Neurochagas: atualização clínica / Neurochagas: clinical update

A doença de Chagas ainda é uma doença tropical muito prevalente no Brasil. Pode apresentar duas fases (aguda e crônica) e exibe grandes repercussões, sobretudo as que envolvem o sistema nervoso periférico e/ou central. Com o aumento do número de pessoas vivendo em estado (transitório ou permanente) de imunossupressão, os casos de manifestações neurológicas por neurochagas aumentaram, e este tornou-se um importante diagnóstico diferencial com outras doenças oportunistas. Este artigo teve como objetivo revisar os principais aspectos clínicos e terapêuticos da doença de Chagas no sistema nervoso central.

Chagas disease is still a very prevalent tropical disease in Brazil. It can have two phases - acute and chronic ­ and shows major repercussions, especially those involving the peripheral and/ or central nervous system. With the increase in the number of people living in the (transient or permanent) state of immunosuppression the cases of neurological manifestations of Chagas disease increased and this became an important differential diagnosis with other opportunistic diseases. This article aimed to review the main clinical and therapeutic aspects of central nervous system Chagas disease

Behavioural alterations are independent of sickness behaviour in chronic experimental Chagas disease

The existence of the nervous form of Chagas disease is a matter of discussion since Carlos Chagas described neurological disorders, learning and behavioural alterations in Trypanosoma cruzi-infected individuals. In most patients, the clinical manifestations of the acute phase, including neurological abnormalities, resolve spontaneously without apparent consequence in the chronic phase of infection. However, chronic Chagas disease patients have behavioural changes such as psychomotor alterations, attention and memory deficits, and depression. In the present study, we tested whether or not behavioural alterations are reproducible in experimental models. We show that C57BL/6 mice chronically infected with the Colombian strain of T. cruzi (150 days post-infection) exhibit behavioural changes as (i) depression in the tail suspension and forced swim tests, (ii) anxiety analysed by elevated plus maze and open field test sand and (iii) motor coordination in the rotarod test. These alterations are neither associated with neuromuscular disorders assessed by the grip strength test nor with sickness behaviour analysed by temperature variation sand weight loss. Therefore, chronically T. cruzi-infected mice replicate behavioural alterations (depression and anxiety) detected in Chagas disease patients opening an opportunity to study the interconnection and the physiopathology of these two biological processes in an infectious scenario.

Neurocisticercose nodular calcificada com sinais de reativação / Nodular calcified neurocysticercosis with signs of reactivation

A neurocisticercose é uma doença caracterizada pelo envolvimento do sistema nervoso central pelo estágio larval intermediário do parasita Taenia solium. O processo de degeneração da larva e a reação inflamatória do organismo causam os sintomas clínicos. Relatamos a reativação clínica e radiológica de uma forma nodular calcificada e assintomática há mais de 20 anos. O tratamento antiparasitário mostrou boa resposta.

Neurocysticercosis is a disease characterized by the involvement of the central nervous system by the intermediate larval stage of the parasite Taenia solium. The larva degeneration process and the inflammatory reaction of the body cause clinical symptoms. The authors report a case of clinical and radiological reactivation of nodular calcified neurocysticercosis in a patient who was asymptomatic for more than 20 years. Antiparasitic treatment showed a good response.

Effects of Acute Chagas'Disease on Mice Central Nervous System

This study has been done to evaluate the central nervous system (CNS) of mice infected with Trypanosoma cruzi and its relationships with the irreversible decrease of motor activity of the rear limbs during acute Chagas´disease. The course of the present study shows the in vivo behaviour of three parasites strains which were isolated from different sources and geographical areas, with the purpose of explaining the parasitemia, mortality rate, clinical, pathological and histopathological changes in the CNS of infected mice. The mice were injected intraperitoneally with 5.103 bloodstreams of different T. cruzi strains. The mice infected with PR and ASM strains from Venezuela, showed low parasitemia and high mortality, while the Y strain produced higher parasitemia levels. At the 30th day post-infection both left parietal brain cortex (LPC) and spinal cord (SC) were sectioned, stained with hematoxilin and eosin (H-E) and examined by means of confocal ligth microscopy. At this time, the pathology of the CNS exhibited focal infiltrates of monocytes, lymphocytes, plasmocytes, polymorphonuclear cells and loss of neuronas and motoneurons. The sections of LPC of infected mice with ASM strain, showed loss neuronal, parasites and abundant T. cruzi antigen deposits in the proximity of the swollen neurons. The sections of SC stained with Enolase-Avidin-Biotin-Peroxidase showed a reduction in the average number of neurons of the cervical region (CR) of the infected mice with PR, ASM and Y strains. Sections stained with Propidium Ioduro (IP) showed a reduction of the number of motoneurons in all regions of the SC, with a significant difference between groups infected with different T. cruzi strains and control uninfected mice (P < 0.05). This study established a correlation between the parasitism in the proximity to inflammatory cells, together the appearance of T. cruzi antigen and neuronal destruction in the brain. Therefore it can be concluded that the changes in CNS may be attributed to early parasitism in nervous tissue, which occur in a few days, involving clinico-pathological manifestations, which produced alterations of the mobility with paralysis of the rear limbs and death in 100% of mice with acute infection produced by PR and ASM-T. cruzi strains from Venezuela.

