Neurological Symptoms in Chagas' Disease

Chagas' disease may cause neurological symptoms in both the acute and chronic phases.

In acute Chagas' infections, there may be clinically silent meningoencephalitis. There is perivascular inflammation, causing microglial proliferation, with lymphocytes, plasma cells, and parasitized cells. There is often leptomeningitis, with mononuclear cells. The inflammatory foci may destroy the ependymal epithelium and be subependymal. Siimilar inflammatory foci occur in the spinal cord.

In the chronic phase, the neurological abnormalities are probably the result of the meningeal thickening and gyral adhesions which follow the acute meningoencephalitis. However, in immunocompromised patients, reactivation of Chagas' disease may occur: the meningoencephalitis is then more severe and more diffuse, and can be fatal, There are more pseudocysts associated with necrotic, hemorrhagic foci. When the immunosuppression is due to AIDS, tumor-like lesions have developed; these are the result of wide areas of necrosis and hemorrhage, with an inflammatory reation and parasitized glial cells (Fig. 4.40). (There may also be reactivation of the myocarditis).