a 33-year - old woman , who had been infected with hiv for 11 years , started receiving lamivudine , zidovudine , and nevirapine at week 26 of pregnancy . at that time , cd4 cell count was 18 cells / ml . she had begun receiving haart 1 year before pregnancy but abandoned treatment after a few months . her compliance with treatment , laboratory tests , and follow - up was poor . at week 32 of pregnancy , she was admitted to the hospital with clinical manifestations of intracranial hypertension and meningoencephalitis ( temporospatial disorientation , slurred speech , nausea and vomiting , and hemiparesis ) . results of serologic tests were negative for toxoplasma gondii , treponema pallidum , and hepatitis b and c viruses but positive for t. cruzi . pcr targeted to t. cruzi kinetoplast dna was positive , and quantitative pcr ( qpcr ) targeted to satellite t. cruzi dna yielded 308.9 parasite equivalents / ml of blood ( 13 ) . the parasite genotype ( discrete typing unit ) detected by pcr strategies was identified as tcv ( 14 ) . most probably , this patient acquired the infection by the vector - borne route in a highly disease - endemic province in argentina where she had lived as a child . diagnosis , treatment , and prophylaxis monitoring of trypanosoma cruzi infection in a pregnant woman and her daughter . the mother , who had chagasic encephalitis and aids , was treated with benznidazole ( bz ) . results of elisa were considered positive when r was > 1.2 ) ; results of iha were considered positive when titers were > 16 . po , positive ; ng , negative ; nd , not determined ; iha , indirect hemagglutination assay ; kdna - pcr , kinetoplast dna - pcr ; qpcr , quantitative pcr ( dynamic range of detection : 1105 parasite equivalents / ml , amplification efficiency 0.95 , r2 = 0.996 ) ; par / ml , parasite equivalents / ml of blood ; nq , positive but not quantifiable ; mri , magnetic resonance imaging ; gwk , gestational week ; pd , postdelivery ; tmt , bz treatment ( 5 mg / kg / d ) ; haart , highly active antiretroviral therapy ; ppx , bz prophylaxis ( 5 mg / kg/3 per week ) . although data on benznidazole use in pregnancy are lacking , after an in - depth discussion of potential risks and benefits of the treatment , we concluded that , because of her severe clinical condition , treatment with benznidazole could be beneficial . within 48 hours of the diagnosis , she received benznidazole ( 5 mg / kg / day , for 84 days ) without side effects . parasitic loads , determined by qpcr , dropped rapidly ( figure ) . during treatment , results of the microhematocrit , pcr , and anti  t . magnetic resonance images showed substantial reduction of edema and the mass and reconstitution of the interventricular line without evidence of ventricular dilatation ( figure ) . seven weeks after treatment initiation , cerebrospinal fluid was negative for t. cruzi by serologic testing , microhematocrit , and pcr . at week 36 of gestation , the patient gave birth to a girl by elective cesarean section . the baby s birthweight was low for gestational age ( 1,700 g , < 3rd percentile ) , and her apgar score was 7/8 . this lack of infection was confirmed by means of serologic testing at 1 year of age , per current chagas disease guidelines ( 12 ) . moreover , results of pcr for hiv and p24 antigen tests were negative in 2 different samples , enabling perinatal infection with hiv to be ruled out . after delivery , the mother continued to receive haart with benznidazole prophylaxis ( 5 mg / kg / day 3/week ) for 6 months . a follow - up computed tomographic scan performed 14 months after delivery showed a favorable response . moreover , serologic , parasitologic , and molecular studies remained negative for t. cruzi ( figure ) . to date , the patient continues to show erratic compliance with follow - up . as a consequence benznidazole is traditionally considered contraindicated in pregnancy because data that support its safety to the fetus are lacking ( 8) . nevertheless , because of the severe clinical picture of the patient , and the known lower risks of fetal toxicity in the second and third trimesters of pregnancy ( 6 ) , treatment was administered on a compassionate basis . among patients who have aids and chagas disease reactivation with cns involvement ( 2 ) reported a mortality rate of 79% in a cohort of 15 patients with co - infection , with a median time of survival of 21 days after hospitalization . however , the researchers associated this high mortality rate with delayed diagnosis , because it took a median of 18 days to recognize the condition . in the patient reported here , the short interval ( 72 hours ) between admission and initiation of benznidazole treatment may have improved the chances of a successful outcome . moreover , to our knowledge , the patient in this case has longest reported survival time after diagnosis of chagasic reactivation caused by hiv co - infection , with 7 years of follow - up ( 15 ) . microhematocrit and pcr successfully demonstrated the presence and elimination of t. cruzi , and qpcr enabled the decrease in parasitic load to be monitored . t. cruzi tcv detected in peripheral blood was described as prevalent in the population from the southern cone ( 14 ) . notably , negative serologic results were achieved early after treatment , which is only usually seen in immunocompetent patients at the acute phase of disease or in recent congenital infections . the continued seronegative results when her immune system presumably was reconstituted suggests strongly that she had an actual parasitologic cure . moreover , the baby s weight at birth was low for gestational age . various reasons could explain the low birthweight , including the infectious status of the mother or the severe stress she was experiencing at the time of admission . also , a potential effect of benznidazole for the baby can not be fully ruled out . nonetheless , the benefit to both mother and child clearly outweighed the risk . this case illustrates that parasiticidal treatment may decrease parasitic load and prevent vertical transmission of t. cruzi , even in co - infected patients among whom a higher incidence of congenital infection and illness of newborns is observed ( 10 ) . this result reinforces the idea that benznidazole has a role in the prevention of congenital transmission of chagas disease .
we report a case of chagasic meningoencephalitis reactivation in a pregnant woman co - infected with trypanosoma cruzi and hiv that was successfully managed with benznidazole and highly active antiretroviral therapy . 
 early diagnosis enabled rapid specific treatment that improved the health of the patient and her baby .