Neurocisticercose / Neurocysticercosis

Os autores relatam o caso clínico de um paciente de 24 anos de idade, suinocultor, portador de neurocisticercose. O paciente apresentou um episódio de crise convulsiva e sua tomografia computadorizada de crãnio revelou lesões parenquimatosas sugestivas de neurocisticercose nos quatro estágios da doença (vesicular, vesicular coloidal, granular nodular e nodular calcificado). A neurocisticercose é a doença parasitária mais comum do sistema nervoso, sendo também a causa mais comum de crises epilépticas nos países em desenvolvimento, onde a prevalência das crises é duas vezes maior que nos países desenvolvidos.

It has been reported a clinical case of 24 years-old patient, farmer with neurocysticercosis. The patient presented a epileptic seizure and his computed tomography showed intraparenchymal lesions in the four stages of disease. Neurocysticercosis is the most common parasitic disease of the nervous system in humans and the single most common cause of acquired epileptic seizures in the developing world, where prevalence rates of active epilepsy are twice those in developed countries.

Malaria and stroke: case report

Malaria is a parasitic disease with high prevalence in several regions of the world. Infestation by Plasmodium faciparum can, in some cases, affect the central nervous system producing encephalitis resulting in death or neurological sequelae. The mechanisms involved in the pathophysiology of the cerebral lesion are not totally clear and there are currently two theories (mechanical and humoral) concerning this. We report a case of malaria with an atypical evolution, with a stroke lesion in the territory of the middle cerebral artery, with no association with encephalitis. We conclude that the mechanical theory is the one applicable to this patient

Comparación de la reacción inflamatoria causada por el metacestodo de T. solium en músculos y encéfalos de cerdos / Comparison of the inflammatory reaction caused by the metacestode of Taenia solium in brains and muscles of pigs

El objetivo de este estudio fue comparar la reacción inflamatoria que causan los metacestodos de T. solium en tejidos muscular y nervioso de cerdos. Se estudiaron músculos y encéfalos parasitados de cerdos, inoculadoss con huevos de parásito adulto y sacrificados a los 70 y 210 días posinoculación. Los resultados demuestran que las larvas alojadas en el tejido muscular causan una respuesta inflmatoria más severa que las localizadas en el encéfalo. El análisis estadístico Kruskal-Wallis y Quade de los resultados, indican una diferencia altamente significativa (p=3.8 E-0.8) con lesiones más acentudas en el tejido muscular

Evaluación de ELISA y contrainmunoelectroforesis en el diagnóstico de la neurocisticercosis humana en Chile / Evaluation of ELISA and counterimmunoelectrophoresis in human neurocysticercosis diagnosis in Chile

The aim of this work was to assess the diagnostic accuracy for neurocysticercosis of ELISA and counterimmunoelectrophoresis techniques, in sera and cerebrospinal fluid. 208 serum samples (47 coming from patients with confirmed cysticercosis) and 87 cerebrospinal fluid samples (27 coming from patients with confirmed cysticercosis) were analyzed. A crude and standardized extract of swine muscle cysticercus cellulosae was used as antigen. ELISA and counterimmunoelectrophoresis had a 100 percent specificity in cerebrospinal fluid, ELISA had a 85.1 percent sensitivity. Cross reactions were observed in sera of patients with confirmed hydatidosis. Thus, the high specificity of both techniques in cerebrospinal fluid is probably due to the low incidence of cerebral hydatidosis in Chile. It is concluded that for the diagnosis of neurocysteicersosis, antibodies against cysticercus cellulosae must be sought paralelly in serum and cerebrospinal fluid using ELISA and counterimmunoelectrophoresis

Aspectos da neurocisticercose. Tomografia computadorizada e ressonância magnética / Neurocysticercosis: CT-scan and MRI-scan

