Two cases of mother-to-child transmission of HIV and Trypanosoma cruzi in Argentina.

Since numerous tropical pathogens lead to opportunistic infections in the context of the human immunodeficiency virus (HIV), coinfection could have significant effects on the course of HIV infection. 1 In this article we report two cases coinfected with HIV and Trypanosoma cruzi presenting unfavorable evolution despite correct treatment. Both patients were infected with both pathogens by mother-to-child transmission (MTCT) route, and both died due to a Klebsiella pneumoniae sepsis. Case 1: Child 1 was admitted to the Central Children's Hospital in La Plata at age 1 month with respiratory difficulty and diarrhea. The patient was a preterm newborn with good weight for the gestational age, with no prenatal care. Both parents were illiterate, and were living with HIV for a year but without treatment, including during pregnancy. The father was an intravenous drug abuser, and had been incarcerated; a 2-year-old brother was HIV-negative but an elder sister had died of HIV/acquired immunodeficiency syndrome (AIDS). Chagas infection in the mother was probably congenital, since her mother emigrated from a high endemic zone. The child presented severe malnutrition and congenital heart disease (interventricular communication). The child started with shortness of breath and diarrhea with a 48-hour evolution, and also presented bilateral inguinal and cervical micropoliadenopaty, splenomegaly, thrush, hypoxemia, and opisthotonus position. Disturbances in the cerebrospinal fluid cell count became apparent and Streptococcus pneumoniae was cultivated. Therefore, the patient was received ceftriaxone at appropriate doses for meningitis treatment for ten days, and an erythrocyte transfusion was performed. Vaccination with DPT-HB-Hib and Salk was indicated. During hospitalization, he presented two episodes of seizures related with fever. Serologies for several pathogens were performed, and antibodies for T. cruzi, Toxoplasma gondii, Epstein-Barr virus (EBV), and HIV were detected. HIV infection was confirmed by polymerase chain reaction (PCR), and T. cruzi infection, by Microstrout (both infections were confirmed in at least two separate samples). Electroencephalography (EEG) and cerebral computed tomography (CT) were abnormal, with muscular hypertonia and opisthostonus, both bilateral clonus and positive Babinsky. The symptoms were interpreted as brain damage due to pneumococcocal meningoencephalitis. At the age of six months, he was released after 155 days in hospital. Then, at the age of 22 months, he presented with diarrhea and sepsis by K. pneumoniae with secondary dehydration. The patient died ten days later; he had been treated with zidovudine since delivery and for two months with combined HAART (lamivudine, stavudine, nelfinavir) and benzonidazol. Three resistance tests …