Neurocisticercosis infantil. A propósito de un caso / Infantile neurocysticercosis. About a case

La neurocisticercosis es una de las infecciones parasitarias más frecuentes, originada por la larva de la Taenia solium al invadir el sistema nervioso central. Esta patología es endémica de algunos países de África, y está relacionada con hábitos dietéticos, costumbres, higiene y factores socioeconómicos, con mayor incidencia en pacientes escolares y adolescentes, aunque puede presentarse a cualquier edad. Su clínica es variable, unida a criterios epidemiológicos que hacen indispensable al médico de asistencia realizar examen clínico y estudios imagenológicos. Se presenta el caso clínico de una niña de 10 años de edad procedente de Kuito-Bie, Angola, que acude a consulta de neurología, con pérdida de la visión de aproximadamente seis meses de evolución, disminución de la fuerza muscular, episodios de alucinaciones, lenguaje incoherente y convulsiones tónico-clónicas generalizadas de siete días de evolución. Se solicita, de urgencia, una tomografía axial computarizada de cráneo, donde se confirma neurocisticercosis activa, con epilepsia sintomática en el curso de la misma. Los hallazgos clínicos e imagenológicos permiten un diagnóstico oportuno y tratamiento eficaz, lo que determina la evolución clínica de la neurocisticercosis en la infancia, según el estadio clínico y la respuesta inmunológica del huésped(AU)

Neurocysticercosis is one of the most frequent parasitic infections caused by the larva of Taenia solium when invading the central nervous system. This pathology is endemic to some African countries, and is related to dietary habits, customs, hygiene and socioeconomic factors, with a higher incidence in school patients and adolescents, although it can occur at any age. Its clinical symptoms are variable, linked to epidemiological criteria that make it essential for the attending physician to perform a clinical examination and imaging studies It is presented the clinical case of a 10-year-old girl from Kuito-Bie, Angola, who attended the neurology clinic with vision loss of approximately 6 months of evolution, decreased muscle strength, episodes of hallucinations, incoherent speech, and generalized tonic-clonic seizures of 7 days of evolution. An emergency computed axial tomography of the skull was requested, where active neurocysticercosis is confirmed, with symptomatic epilepsy in its course. Clinical and imaging findings allow timely diagnosis and effective treatment, which determines the clinical evolution of neurocysticercosis in childhood, depending on the clinical stage and the host's immune response(AU)

Neurocisticercosis y epilepsia en un hospital universitario de Popayán, Colombia: una serie de casos / Neurocysticercosis and epilepsy in a university hospital in Popayán, Colombia: A case series

RESUMEN INTRODUCCIÓN: La neurocisticercosis es una infección del sistema nervioso central causada por el estadio larvario del cestodo Taenia solium, y se estima que puede ocasionar hasta 30% de los casos de epilepsia en los países donde esta parasitosis es endémica. El objetivo de este estudio fue determinar la frecuencia de pacientes que presentaron epilepsia como secuela de neurocisticercosis en un hospital universitario en Popayán. MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo con todos los pacientes con diagnóstico de neurocisticercosis que ingresaron al Hospital Universitario San José entre enero 2014 y diciembre 2018 que cumplieron los criterios de inclusión. RESULTADOS: Se encontraron 50 pacientes, de estos, 40 (80%) reingresaron, encontrándose que 37 (74%) presentaron epilepsia como secuela. Las edades más afectadas fueron la de 41 a 60 años; 48 (96%) provenían del departamento del Cauca en especial de Mercaderes, y 33 (66%) de área rural. El síndrome convulsivo fue la manifestación clínica de ingreso más frecuente. La TAC fue la técnica de imagen de elección. CONCLUSIÓN: El departamento del Cauca se considera como una de las áreas endémicas para neurocisticercosis en Colombia, y la epilepsia secundaria es un secuela común.

