Reactivation of Chagas disease in a heart transplant patient infected by sylvatic <i>Trypanosoma cruzi</i> discrete typing unit I

Inga, Leydi Alexandra Ceballos; Olivera, Mario Javier

doi:10.1590/0037-8682-0512-2018

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Revista da Sociedade Brasileira de Medicina Tropical

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Case Report • Rev. Soc. Bras. Med. Trop. 52 • 2019 • https://doi.org/10.1590/0037-8682-0512-2018 copy

Reactivation of Chagas disease in a heart transplant patient infected by sylvatic Trypanosoma cruzi discrete typing unit I

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Heart transplantation is an effective treatment for Chagas disease patients with severe cardiomyopathy. However, Trypanosoma cruzi reactivation is of great concern. The T. cruzi parasite is classified into six discrete typing units (DTUs identified as TcI-TcVI). It is unknown whether there is an association between T. cruzi genetic lineages and the different clinical manifestations of the disease. We report the case of a 51-year-old man who received a heart transplantation and presented with a reactivation of the disease. The molecular characterization of the parasite showed that the reactivation was related to specific infection by a DTU I (TcI_SYL) parasite.

Keywords:
Chagas disease; Organ transplantation; Reactivation

Date	qPCR		ELISA			IFA
(d/m/y)	Result	Parasite load	Result	Absorbance	Index	Result	Titer
09/10/2012	Negative	-	Positive	0.924	3.14	Reactive	1024
16/10/2012	Heart transplantation
25/02/2013	Positive	16 parasite equivalents/mL	Positive	1.545	5.15	Reactive	1024
25/03/2013	Positive	36.2 parasite equivalents/mL	Positive	2.379	7.93	Reactive	2048
24/04/2013	Negative	-	Positive	2.785	9.28	Reactive	2048
23/05/2013	Negative	-	Positive	2.134	7.11	Reactive	1024
20/05/2014	Negative	-	Positive	2.003	6.68	Reactive	1024
21/06/2015	Negative	-	Positive	1.981	6.6	Reactive	1024
14/06/2016	Negative	-	Positive	1.433	4.78	Reactive	1024
27/04/2017	Negative	-	Positive	1.428	4.76	Reactive	1024
18/06/2018	Negative	-	Positive	1.420	4.70	Reactive	1024

Time after transplantation	Frequency
Day 0 - day 60	Once a week
Day 61 - day 180	Every eight weeks
Day 181 and later	Annually

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[1] Corresponding author: Dr. Mario Javier Olivera. e-mail:moliverajr@gmail.com