Dos casos de meningitis crónica por Angiostrongylus cantonensis. Réplica / Two cases of chronic meningitis due to Angiostrongylus cantonensis. Reply

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[C3c activation and intrathecal biosynthesis in children suffering from eosinophilic meningoencephalitis due to Angiostrongylus cantonensis]. / Activación y biosíntesis intratecal de C3c en niños con meningoencefalitis eosinofilica por Angiostrongylus cantonensis.

INTRODUCTION: Eosinophilic meningoencephalitis due to Angiostrongylus cantonensis is an emergent infectious disease in our area. The objective of the present paper is to determine if the activation of the complement system was taken placed with the C3c production in cerebrospinal fluid. PATIENTS AND METHODS: 14 patients with an average age 4.5 years were studied. In such patients a lumbar punction was performed. C3c was quantified in serum and cerebrospinal fluid by radial immunodiffusion. RESULTS: Median cell number was 396 x 10(-6)/L with an average of 8.8% of eosinophils. Main symptoms were headache, vomiting and fever. Meningeal signs were present in 50% of the patients. C3c intrathecal synthesis occurred in 13 patients (92.8%). CONCLUSION: It was demonstrated the participation of complement system in third-stage larvae destruction in cerebrospinal fluid.

Seasonal distribution and evolving forms of multiple sclerosis patients diagnosed from April 2004 to November 2007

Multiple sclerosis (MS) was first reported in Cuba in 1965. The most frequent appearance is observed in the first six months of the year. Objetive: To determine the seasonal distribution and evolving forms of MS patients diagnosed with the disease between April 2004 and November 2007. Twenty-one patients with suspected MS and 42 outbreaks were studied. Patients were classified according to Lublin and Revingold's criteria for clinical forms and according to McDonald. Most patients were classified in outbreak and remission and only two patients classified as primary-progressive multiple sclerosis. The higher number of outbreaks occurred in the first two quarters of the year. It is recommended to study further weather variables that may be related to the emergence of these outbreaks in our environment(AU)

La esclerosis múltiple (EM) fue reportada en Cuba por primera vez en 1965. Se ha venido observando la aparición más frecuente en los primeros seis meses del año. Objetivo: Determinar la distribución estacional y formas evolutivas de EM en pacientes con diagnóstico de esta enfermedad entre abril 2004 y noviembre 2007. Se estudiaron 21 pacientes con sospecha de EM y un total de 42 brotes. Los pacientes fueron clasificados según los criterios de Lublin y Revingold para las formas evolutivas y según los criterios de McDonald. Solo dos pacientes clasificaron en la forma evolutiva progresiva primaria; los primeros dos trimestres del año fueron los de mayor número de brotes. Se recomienda profundizar en las variables climatológicas que pudieran tener vínculo con la aparición de estos brotes en nuestro medio(AU)

[Peculiarities of meningoencephalitis caused by Angiostrongylus cantonensis in America]. / Peculiaridades de la meningoencefalitis por Angiostrongylus cantonensis en América.

INTRODUCTION: 25 years ago was first reported in Cuba and in the western hemisphere an emergent disease: eosinophilic meningoencephalitis due to Angiostrongylus cantonensis larvae. AIM: To collect in a summary form the accumulated experience and the findings of the study of this parasitosis during the period in the Western hemisphere. DEVELOPMENT AND CONCLUSIONS: There have been collected the first evidences, the parasitological and malacological findings, the experimental and molecular studies on immunology and neuroimmunology, the clinic-pathological findings in children and adults with the particularities of this diseases in our environment with special emphasis in the never-before scientific findings reported. It has been documented the testimony, the main findings among the malacological studies, the role of the immunoglobulin E and the mechanism involved in the central nervous system, the intrathecal synthesis patterns of immunoglobulins and the clinical elements in children and adults.

Peculiaridades de la meningoencefalitis por Angiostrongylus cantonensis en América / Peculiarities of meningoencephalitis caused by Angiostrongylus cantonensis in America

Introducción. Hace 25 años se informó por primera vez en Cuba y en el hemisferio occidental de la aparición deuna enfermedad emergente: la meningoencefalitis eosinofílica producida por larvas del helminto Angiostrongylus cantonensis.Objetivo. Recopilar de forma resumida la experiencia acumulada y los aportes al estudio de esta zoonosis realizados a lo largo de estos años en el hemisferio occidental. Desarrollo y conclusiones. Se recogen las evidencias iniciales, los aportes a la parasitología y la malacología, los estudios experimentales y moleculares en la esfera de la inmunología y la neuroinmunología, los hallazgos clinicopatológicos en niños y adultos enfermos con las particularidades de la enfermedad en nuestro medio, con especial acento en los aportes científicos nunca antes comunicados. Se documentan el testimonio, los principalesaportes y hallazgos, entre los cuales se encuentran los estudios malacológicos, el papel de la inmunoglobulina E y los mecanismos involucrados en el sistema nervioso central, los patrones de síntesis intratecal de inmnoglobulinas y los elementos clínicos que brinda en niños y adultos(AU)

Introduction. 25 years ago was first reported in Cuba and in the western hemisphere an emergent disease: eosinophilic meningoencephalitis due to Angiostrongylus cantonensis larvae. Aim. To collect in a summary form the accumulated experience and the findings of the study of this parasitosis during the period in the Western hemisphere. Development and conclusions. There have been collected the first evidences, the parasitological and malacological findings, the experimental and molecular studies on immunology and neuroimmunology, the clinic pathological findings in children and adults with theparticularities of this diseases in our environment with special emphasis in the never-before scientific findings reported. It has been documented the testimony, the main findings among the malacological studies, the role of the immunoglobulin E and the mechanism involved in the central nervous system, the intrathecal synthesis patterns of immunoglobulins and the clinicalelements in children and adults(AU)