ABSTRACT INTRODUCTION: Neurocysticercosis is an infection of the central nervous system caused by the larval stage of the cestode Taenia solium, it has been estimated to produce up to 30% of the cases in countries where this parasitosis is endemic. The objective of this study was to determine the frequency of patients who presented epilepsy as a sequel of neurocysticercosis in a university hospital in Popayán. MATERIALS AND METHODS: A retrospective study was conducted with all patients with a diagnosis of neurocysticercosis who were admitted to the Hospital Universitario San José between January 2014 and December 2018 who met the inclusion criteria. RESULTS: We found 50 patients, 40 (80%) of which were readmitted and 37 (74%) presented epilepsy as sequela. The most affected age-group was 41 to 60 years; 48 (96%) were from the department of Cauca, especially Mercaderes, and 33 (66%) from rural areas. Convulsive syndrome was the most frequent clinical manifestation on admission. CT was the imaging technique of choice. CONCLUSION: The department of Cauca is considered as an endemic area for neurocysticercosis, and secondary epilepsy was a common consequence.

Mielopatía dorsal aguda como presentación atípica de una neurocisticercosis espinal / Acute dorsal myelopathy as an atypical presentation of spinal neurocysticercosis

La neurocisticercosis espinal es una enfermedad infecciosa poco frecuente. Su presentación puede ser extraespinal o intraespinal y la mayoría de casos es de evolución subaguda o crónica. Se presenta el caso de una paciente mujer de 55 años, natural y procedente de Lima, Perú, con cuadro clínico de una paraparesia aguda secundaria a una mielopatía dorsal por lesiones quísticas de cisticercosis espinal. La paciente recibió tratamiento médico y quirúrgico con una evolución clínica y de imágenes favorable. Es importante considerar en nuestro contexto epidemiológico, la cisticercosis espinal como diagnóstico diferencial, ante un cuadro clínico de mielopatía aguda, ya que el adecuado enfoque diagnóstico y tratamiento oportuno de esta rara entidad pueden mejorar el pronóstico de los pacientes.

Spinal neurocysticercosis is an infectious and rare disease. Its presentation can be extraspinal or intraspinal and most cases are of subacute or chronic evolution. We report the case of a 55-year-old female patient from Lima, Peru with a 2-day history of acute paraparesis secondary to dorsal myelopathy due to cystic lesions of spinal cysticercosis. The patient received medical and surgical treatment with a favorable clinical and imaging evolution. In our epidemiological context, it is important to consider a spinal cysticercosis as a differential diagnosis when faced with a clinical picture of acute myelopathy, since the appropriate diagnostic approach and timely treatment of this rare entity can improve the prognosis of patients.

Analysis of the effect of in vitro dissolution on the pharmacokinetics of albendazole

Abstract Albendazole is an anthelmintic drug commonly used in parenchymal neurocysticercosis and cystic echinococcosis. The aim of this study was to explore whether disparities in the dissolution profiles of albendazole products lead to significant differences in pharmacokinetic parameters. Three generic products and the innovator were evaluated in vitro. Quality control tests were performed, and dissolution profiles were obtained according to the Mexican Pharmacopeia. Although all products passed the quality control tests, none of the generic products complied with the similarity factor (f 2). The product with the lowest f 2 value in respect to the reference was chosen for in vivo evaluation. The study was carried out in 12 healthy volunteers who received 400 mg of the generic or reference product according to a crossover design. No significant differences were found in Cmax and AUC for albendazole and its main metabolite, albendazole sulfoxide, between products. Two absorption peaks were observed in the pharmacokinetic profile, and a population (22%) with different absorption rates and delay time for the the second peak was found. Based on the results, due to the high variability in the absorption process the differences observed in vitro could not be observed in vivo.

Riesgo y distribución geográfica de neurocisticercosis en Chile según egresos hospitalarios (2002-2019) / Epidemiology of cysticercosis in Chile

BACKGROUND: Neurocysticercosis is the most prevalent parasitic disease of the central nervous system in Chile, where sporadic cases are reported, without information about the epidemiology or distribution of the disease. AIM: To identify the main risk zones for cysticercosis in Chile. MATERIAL AND METHODS: Analysis of hospital discharge databases between 2002 and 2019, available at the website of the Chilean Ministry of Health. Cases with B69 code of the tenth international classification of diseases were identified. RESULTS: In the study period, there were 1752 discharges with the diagnoses of neurocysticercosis, ocular cysticercosis and cysticercosis of other sites. The ages of patients ranged from 0 to 89 years with a clustering between 30 and 59 years. Sixty two percent were males. The zone between the regions of Maule and Araucania concentrated 82% of cases. CONCLUSIONS: We identified the zone with the greatest concentration of cysticercosis in Chile, where preventive strategies should eventually be directed.

