ABSTRACT
El absceso cerebral es una infrecuente y fatal complicación extraintestinal de la infección por E. histolytica. Presentamos el caso de un paciente que falleció por múltiples abscesos cerebelosos asociados con absceso hepático amebiano. Caso clínico: Se trata de paciente masculino, 62 años, proveniente del área metropolitana. Consulta por presentar dolor abdominal en hipocondrio derecho, nauseas, vómitos, fiebre y evacuaciones líquidas. Se diagnosticó absceso hepático de 12 x 8 cm de diámetro, por ultrasonido abdominal, correlacionado con la clínica y hallazgos de laboratorio (leucocitosis, elevación de transaminasas y fosfatasas alcalinas). Adicionalmente, el ELISA indirecto para determinar IgG para E. histolytica resultó positivo. La biopsia guiada por ultrasonido sugiere absceso hepático. Recibió tratamiento con metronidazol y ciprofloxacina por 10 días presentando mejoría clínica y de laboratorio. Sin embargo, consulta nuevamente con reaparición de los síntomas, pero se agrega cefalea occipital de fuerte intensidad. Al examen físico de reingreso se encuentran cifras tensiónales de 157/122 mmHg, refractarias al tratamiento, así como hallazgos de déficit neurológico sugestivos de síndrome cerebeloso. Se realizó tomografía de cráneo donde se evidencian múltiples imágenes hipodensas en probable relación con abscesos. Se planteó drenaje quirúrgico, sin embargo el paciente, falleció a las pocas horas.
Brain abscess are a rare and fatal complication of infection with extraintestinal E. histolytica. We present a patient who died of multiple cerebellar abscesses associated with amebic liver abscess. Clinical case: male, 62 years old, from the metropolitan area. Who came in 4 weeks before his death due to abdominal pain in the right hypochondrium, nausea, vomiting, fever and diarrhea. Liver abscess were diagnosed in 12 x 8 cm diameter, by abdominal ultrasound, correlated with clinical and laboratory findings (leukocytosis, high transaminases and alkaline phosphatases). Additionally, the indirect ELISA to determine IgG to E. histolytica was positive. Biopsy guided by ultrasound is concluded as abscess. The patient received treatment with metronidazole and ciprofloxacin for 10 days showing improvement. However, checked again with recurrence of symptoms, but adds strong occipital headache intensity. Initial physical examination re-found the blood pressure 157/122 mmHg, refractory to treatment, and findings of neurological deficits suggestive of cerebellar syndrome. Cranial tomography was performed which showed multiple hypodense images in connection with probable abscess. Surgical drainage was raised; however the patient evolved torpidly and died within hours.
ABSTRACT
We have previously confirmed the presence of common antigens between Schistosoma mansoni and its vector, Biomphalaria glabrata. Cross-reactive antigens may be important as possible candidates for vaccine and diagnosis of schistosomiasis. Sera from outbred mice immunized with a soluble Biomphalaria glabrata antigen (SBgA) of non-infected B. glabrata snails recognized molecules of SBgA itself and S. mansoni AWA by Western blot. Recognition of several molecules of the SBgA were inhibited by pre-incubation with AWA (16, 30, 36, 60 and 155 kDa). The only specific molecule of AWA, inhibited by SBgA, was a 120 kDa protein. In order to determine which epitopes of SBgA were glycoproteins, the antigen was treated with sodium metaperiodate and compared with non-treated antigen. Molecules of 140, 60 and 24 kDa in the SBgA appear to be glycoproteins. Possible protective effects of the SBgA were evaluated immunizing outbred mice in two different experiments using Freund's Adjuvant. In the first one (12 mice/group), we obtained a significant level of protection (46 percent) in the total worm load, with a high variability in worm recovery. In the second experiment (22 mice/group), no significant protection was observed, neither in worm load nor in egg production per female. Our results suggest that SBgA constitutes a rich source of candidate antigens for diagnosis and prophylactic studies