Three new cases of reactivation of Chagas' disease in patients with AI
DS, with central nervous system and/or cardiac involvement, are report
ed. One patient had histological evidence of acute esophageal and gast
ric Trypanosoma cruzi myositis, a previously unrecognized finding in p
atients with reactivated Chagas' disease. The patients had a low CD4 l
ymphocyte count and had other AIDS-defining opportunistic infections.
One patient's condition improved with benznidazole therapy. Analysis o
f these three cases and review of the 13 others published in the liter
ature revealed that the central nervous system is the most commonly in
volved site (75%), followed by the heart (44%). Early diagnosis and tr
eatment with benznidazole or nifurtimox probably improve the survival
rate. Long-term secondary prophylaxis should be recommended for patien
ts who respond to therapy, although it is uncertain which drug to use
for this purpose. T. cruzi should be included in the list of opportuni
stic pathogens causing infection in severely immunocompromised patient
s with AIDS.