Endoscopic endonasal surgery for massive subarachnoid neurocysticercosis: illustrative case / Cirugía endoscópica endonasal para neurocisticercosis subaracnoidea masiva: caso ilustrativo

BACKGROUND. Subarachnoid neurocysticercosis (NCC) is associated with high morbidity and mortality rates. Conventional transcranial approaches and transventricular endoscopy have been previously reported for extraparenchymal NCC and ventricular NCC, respectively. By October 2019, endonasal endoscopic approaches had not been used for the treatment of NCC. OBSERVATIONS. A 54-year-old-woman with NCC was admitted with acute neurological deterioration due to severe intracranial hypertension caused by massive subarachnoid NCC cysts, as evidenced on magnetic resonance imaging (MRI) with great brainstem compression. The case was discussed, and an endoscopic endonasal resection of the NCC cysts was scheduled. The diagnosis was confirmed by pathological anatomy. There were no complications in the surgery, with marked neurological improvement. Control MRIs demonstrated a significant reduction of NCC cysts. LESSONS. Minimally invasive approaches are an excellent alternative for skull-base tumoral and infectious pathology. Prior knowledge of the pathophysiology and the authors' experience in the management of patients with NCC allowed them to propose this approach, with optimal results.

FONDO. La neurocisticercosis subaracnoidea (NCC) se asocia a altas tasas de morbilidad y mortalidad. Se han descrito anteriormente abordajes transcraneales convencionales y endoscopia transventricular para la NCC extraparenquimatosa y la NCC ventricular, respectivamente. Hasta octubre de 2019, no se habían utilizado abordajes endoscópicos endonasales para el tratamiento de la NCC. OBSERVACIONES. Una mujer de 54 años con carcinoma de células no pequeñas fue ingresada con deterioro neurológico agudo debido a hipertensión intracraneal grave causada por quistes de carcinoma de células no pequeñas subaracnoideos masivos, evidenciados en la resonancia magnética (RM) con gran compresión del tronco encefálico. Se discutió el caso y se programó una resección endoscópica endonasal de los quistes de carcinoma de células no pequeñas. El diagnóstico se confirmó mediante anatomía patológica. No hubo complicaciones en la cirugía, con una marcada mejoría neurológica. Las RM de control demostraron una reducción significativa de los quistes de carcinoma de células no pequeñas. LeECCIONES. Los abordajes mínimamente invasivos son una excelente alternativa para la patología tumoral e infecciosa de la base del cráneo. El conocimiento previo de la fisiopatología y la experiencia de los autores en el manejo de pacientes con NCC les permitió proponer este abordaje, con óptimos resultados.

Higher Concentration of Taenia Antigens in the CSF is Related to Slight Ventricle Enlargement and Periventricular Neuronal Decrease in Young Rats

Purpose Experimental models might help understand the pathophysiology of neurocysticercosis-associated hydrocephalus. The present study aimed to compare the extent of hydrocephalus and tissue damage in rats with subarachnoid inoculation of different concentrations of Taenia crassiceps cyst proteins. Methods Sixty young rats were divided into two groups: low- and high-concentration groups. The animals in the low concentration group received 0.02ml of 2.4mg/ml T. crassiceps cyst proteins while those in the high concentration group received 0.02 ml of 11.6mg/ml T. crassiceps cyst proteins. The animals underwent magnetic resonance imaging at 1, 3, and 6 months postinoculation to assess the ventricle volume. Morphological assessment was performed at the end of the observation period. Results Repeated measures of ventricle volumes at 1, 3, and 6 months showed progressive enlargement of the ventricles. At 1 and 3 months, we observed no differences in ventricle volumes between the 2 groups. However, at 6 months, the ventricles were larger in the high concentration group (median » 3.86mm3, range: 2.37­12.68) compared with the low concentration group (median » 2.00mm3, range: 0.37­11.57), p » 0.003. The morphological assessment revealed a few inflammatory features in both groups. However, the density of oligodendrocytes and neurons within the periventricular region was lower in the high concentration group (5.18 versus 9.72 for oligodendrocytes and 15.69 versus 21.00 for neurons; p < 0.001 for both). Conclusion Our results suggest that, in rats, a higher concentration of T. crassiceps cyst proteins in the subarachnoid space could induce ventricle enlargement and reduce the number of neurons within the periventricular area.

