Table 1.

Published Reports of Trypanosoma cruzi Reactivation in People With HIV in the United States

Location of Admission	Country of Origin	Clinical Presentation	CD4+ Cell Count, cells/mm3	Imaging	Outcome	Reference
Los Angeles	El Salvador	33-year-old man presented 3 months after initial HIV diagnosis with fever, hemiparesis, and papilledema; brain biopsy interpreted as histoplasmosis	45	Irregular contrast enhancing left temporal lesion on CT	Died 14 days post-admission; postmortem T. cruzi diagnosis	Gluckstein, 1992 [18]
Los Angeles	El Salvador	22-year-old man with headaches, epistaxis, and new HIV diagnosis; improvement and disappearance of basal lesions with treatment for toxoplasmosis; 3 weeks later presented with ataxia, spastic hemiparesis, and new CNS lesions on MRI; T. cruzi on CSF	77	Abnormal high- intensity signal in posterior limb of left internal capsule on diffusion-weighted MRI	Died despite treatment with nifurtimox	Yoo, 2004 [23]
North Carolina	Mexico	56-year-old man with progressive paraparesis, urinary retention and new HIV diagnosis; treated for presumed CNS toxoplasmosis without response; T. cruzi on brain biopsy	37	Multiple enhancing lesions; worsened with new lesions 10 days later	Died despite treatment with nifurtimox	Lambert, 2006 [20]
Houston	Honduras	38-year-old woman with 10-day history of right-sided hemiparesis and headache, and new HIV diagnosis; initially diagnosed as toxoplasmosis; T. cruzi on brain biopsy	104	Multiple enhancing lesions on MRI	After several days of nifurtimox, ART was added; 4 days later mental status deteriorated, and required intubation; developed sepsis, worsening brain lesions; died on day 54	Campos, 2010
Houston	Honduras	49-year-old woman with 3-week history of altered mental status, headache, and hemiparesis; initially treated for toxoplasmosis at another hospital and discharged; admitted for worsening mental status; T. cruzi in CSF and review of brain biopsy (initially read as toxoplasmosis)	38	Ring-enhancing lesions in right superior gyrus and left parietal lobe	Treated with benznidazole followed 17 days later by addition of ART; alive 5 months later, clinically stable with residual hemiparesis and CD4 >350 cells/mm3	Yasukawa, 2014 [21]
Palo Alto	El Salvador	31-year-old man with fever, ataxia, and recent HIV diagnosis; T. cruzi on brain aspirate	60	Large mass in corpus callosum, right parietal and occipital lobes	Improved mentation and gait after 2 weeks of benznidazole and ART; no information on long-term outcome	Gomez, 2018 [19]

Abbreviations: ART, antiretroviral therapy; CNS, central nervous system; CSF, cerebrospinal fluid; CT, computed tomography; HIV, human immunodeficiency virus; MRI, magnetic resonance imaging.