google Scholar 

  130. Rocha A, de Meneses AC, da Silva AM, Ferreira MS, Nishioka SA, Burgarelli MK, et al. Pathology of patients with Chagas disease and acquired immunodeficiency syndrome. Am J Trop Med Hyg. 1994;50(3):261–8.

    Article  CAS  PubMed  Google Scholar 

  131. Lazo JE, Meneses AC, Rocha A, Frenkel JK, Marquez JO, Chapadeiro E, et al. Toxoplasmic and chagasic meningoencephalitis in patients with human immunodeficiency virus infection: anatomopathologic and tomographic differential diagnosis. Rev Soc Bras Med Trop. 1998;31(2):163–71.

    Article  CAS  PubMed  Google Scholar 

  132. Strout RG. A method for concentrating hemoflagellates. J Parasitol. 1962;48:100.

    Article  CAS  PubMed  Google Scholar 

  133. Lages-Silva E, Ramirez LE, Silva-Vergara ML, Chiari E. Chagasic meningoencephalitis in a patient with acquired immunodeficiency syndrome: diagnosis, follow-up, and genetic characterization of Trypanosoma cruzi. Clin Infect Dis. 2002;34(1):118–23.

    Article  CAS  PubMed  Google Scholar 

  134. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed 18 Feb 2018.

  135. Castro-Sesquen YE, Gilman RH, Mejia C, Clark DE, Choi J, Reimer-McAtee MJ, et al. Use of a Chagas Urine Nanoparticle Test (Chunap) to correlate with parasitemia levels in T. cruzi/HIV co-infected patients. PLoS Negl Trop Dis. 2016;10(2):e0004407. https://doi.org/10.1371/journal.pntd.0004407.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  136. Cura CI, Lattes R, Nagel C, Gimenez MJ, Blanes M, Calabuig E, et al. Early molecular diagnosis of acute Chagas disease after transplantation with organs from Trypanosoma cruzi-infected donors. Am J Transplant. 2013;13(12):3253–61. https://doi.org/10.1111/ajt.12487.

    Article  CAS  PubMed  Google Scholar 

  137. Simioli F, Sánchez-Cunto M, Velázquez E, Lloveras S, Orduna T. Chagas disease in the central nervous system in patient infected with HIV: diagnostic and therapeutic difficulties. Rev Chil Infectol. 2017;34(1):62–6. https://doi.org/10.4067/S0716-10182017000100009.

    Article  Google Scholar 

  138. Ferreira MS, Nishioka SA, Silvestre MT, Borges AS, Nunes-Araújo FR, Rocha A. Reactivation of Chagas’ disease in patients with AIDS: report of three new cases and review of the literature. Clin Infect Dis. 1997;25(6):1397–400.

    Article  CAS  PubMed  Google Scholar 

  139. Ferreira MS, Nishioka S, Rocha A, Silva AM, Ferreira RG, Olivier W, et al. Acute fatal Trypanosoma cruzi meningoencephalitis in a human immunodeficiency virus-positive hemophiliac patient. Am J Trop Med Hyg. 1991;45(6):723–7.

    Article  CAS  PubMed  Google Scholar 

  140. Solari A, Saavedra H, Sepúlveda C, Oddó D, Acuña G, Labarca J, et al. Successful treatment of Trypanosoma cruzi encephalitis in a patient with hemophilia and AIDS. Clin Infect Dis. 1993;16(2):255–9.

    Article  CAS  PubMed  Google Scholar 

  141. Valerga M, Bases O, Martin M, Papucci T. Multifocal encephalitis in an AIDS patient. Enferm Infecc Microbiol Clin. 2005;23(9):569–70.

    Article  PubMed  Google Scholar 

  142. Panel de expertos de Grupo de Estudio del SIDA. Prevention of opportunistic infections in HIV-infected adolescents and adults guidelines. Recommendations of GESIDA/National AIDS Plan AIDS Study Group (GESIDA) and National AIDS Plan. Enferm Infecc Microbiol Clin. 2008;26(7):437–64.

