The majority of these have occurred in Brazil and Argentina. Cerebrospinal fluid exhibits a light pleocytosis with an increase in the number of lymphocytes and monocytes and raised protein levels. Computerized tomography and magnetic resonance show the presence of lesions generally located between the cortex and white matter. Frequently they have the shape of a ring - enhancing lesion or a dense nodule after contrast injection. An inflammatory infiltration is histologically observed in the presence of numerous T. cruzi amastigotes infecting the glial cells and rarely neurons.
Immunohistochemical techniques are fundamental to confirm the parasite's identity.
Arrhythmias and heart failure may occur due to myocardial involvement. Endocavitary biopsy, when available, may confirm the diagnosis. Direct detection of the parasite in the blood, pericardial fluid blood cultures and biopsies of infected tissues are the main ways to confirm diagnosis. Benznidazol and nifurtimox are both effective in the treatment of disease reactivation in the immunosuppressed. Side effects are common, especially dermatitis, agranulocytosis and peripheral neuropathy.