Neurocisticercosis: lesión única cerebral con serología negativa y confirmación post exéresis. Reporte de caso. / Neurocysticercosis: single brain lesion with negative serology and post exeresis confirmation. Case report

Los diagnósticos diferenciales de una lesión única intraparenquimatosa cerebral con borde en anillo son múltiples, desde un proceso infeccioso parasitario hasta una neoplasia primaria del sistema nervioso, por lo que su manejo puede ser controversial y debe tenerse en cuenta la prevalencia epidemiológica según la situación demográfica donde se presente. De esta manera, presentamos el caso de una paciente adulta joven que ingresó al servicio de neurocirugía con sintomatología focal sensitiva asociado a cefalea intermitente, con una TC de encéfalo que reveló una lesión subcortical localizada en la parte superior del giro postcentral izquierdo con edema perilesional importante y realce periférico tras contraste. Se realizaron pruebas de serología en suero y LCR para neuroparásitos, las cuales se reportaron negativas. Se procedió a realizar exéresis completa de la lesión con uso de ecografía intraoperatoria para minimizar tiempo quirúrgico y área de lesión cortical, la cual se envió a estudio de histopatología y reportó el diagnóstico de neurocisticercosis en estadio nodular granulomatoso. Se realiza el presente reporte de caso con una búsqueda exhaustiva en la literatura sobre la sensibilidad y utilidad de las pruebas de serología parasitaria para la confirmación diagnóstica de la neurocisticercosis y para evitar intervenciones neuroquirúrgicas invasivas

The differential diagnoses of single, ring-enhancing brain lesions are multiple, from a parasitic infection to a primary tumor of the central nervous system, therefore, the management of these lesions can be controversial, and the epidemiological prevalence must be taken into account according the demographic situation of the patient. We present the case of a young adult female who was admitted to the neurosurgery service, debuting sensory focal symptoms associated with headache. Brain CT and MRI revealed a subcortical cyst-like lesion in the left superior postcentral gyrus, with large perilesional edema and peripheral enhancement following contrast administration. Serological test for CNS parasites in serum and CSF were negative. Consequently, we realized a complete removal of the cyst with intraoperative ultrasound to optimize the surgical time and the cortical surgical area. The histopathological examination revealed a degenerating cysticercus. For this reason, a bibliographic research was carried out to identify the sensitivity of serological tests for the diagnostic confirmation of neurocysticercosis and thus avoid invasive neurosurgical interventions

Características clínicas de la neurocisticercosis en un hospital referencial del norte del Perú. 2016-2018 / Clinical characteristics of neurocysticercosis from a reference hospital of the northern of Peru. 2016-2018

INTRODUCCIÓN: La neurocisticercosis (NCC) es la parasitosis más común del sistema nervioso central, siendo una causa muy importante de epilepsia. OBJETIVO: Describir las características de pacientes con NCC atendidos en un hospital de alta complejidad de Lambayeque durante el período 2016-2018. PACIENTES Y MÉTODOS: Se revisaron las historias clínicas de pacientes con diagnóstico de NCC y se recolectó su información en una ficha de datos. RESULTADOS: 46 historias cumplieron criterios de inclusión; 23 correspondían a varones, la mediana de edad fue 46,5 años (RIC: 26,5-63), el paciente más joven tuvo 7 años, el más longevo 85 años; 30 procedían de la región Lambayeque. Epilepsia se presentó en 24 pacientes, hipertensión endocraneal en 10, síndrome psíquico en dos, déficit neurológico focal en 1, síndrome visual en 1, un paciente fue asintomático. Siete pacientes tuvieron epilepsia y otro síndrome simultáneamente. En las neuroimágenes, las calcificaciones cerebrales fueron las lesiones más comunes; 9 tuvieron quistes sub-aracnoideos. En 20 pacientes se efectuó serología por western blot, siendo positiva en 11; 38 fueron clasificados como NCC definitiva y 8 probable. Recibieron solamente tratamiento sintomático18 pacientes, 27 tratamiento antiparasitario y 6 adicionalmente tratamiento neuroquirúrgico. Falleció un paciente. CONCLUSIONES: La sintomatología y los hallazgos de neuroimágenes fueron proteiformes y la mortalidad fue baja.

