Accidental infection by Trypanosoma cruzi follow-up by the polymerase chain reaction: case report.

We report a case of accidental infection by Trypanosoma cruzi in a 42-year-old female patient who presented an inoculation chagoma. Laboratory confirmation was based on examination of fresh blood, Giemsa-stained blood smear, immunoenzyme test (EIA-IgG), indirect immunofluorescence (IIF-IgM, IgG) and polymerase chain reaction (PCR). Only the PCR gave a positive result, and the EIA test was inconclusive. Two treatments with benznidazole were necessary. PCR was the only technique that continued to give positive results for approximately two months (65 days, or 2.2 months) following the second treatment and negative results from 96 days (3.2 months) to 850 days (28.3 months). We concluded that the presence of an inoculation chagoma and use of PCR were important and decisive for diagnosis and follow-up of the case.

Accidental infection by Trypanosoma cruzi follow-up by the polymerase chain reaction: case report / Infecção acidental pelo Trypanosoma cruzi acompanhada pela reação em cadeia da polimerase: relato de caso

We report a case of accidental infection by Trypanosoma cruzi in a 42-year-old female patient who presented an inoculation chagoma. Laboratory confirmation was based on examination of fresh blood, Giemsa-stained blood smear, immunoenzyme test (EIA-IgG), indirect immunofluorescence (IIF-IgM, IgG) and polymerase chain reaction (PCR). Only the PCR gave a positive result, and the EIA test was inconclusive. Two treatments with benznidazole were necessary. PCR was the only technique that continued to give positive results for approximately two months (65 days, or 2.2 months) following the second treatment and negative results from 96 days (3.2 months) to 850 days (28.3 months). We concluded that the presence of an inoculation chagoma and use of PCR were important and decisive for diagnosis and follow-up of the case.

Reportamos caso de infecção acidental pelo Trypanosoma cruzi em paciente do gênero feminino, 42 anos, que apresentou chagoma de inoculação. A confirmação laboratorial foi realizada pelo exame de sangue a fresco, esfregaço corado com Giemsa, imunoenzimaensaio (ELISA-IgG), imunofluorescência indireta (IFI-IgM, IgG) e reação em cadeia da polimerase (PCR). Somente a PCR foi positiva e a ELISA foi inconclusiva. Dois tratamentos com benznidazol foram necessários. PCR foi a única técnica que permaneceu positiva por aproximadamente dois meses (65 dias ou 2,2 meses) após o segundo tratamento e negativa de 96 dias (3,2 meses) a 850 dias (28,3 meses). Concluimos que a presença do chagoma de inoculação e o uso da PCR foram importantes e decisivos para o diagnóstico e o acompanhamento do caso.

[An entomological case report during the winter months: estimation of the post-mortem interval considering the influence of cold temperatures on the development of the forensically important blowfly Calliphora vomitoria]. / Eine insektenkundliche Fallbetrachtung in den Wintermonaten: Leichenliegezeitbestimmung unter Berücksichtigung des Einflusses niedriger Temperaturen auf die Entwicklung der forensisch wichtigen Schmeissfliege Calliphora vomitoria.

The authors describe a case report with entomological estimation of the post-mortem interval in the winter months. In early December 2007, the body of a suicide was discovered not far from a lake near Bonn in North Rhine-Westphalia four weeks after the man had disappeared from a hospital. The corpse was very well preserved and did not show any signs of advanced putrefaction. The stage of decomposition did not allow a correct estimation of the time since death. Infestation of insect larvae of the species Calliphora vomitoria was detected in the oral cavity as well as in the self-inflicted deep cut to the throat responsible for death. The age of the larvae was determined by considering the specific minimum threshold of the species (minimum temperature necessary for development). To estimate the time until the blowflies detect the body and start to oviposit, the authors ran an experiment with a pig in a comparable environment with similar temperatures. Altogether, these investigations suggested that the man had committed suicide shortly after disappearing from the hospital. Without the entomological evaluation it would have been very difficult to narrow down the post-mortem interval correctly.