Neurocisticercose é a principal infestaçäo parasitária do sistema nervoso central. O parênquima cerebral é o local mais acometido, e ocorre na metade dos casos. As imagens obtidas variam de acordo com a fase de infecçäo, desde cistos simples até nódulos calcificados. Säo revistas as imagens obtidas na tomografia computadorizada e na ressonância magnética em dez casos

La prueba de ELISA en el diagnóstico de neurocisticercosis en niños / ELISA test in the diagnosis of neurocysticercosis in children

Se estudiaron 57 pacientes entre uno y 14 años de edad y se dividieron en dos grupos, uno de ellos con sospecha de neurocisticercosis consistente en 37 casos, y un grupo control de 20 pacientes similares en edad y sexo asintomáticos. A los pacientes del grupo control se les tomó muestras de sangre y liquido cefalorraquídeo (L.C.R) para realizar la prueba de ELISA, mientras que el grupo sospechoso se le tomó a todos muestra de suero; pero de L.C.R. sólo aquellos que tuvieran titulaciones iguales o mayores de 1:256. En el grupo control (I), se obtuvieron titulaciones hasta de 1:128 en suero, mientras que 19 fueron negativos en L.C.R. En el grupo sospechoso (II), 25 pacientes tubieron similares tutulaciones al grupo control y 11 las tuvieron superiores. De estos 11, seis fueron positivos en L.C.R. Se demuestra una diferencia significativa (p<0.05) en los dos grupos en lo que respecta a las titulaciones en suero; y se detectan las titulaciones sugestivas de la enfermedad. Se evidencia la baja sensibilidad de la prueba de ELISA para el diagnostico de neurocisticercosis en niños

Historia natural y evolución clínica de la neurocisticercosis / Neurocysticercosis: natural history and clinical evolution

La cisticercosis cerebral constituye un problema sanitario en Guatemala. Desde el advenimiento e introducción de la tomografía computada se ha facilitado el diagnóstico de muchos casos que previamente se diagnoticaron como "síndrome convulsivo idiop tico". Presentamos un total de 33 pacientes con cisticercosis cerebral, comprendido en las edades de 2 a 49 años, quienes fueron observados por períodos de 6 semanas a 6 años. Se encontraron lesiones únicas en 16 pacientes, múltiples en 15 pacientes y edema difuso en 2. Las formas de presentación clínica fueron: síndrome convulsivo en 22 pacientes, síndrome de hipertensión endocraneana en 6 pacientes y par lisis en 3 de ellos. Los pacientes recibieron tratamiento sintom tico con anticonvulsivantes y/o esteroides, así como analgésicos, logr ndose una resolución clínica y radiológica en 33 y 30 pacientes respectivamente. En ninguno de los casos se utilizó Praziquantel u otro antiparasitario como tratamiento. El pronóstico de la enfermedaad es generalmente bueno, ya que la neurocisticercosis es un proceso clínico autolimitado en la mayoría de los casos. (Rev. Me Intern 1991, 2:3-6. La teniasis es causada por la presencia de Taenia solium en el intestino humano. La Cisticercosis es causada por el estado larvario en el tejido humano. La Taenia solium est distribuída ampliamente en diversas regiones del mundo. En los países occidentales altamente desarrollados la infestación es rara, aunque a principios de siglo era endémica en muchas de estas regiones del mundo. En Berlín, por ejemplo en la época de Rudolph Virchow era un hallazgo común de necropsia (2/100 del total de necropsias) (1,2,3) (Rev Med Inter 1991; 2:3-6)

Pathological findings in four cases of human angiostrongyliasis.

Three adults and a 3 1/2-year-old child presented with eosinophilic meningitis. A history of consumption of raw snails was elicited in 2; evidence of a constant diet of raw food, in the form of opisthorchiasis and taeniasis, as well as angiostrongyliasis, was present in the third; no history of raw food ingestion was obtained in the fourth, the child. Pathologic changes were similar in all 4 cases. There was infiltration of the meninges and around intracerebral vessels by varying proportions of lymphocytes, plasma cells and eosinophils. Numerous tracks and microcavities were found in the brains, and in the spinal cords in 2 cases, varying in size from 0.1 to 2 mm, and in age, with older tracks containing debris and gitter cells, newer tracks showing disruption of brain tissue, with and without haemorrhage. Numerous 4th and 5th stage Angiostrongylus larvae, alive and dead, were found in the meninges and brain tissue, sometimes in blood vessels or perivascular spaces, in 3 cases; in the fourth case a 5th stage larva was found on the surface of the right frontal lobe. In one case a degenerating larva was found in a pulmonary vessel. Cellular reaction was more often associated with dead larvae.