BACKGROUND: Neurocysticercosis (NCC) is the most common parasitosis of the central nervous system, and a very important cause of epilepsy. AIM: To describe the clinical features of patients with NCC attending a high level hospital from Lambayeque during: 2016-2018. METHODS: The medical records of patients with NCC were reviewed, and their information was collected on a data sheet. RESULTS: 46 stories met the inclusion criteria; 23 patients were male, the median age was 46.5 years (IQR: 26.5-63), the youngest patient was 7 years old, and the longest 85. Thirty patients were from Lambayeque. Epilepsy occurred in 24 patients, intracranial hypertension in 10, psychic syndrome in 2 and focal neurological deficit and visual syndrome in 1; there was one asymptomatic patient and seven had epilepsy and another syndrome. In neuroimaging, cerebral calcifications were the most common lesions; 9 patients had subarachnoid cysts. Serology (western blot) was performed in 20 patients being positive in 11; 38 were definitive NCC and 8 probable. Eighteen patients received only symptomatic treatment, 27 antiparasitic treatment and 6, additionally neurosurgical treatment. Only one patient died. CONCLUSIONS: The symptoms and neuroimaging findings were proteiform and the mortality found was low.

Bruns Syndrome Caused by Intraventricular Neurocysticercosis: Literature Review

Bruns syndrome is one of the clinical presentations of intraventricular neurocysticercosis, and it is characterized by episodes of headache, vertigo and vomiting. The intraventricular form of neurocysticercosis occurs in 7% to 20% of the cases, and it is more serious than the intraparenchymal form. The management is primarily surgical, associated with pharmacological therapy with anthelmintic drugs and corticosteroids. We report the case of a patient who presented Bruns syndrome due to neurocysticercosis.

Demyelination in experimental intraventricular neurocysticercosis / Desmielinização na neurocisticercose intraventricular experimental

Abstract Neurocysticercosis (NCC) is classified as a neglected tropical disease, which affects mainly Latin America and Africa in spite of some reports in North America and Europe. NCC represents the cause of up to 30% of the reported cases of epilepsy in endemic countries. The NCC injuries present direct relation to the development stage, location, and number of parasites as well as to the host immune response. This study aimed the characterization of the inflammatory response and tissue injuries by means of the analyses of the periventricular and parenchymatous demyelination through the experimental intraventricular NCC infection. Therefore, BALB/c mice were submitted to experimental NCC inoculation with Taenia crassiceps cysticerci. Their brains were removed at 7, 30, 60, and 90 days after the inoculation (DAI), and analyzed after staining with hematoxylin and eosin (HE), Luxol Fast Blue, and Nissl. It was possible to observe ventriculomegaly, inflammatory infiltration composed by polymorphonuclear and mononuclear cells, and foamy macrophages. The presence of inflammatory cells was associated with neurodegeneration detected by the areas with demyelination observed initially in the periventricular area and lately in the parenchyma. In conclusion, the presence of cysticerci and the consequent inflammation were able to promote initial periventricular demyelination followed by parenchymatous demyelination as the infection progressed.

Resumo A neurocisticercose (NCC) é classificada como uma doença tropical negligenciada que afeta principalmente a América Latina e a África, apesar de alguns relatos na América do Norte e na Europa. A NCC é responsável por cerca de 30% dos casos de epilepsia em países endêmicos. Estas lesões parecem ter estreita relação com o estádio de desenvolvimento, com a localização e o número de parasitas, bem como a resposta imune do hospedeiro. O presente estudo objetivou caracterizar a resposta de células inflamatórias e as lesões teciduais pela análise da desmielinização periventricular e parenquimatosa ao longo da infecção experimental de NCC intraventricular. Para tanto, camundongos BALB/c foram submetidos a NCC experimental através da inoculação de cisticercos de Taenia crassiceps. O encéfalo foi retirado aos 7, 30, 60 e 90 dias após inoculação (DAI) e analisado após coloração por Hematoxilina e Eosina (HE), Luxol Fast Blue e Nissl. Observou-se ventriculomegalia, processo de infiltração inflamatório composto por células polimorfonucleares, mononucleares e macrófagos espumosos. A presença de células inflamatórias foi associada com neurodegeneração, observada pelas áreas de desmielinização que foram inicialmente periventricular e mais tardiamente no parênquima. Em conclusão, observa-se que a presença dos cisticercos e a inflamação foram capazes de promover desmielinização periventricular inicial e parenquimatosa conforme houve progressão tardia da infecção.