    Article  Google Scholar 

  143. de Almeida EA, Silva EL, Guariento ME, Aoki FH, Pedro RJ. Aetiological treatment with itraconazole or ketoconazole in individuals with Trypanosoma cruzi/HIV coinfection. Ann Trop Med Parasitol. 2009;103(6):471–6.

    Article  PubMed  CAS  Google Scholar 

  144. Pinazo MJ, Espinosa G, Gállego M, López-Chejade PL, Urbina JA, Gascón J. Successful treatment with posaconazole of a patient with chronic Chagas disease and systemic lupus erythematosus. Am J Trop Med Hyg. 2010;82(4):583–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  145. Corrêa VR, Barbosa FG, Melo Junior CA, D’Albuquerque e Castro LF, Andrade HF Jr, Nascimento N. Uneventful benznidazole treatment of acute Chagas disease during pregnancy: a case report. Rev Soc Bras Med Trop. 2014;47(3):397–400.

    Article  PubMed  Google Scholar 

  146. Bisio M, Altcheh J, Lattner J, Moscatelli G, Fink V, Burgos JM, et al. Benznidazole treatment of chagasic encephalitis in pregnant woman with AIDS. Emerg Infect Dis. 2013;19(9):1490–2.

    Article  PubMed  PubMed Central  Google Scholar 

  147. Seden K, Khoo S, Back D, Prevatt N, Lamorde M, Byakika-Kibwika P, et al. Drug-drug interactions between antiretrovirals and drugs used in the management of neglected tropical diseases: important considerations in the WHO 2020 Roadmap and London Declaration on Neglected Tropical Diseases. AIDS. 2013;27(5):675–86. https://doi.org/10.1097/QAD.0b013e32835ca9b4.

    Article  CAS  PubMed  Google Scholar 

  148. Almeida EA, Silva EL, Guariento ME, Souza ML, Aoki FH, Pedro RJ. Fatal evolution of Chagas’ disease/AIDS co-infection: diagnostic difficulties between myocarditis reactivation and chronic chagasic myocardiopathy. Rev Soc Bras Med Trop. 2009;42(2):199–202.

    Article  PubMed  Google Scholar 

  149. Bern C, Montgomery SP, Herwaldt BL, Rassi A Jr, Marin-Neto JA, Dantas RO, et al. Evaluation and treatment of Chagas disease in the United States: a systematic review. JAMA. 2007;298(18):2171–81.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Instituto Nacional de Parasitología Dr. M Fatala Chaben, Administración de Laboratoriose Institutos de Salud (ANLIS) Dr. CG Malbran [Parasitology Institute–Ministry of Health], Ministerio de Salud, Buenos Aires, Argentina

    Adelina R. Riarte & Marisa L. Fernandez

  2. Centro Municipal de Patología Regional Argentina-Medicina Tropical [Tropical Medicine and Regional Pathology Centre], Hospital de Infecciosas FJ Muñiz [Infectious Diseases Hospital], Buenos Aires, Argentina

    Marisa L. Fernandez

  3. Infectious Diseases Unit, Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina

    Claudia Salgueira & Javier Altclas

  4. Infectious Diseases Unit, Sanatorio Anchorena, Buenos Aires, Argentina

    Claudia Salgueira & Javier Altclas

Authors
  1. Adelina R. Riarte
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marisa L. Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudia Salgueira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Javier Altclas
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños “Ricardo Gutiérrez”, Buenos Aires, Argentina

    Jaime Marcelo Altcheh

  2. Servicio de Parasitología y Enfermedad de Chagas, Hospital de Niños “Ricardo Gutiérrez”, Buenos Aires, Argentina

    Hector Freilij

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Riarte, A.R., Fernandez, M.L., Salgueira, C., Altclas, J. (2019). Chagas Disease in Immunosuppressed Patients. In: Altcheh, J., Freilij, H. (eds) Chagas Disease. Birkhäuser Advances in Infectious Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-00054-7_13

Download citation

Publish with us

Policies and ethics

Search

Navigation