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Reactivation of Chagas Disease in the Central Nervous System Among Heart Transplant Recipients: A Clinical Series
Jacqueline Ferreira de Oliveira1, Ana Luiza Barbosa1, Gláucia Cota1
1Division of Internal Medicine, Transplant Infectious Diseases Service, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Insights
Neurological reactivation of Chagas disease (Trypanosoma cruzi) is a rare but severe complication after heart transplantation. Early diagnosis and consideration are crucial for at-risk patients.
Area of Science:
- Infectious Diseases
- Transplantation Immunology
- Neurology
Background:
- Chagas disease necessitates heart transplantation in endemic regions.
- Post-transplant reactivation of Trypanosoma cruzi poses a significant concern.
- Central nervous system (CNS) involvement requires further investigation.
Purpose of the Study:
- To determine the prevalence of neurological reactivation of Chagas disease post-heart transplant.
- To characterize clinical features and outcomes of CNS Trypanosoma cruzi reactivation.
- To evaluate diagnostic methods for CNS T. cruzi infection.
Main Methods:
- Retrospective analysis of heart transplant recipients for Chagas disease (2006-2023).
- Review of clinical data, neurological events, and diagnostic findings.
- Correlation of diagnostic methods with confirmed CNS T. cruzi reactivation.
Main Results:
- 11 neurological reactivation episodes in 9/187 recipients, median 160 days post-transplant.
- Focal neurological deficits and white matter lesions were common.
- Brain biopsy and CSF PCR showed diagnostic utility; blood tests and direct examination were less sensitive.
Conclusions:
- Neurological Chagas reactivation is a rare, severe post-transplant complication.
- Consideration of CNS T. cruzi reactivation is vital for at-risk heart recipients.
- Prompt diagnosis and management are essential for improved outcomes.
Background:
Chagas disease is a relevant cause of heart transplantation. The risk of reactivation is a potential concern. This study aimed to describe the reactivation of Trypanosoma cruzi in the central nervous system (CNS).
Methods:
We performed a retrospective study of all heart transplants for Chagas disease undertaken between 2006 and 2023 at a single institution in Brazil to define the prevalence of neurological reactivation and reviewed clinical characteristics and outcomes associated with CNS T. cruzi involvement.
Results:
Among 187 Chagas disease recipients, 11 episodes of neurologic reactivation were identified in nine patients, at a median of 160 days after transplant. Two patients had a relapse more than a year after the first episode. Three patients died and the remaining six had neurological sequelae. Of the 11 episodes of CNS reactivation, eight were confirmed based on finding T. cruzi parasites or DNA in cerebrospinal fluid or brain tissue biopsy, the remaining three episodes were considered probable by demonstrating parasites in blood and other tissues. Focal neurological manifestations (8 of 11 episodes) and a single lesion with the predominant involvement of white matter (6 of 11 episodes) were the most common features. Brain biopsy was the gold standard tool, detecting five of seven CNS reactivation. T. cruzi PCR in cerebrospinal fluid confirmed two of three cases, and direct examination has a low diagnostic yield, detecting only one of six episodes.
Conclusion:
Neurological Chagas reactivation is a rare and severe posttransplant complication that should be considered in any at-risk heart recipient.
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