Neurocisticercosis racemosa gigante resistente al tratamiento farmacológico convencional. Reporte de un caso clínico y revisión de la literatura / Giant Racemose Neurocysticercosis Resistant to Conventional Pharmacological Treatment. Case Report and Literature Review / Neurocisticercose racemosa gigante resistente ao tratamento farmacológico convencional. Relatório de um caso clínico e revisão da literatura

Resumen: La teniosis/cisticercosis es una enfermedad parasitaria causada por la infección del estado larvario de Taenia solium. La Organización Mundial de la Salud (OMS) considera esta patología un problema de salud pública, así como una infección olvidada. Las manifestaciones pueden variar según el tipo de presentación de la lesión, requiere manejo farmacológico en la mayoría de los casos e incluso puede llegar a requerir tratamiento quirúrgico, en algunas condiciones específicas. Se han reportado casos de resistencia del parásito al manejo con cisticidas, reportes en los cuales la ivermectina, antiparasitario de uso veterinario, se convierte en una importante opción de manejo. Para esta disertación, se presenta un caso de neurocisticercosis racemosa gigante, que requirió manejo quirúrgico en el cual se evidencia persistencia de las lesiones luego del tratamiento con cisticidas, el cual presentó mejoría con el manejo con albendazol de marca, en combinación con ivermectina.

Abstract: Taeniasis/cysticercosis is a parasitic disease caused by Taenia solium larval stage infection. The World Health Organization (WHO) considers this pathology a public health problem, as well as a neglected infectious disease. Its manifestations may vary according to the type of lesion, needs pharmacological management in most cases, and even requires surgical treatment in some specific conditions. Cases of parasite resistance to cysticides have been reported, in which ivermectin, an antiparasitic drug for veterinary use, has become an important treatment option. This paper presents a case of giant racemose neurocysticercosis that required surgical management because of persistent lesions after treatment with cysticides, which showed improvement with branded albendazole in combination with ivermectin.

Resumo: A teniose/cisticercose é uma doença parasitária causada pela infecção do estágio larval da Taenia solium. A Organização Mundial da Saúde (OMS) considera essa patologia um problema de saúde pública e uma infecção esquecida. As manifestações podem variar de acordo com o tipo de apresentação da lesão, que requer um tratamento farmacológico, na maioria dos casos, e pode até exigir tratamento cirúrgico, em alguns casos específicos. Foram relatados casos de resistência do parasita ao tratamento com cisticidas, relatórios nos quais a ivermectina, um antiparasitário para uso veterinário, torna-se uma importante opção de tratamento. Para esta dissertação, um caso de neurocisticercose racemose gigante é apresentado. Esse caso exigiu um tratamento cirúrgico, no qual a persistência das lesões após o tratamento com cisticidas foi evidente, mas mostrou melhoras após o tratamento com o albendazol e ivermectina.

Evaluación del método de ELISA para detección de anticuerpos anti-cisticercos en sueros humanos / Evaluation of the ELISA method for the detection of anti-cysticercus antibodies in human sera / Avaliação do método ELISA para a detecção de anticorpos anti-cisticercos em soros humanos

