Version July 2025
| Clinical scenario | HIV-T. cruzi co-infection | Organ donor-derived CD | Transplant recipients with pre-existing CD | CD patients with other causes of immunosuppression |
| CD phase | Chronic | Acute | Chronic | Chronic |
| Etiology of immunosuppression | HIV | Anti-rejection regimen | Anti-rejection regimen | Chemotherapy for neoplasm and immunosuppressives for rheumatologic diseases |
| Degree of immunosuppression | Progressive in the absence of effective ART | Dependent on regimen intensity and duration | Dependent on regimen; increased risk during anti-rejection pulses | Dependent on regimen; steroids alone not associated with documented reactivation risk |
| Diagnosis | Microscopy in blood, CSF, other fluids, PCR in CSF, and tissue PCR/histology | PCR, microscopy in blood, other fluids, and tissue PCR/histology (eg, EMB) | Rising parasite loads by quantitative PCR (qPCR) in blood, blood microscopy, and tissue histology (eg, EMB, skin) | Rising parasite loads by qPCR in blood, blood microscopy, and tissue PCR/histology |
| Signs/symptoms | Most frequent in CNS; myocarditis is second in frequency | Fever, myocarditis, and CNS infrequent | Fever, myocarditis, skin lesions, panniculitis, and CNS infrequent | Fever, skin lesions, and CNS |
| Management | ART and antiparasitic treatment | Antiparasitic treatment | Antiparasitic treatment and lighten antirejection regimen if possible | Antiparasitic treatment and lighten immunosuppression if possible |
| Primary prevention | N/A | Donor screening prior to transplant | N/A | N/A |
| Secondary prevention | CD screening during care for at-risk PWH | Post-transplant recipient monitoring | Recipient screening prior to transplant and post-transplant monitoring | CD screening prior to initiation of immunosuppression |
