Chagas disease differentiating chagas disease from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Chagas disease must be differentiated from other diseases the cause cardiomyopathy, hepatosplenomegaly, or esophageal/colonic dysfunction, such as electrophysiological cardiac diseases, GI hypomotility disorders, and malignancies.

Differentiating Chagas disease from other Diseases

Chagas disease should be differentiated from the following diseases:

Disease Differentiating signs and symptoms Differentiating tests
CNS lymphoma
  • Single solitary ring enhacning lesion on CT or MRI
Disseminated tuberculosis
Aspergillosis
  • CSF fungal culture, galactomannan.
Cryptococcosis
Chagas disease
  • History of residence in Central and South America
  • Acute infection is rarely symptomatic,
  • Encephalitis or focal brain lesions
  • Myocarditis
  • Chronic infections in immunocompromised patients develops into encephalitis with necrotic brain lesions causing mass effect.
  • Trypanosoma cruzi in blood, tissue or CSF, PCR of tissue or body fluids, serologic tests.
CMV infection
  • Brain CT/MRI/biopsy: location of lesions are usually near the brain stem or periventricular areas.
  • PCR of CSF with detectable virus is diagnostic.
  • Brain biopsy with + staining for CMV or evidence of owl's eyes is also diagnostic, but it is rarely performed, because of the location of brain lesions.
HSV infection
  • Seizures, headache, confusion and/or urinary retention can be seen in disseminated disease, which usually affects only immunocompromised or acute infections
  • In pregnant women it may be associated with concurrent genital/oral lesions; can be spread to the neonate during acute infection in the mother, or via viral shedding in the birth canal.
  • Neonatal HSV can range from localized skin infections to encephalitis, pneumonitis, and disseminated disease.
  • Brain CT/MRI/biopsy: location of lesions is usually the medial temporal lobe or the orbital surface of the frontal lobe.
  • PCR of CSF with detectable virus is diagnostic.
Varicella Zoster infection
  • Multifocal involvement has subacute course, usually only in immunosuppressed, with headache, fever, focal deficits, and seizures.
  • Unifocal involvement is more typically seen in immunocompetent hosts, occurring after contralateral cranial nerve herpes zoster, with mental status changes, TIAs, and stroke.
  • Disseminated varicella zoster virus can occur in adults during primary infection, presenting with pneumonitis and/or hepatitis.
  • Disease is a vasculopathy, with hemorrhage and stroke.
  • PCR of CSF with detectable virus is diagnostic.
Brain abscess
  • Associated with sinusitis (abutting the sinuses) or with bacteremia.
  • Signs and symptoms includes fever and necrotizing brain lesions with mass effect
  • CSF culture or culture of brain abscess.
Progressive multifocal leukoencephalopathy
  • Symptoms are often more insidious in onset and progress over months. Symptoms include progressive weakness, poor coordination, with gradual slowing of mental function. Only seen in the immunosuppressed. Rarely associated with fever or other systemic symptoms.
  • PCR of CSF for JC virus.
  • Biopsy reveals white matter lesions and not well-circumscribed lesions.

References

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