La neurocisticercosis (NCC) es la localización en el sistema nervioso central (SNC) humano de la parasitosis provocada por el estadio larvario de la Taenia solium, el cisticerco, que prevalece en áreas urbanas y rurales y constituye un problema de salud pública. El diagnóstico puede efectuarse por exploración imagenológica del SNC con resonancia magnética o tomografía axial computarizada, no siempre disponible, y por pruebas de inmunoensayo (EIA) en sangre, que aportan al diagnóstico rapidez, bajo costo y transferibilidad. Para evaluar su capacidad diagnóstica y validar la precisión de la técnica de ELISA (ensayo inmunoabsorbente ligado a enzimas), en la detección de anticuerpos anti-cisticercos en sueros humanos, se diseñó una seroteca en forma aleatoria y en doble ciego, y se realizó el ELISA con las muestras, utilizando placas sensibilizadas con antígenos obtenidos del fluido vesicular de cisticercos de T. solium. Para la validación se realizaron 20 ensayos empleando controles positivos y negativos, por cuadruplicado en diferentes días, y realizados por más de un operador; el punto de corte para este método fue una densidad óptica de 0,325. La precisión intralaboratorio para el control débil (media=0,532±0,09) fue de %CV=17,51±0,09, y un valor de repetibilidad de %CV=7,04±0,04, cifras que se encuentran dentro de los límites esperados para el método. Con estos resultados se puede concluir que la precisión del ELISA para el serodiagnóstico de NCC se encuentra validada. El ensayo validado proporcionó resultados coherentes y repetidos que permitieron discriminar entre dos resultados dicotómicos y establecer con exactitud la condición de una posible infección, con un nivel de certidumbre estadística predeterminado.

Neurocysticercosis (NCC) is the location in the human central nervous system (CNS) of the parasitosis caused by the larval stage of Taenia solium, the cysticercus which prevails in urban and rural areas, constituting a public health problem. Diagnosis can be made by CNS imaging with magnetic resonance or computerized axial tomography, not always available, and by blood immunoassay (EIA) tests, which provide rapidity, low cost and transferability. In order to evaluate its diagnostic capacity and validate the ELISA (Enzyme- Linked ImmunoSorbent Assay) technique in the detection of anti-cysticercus antibodies in human sera, a collection of sera was designed in a randomized and double-blind manner, and the ELISA was performed with the samples, using plates sensitized with antigens obtained from the vesicular fluid of T. solium cysticerci. Twenty trials were conducted, using positive and negative controls, in quadruplicate, on different days, and performed by more than one operator; the cutoff for this method was an optical density of 0.325. The intralaboratory precision for the weak control (mean=0.532±0.09) was %CV=17.51±0.09, and a repeatability value of %CV=7.04±0.04, figures that are within the expected limits for the method, It can be concludedthat the accuracy of the ELISA for serodiagnosis of NCC is validated. The validated test provided consistent and repeated results, which made it possible to discriminate between two dichotomous outcomes, and to establish with accuracy the condition of a possible infection, with a predetermined level of statistical certainty.

A neurocisticercose (NCC) é o local no sistema nervoso central (SNC) humano de parasitose causada pelo estágio larval da Taenia solium, o cisticerco, prevalecente em áreas urbanas e rurais, constituindo um problema de saúde pública. O diagnóstico pode ser feito por varredura imagenológica do SNC com ressonância magnética ou tomografia axial computadorizada, nem sempre disponível, e por testes de imunoensaio (EIA) em sangue, que fornecem ao diagnóstico rapidez, baixo custo e portabilidade. Para avaliar a sua capacidade de diagnóstico e validar a precisão da técnica de ELISA (ensaio imunoabsorvente ligado a enzimas), na detecção de anticorpos anti-cisticercos em soros humanos, um serrarium foi projetado em forma aleatória e em duplo cego, e foi realizado com as amostras o ELISA, utilizando placas sensibilizadas com antígenos derivados do fluido vesicular de cisticercos de T. solium. 20 testes para validação foram realizados, utilizando controles positivos e negativos, em quadruplicado, em dias diferentes, e realizados por mais de um operador; o ponto de corte para este método era uma densidade óptica de 0,325. A precisão intralaboratorial para o controle fraco (média=0,532±0,09) foi de CV%=17,51±0,09, e um valor de repetibilidade de CV%=7,04±0,04, valores que estão dentro dos limites esperados para o método, podendo concluir com esses resultados que a precisão do ELISA para diagnóstico sorológico de NCC é validado. O ensaio validado forneceu resultados consistentes e repetidos, o que permitiu discriminar entre dois resultados dicotômicos e identificar com exatidão a condição de possível infecção com um nível de certeza pré-determinado estatisticamente.

Descripción clínico-radiológica de un angiosarcoma cardiaco con metástasis cerebral que simula un quiste hidatídico / A radiological and clinical description of metastatic angiosarcoma simulating a hydatid cyst

RESUMEN Los angiosarcomas son sarcomas malignos que se originan en las células endoteliales vasculares. Su diagnóstico diferencial es muy amplio debido a su parecido con otras enfermedades, como las parasitarias, y usualmente es un diagnóstico por exclusión. La neurocisticercosis y la hidatidosis cerebral son parasitosis intestinales que pueden comprometer el sistema nervioso central y tienen mayor incidencia en los países suramericanos. El diagnóstico se establece a partir del perfil epidemiológico, el estudio parasitológico, la apariencia radiológica de las lesiones y el estudio de histopatología del espécimen. Se presenta el caso de una adolescente con factores de riesgo para parasitosis y neuroimágenes sugestivas de hidatidosis cerebral, cuyo diagnóstico definitivo fue angiosarcoma cardiaco metastásico.

ABSTRACT Angiosarcoma is the most malignant sarcoma originating in endothelial vascular cells. It has a wide differential diagnosis due to its similarities with other entities, such as parasitic diseases. More often, angiosarcoma is diagnosed by exclusion. Neurocysticercosis and hydatid disease, or echinococcosis, are parasitic infections that may involve the central nervous system and their incidence is higher in South American countries. Diagnosis is established based on the epidemiological profile, the parasitological examination, the radiological appearance of the lesions, and the histopathology analysis of specimens. We present the case of a female adolescent with parasitosis risk factors whose neuroimages suggested cerebral hydatid cysts and who was finally diagnosed with cardiac metastatic angiosarcoma.

First report of an outbreak of cerebral coenurosis in Dhofari goats in Oman / Primeiro relato de um surto de coenurose cerebral em cabras Dhofari em Omã

Abstract This study documented the first outbreak of cerebral coenurosis in goats in Salalah, southern Oman. Deaths of 130 (16.6%) adult native goats in a herd (n=780) were reported from January to June 2017. Affected goats showed various nervous signs ended by death. Investigations for thiamine deficiency, polioencephalomalacia, caprine arthritis encephalitis, and listeriosis were negative. Upon necropsy, multiple (1-4) thin-walled cysts 2-3.5 cm in diameter containing clear fluid with numerous clusters of protoscolices in the cerebrum and cerebellum had replaced the brain parenchyma, causing space-occupying lesions. Parasitologically, the recovered cysts were Coenurus cerebralis, based on the arrangement of protoscolices, and the number and size of their hooks. Morphologically, each protoscolex had four suckers and a rostellum with double-crown hooks. The large and small hooks were 157.7±0.5 µm and 115±0.6 µm in length, respectively. Histopathologically, the parasite destroyed the affected tissues associated with multifocal to diffuse lymphocytic, non-suppurative meningoencephalitis; ischemic neuronal necrosis; and malacia. This is the first report of cerebral coenurosis in livestock in Oman, which should alert the local public health authorities for the application of prevention and control measures.

Resumo Este estudo documentou o primeiro surto de coenurose cerebral em cabras em Salalah, Oman. A morte de 130 (16,6%) caprinos adultos nativos (n=780) foi relatada de janeiro a junho de 2017. As cabras afetadas mostraram distúrbios neurológicos, que culminaram em óbito. Investigações para deficiência de tiamina, polioencefalomalácia, encefalite por artrite caprina e listeriose foram negativas. Na necropsia, múltiplos (1-4) cistos de paredes finas com 2-3,5 cm de diâmetro contendo líquido claro com numerosos aglomerados de protoescólices no cérebro e no cerebelo haviam substituído o parênquima cerebral, causando compressão nas estruturas adjacentes. Os cistos recuperados foram identificados como sendo de Coenurus cerebralis, com base no arranjo dos protoescólices, e no número e tamanho de seus ganchos. Morfologicamente, cada protoescólice tinha quatro ventosas e um rostelo com dupla coroa de ganchos. Os ganchos grandes e pequenos tinham 157,7±0,5 µm e 115±0,6 µm de comprimento, respectivamente. Histopatologicamente, o parasita causou a destruição dos tecidos afetados associada à meningoencefalite linfocítica não-supurativa, que variou de multifocal a difusa, necrose neuronal isquêmica e malacia. Este é o primeiro relato de coenurose em ruminantes no Oman, o que deve servir de alerta para as autoridades locais da área de saúde para a aplicação de medidas de prevenção e controle.