Peculiaridades de la meningoencefalitis por Angiostrongylus cantonensis en América / Peculiarities of meningoencephalitis caused by I Angiostrongylus cantonensis I in America

25 years ago was first reported in Cuba and in the western hemisphere an emergent disease: eosinophilic meningoencephalitis due to Angiostrongylus cantonensis larvae, Aim, To collect in a summary form the accumulated experience and the findings of the study of this parasitosis during the period in the Western hemisphere, Development and conclusions, There have been collected the first evidences, the parasitological and malacological findings, the experimental and molecular studies on immunology and neuroimmunology, the clinic-pathological findings in children and adults with the particularities of this diseases in our environment with special emphasis in the never-before scientific findings reported; It has been documented the testimony, the main findings among the malacological studies, the role of the immunoglobulin E and the mechanism involved in the central nervous system, the intrathecal synthesis patterns of immunoglobulins and the clinical elements in children and adults(AU)

Peculiaridades de la meningoencefalitis por Angiostrongylus cantonensis en América / Peculiarities of meningoencephalitis caused by angiostrongylus cantonensis in America

Hace 25 años se informó por primera vez en Cuba y en el hemisferio occidental de la aparición de una enfermedad emergente: la meningoencefalitis eosinofílica producida por larvas del helminto Angiostrongylus cantonensis.Objetivo. Recopilar de forma resumida la experiencia acumulada y los aportes al estudio de esta zoonosis realizados a lo largo de estos años en el hemisferio occidental. Desarrollo y conclusiones. Se recogen las evidencias iniciales, los aportes a la parasitología y la malacología, los estudios experimentales y moleculares en la esfera de la inmunología y la neuroinmunología, los hallazgos clinicopatológicos en niños y adultos enfermos con las particularidades de la enfermedad en nuestro medio, con especial acento en los aportes científicos nunca antes comunicados. Se documentan el testimonio, los principalesaportes y hallazgos, entre los cuales se encuentran los estudios malacológicos, el papel de la inmunoglobulina E y los mecanismos involucrados en el sistema nervioso central, los patrones de síntesis intratecal de inmnoglobulinas y los elementos clínicosque brinda en niños y adultos

25 years ago was first reported in Cuba and in the western hemisphere an emergent disease: eosinophilicmeningoencephalitis due to Angiostrongylus cantonensis larvae. Aim. To collect in a summary form the accumulatedexperience and the findings of the study of this parasitosis during the period in the Western hemisphere. Development and conclusions. There have been collected the first evidences, the parasitological and malacological findings, the experimentaland molecular studies on immunology and neuroimmunology, the clinic-pathological findings in children and adults with the particularities of this diseases in our environment with special emphasis in the never-before scientific findings reported. It hasbeen documented the testimony, the main findings among the malacological studies, the role of the immunoglobulin E and the mechanism involved in the central nervous system, the intrathecal synthesis patterns of immunoglobulins and the clinicalelements in children and adults

[Patterns of immunoglobulin synthesis in pediatric patients with Coxsackie A9 meningoencephalitis during the neuropathy epidemic in Cuba]. / Patrones de síntesis de inmunoglobulinas en pacientes pediátricos con meningoencefalitis por Coxsackie A9 durante la epidemia de neuropatía en Cuba.

INTRODUCTION: Simultaneously with the origin and development of the Cuban epidemic neuropathy, cases of viral meningoencephalitis with particular characteristics due to Coxsackie were found. This virus and Inoue-Melnick virus were found too in patients suffering from Cuban epidemic neuropathy. PATIENTS AND METHODS: 31 pediatric patients suffering from viral meningoencephalitis were studied. Albumin, IgA, IgM and IgG were quantified in serum and cerebrospinal fluid by nephelometry. Cytochemical studies and reibergrams were performed. RESULTS: There was a lymphocyte predominance in cerebrospinal fluid. A dysfunction of blood-cerebrospinal fluid barrier was shown in 10 patients. Twenty patients have no immunoglobulins intrathecal synthesis. The synthesis patterns were: five patients with local IgM synthesis, two patients with local IgG synthesis and IgA + IgM. IgA + IgG and IgA + IgM pattern was synthesized in one patient respectively. Two patients with low IgG synthesis percentage or IgG intrathecal fractions were reported. CONCLUSIONS: The absence of immunoglobulins intrathecal synthesis and the immunoglobulins synthesis patterns differ from other pediatric patients with enterovirus meningoencephalitis. These patterns may have relationship with modified antigenic characteristics of the virus, also found in Cuban epidemic neuropathy.

Patrones de síntesis de inmunoglobulinas en pacientes pediátricos con meningoencefalitis por Coxsackie A9 durante la epidemia de neuropatía en Cuba / Patterns of immunoglobulin sysnthesis in paediatric patients with coxsackie Ag meningoencephalitis during the neuropathy epidemic in Cuba

Introducción. Simultáneamente a la aparición y desarrollo de la neuropatía epidémica cubana se detectaron casos de meningoencefalitisvírica por Coxsackie con características peculiares. En pacientes con neuropatía epidémica cubana se aisló este virus y también el Inoue-Melnick. Pacientes y métodos. Se estudiaron 31 pacientes pediátricos con meningoencefalitis por este virus. Se cuantificó la albúmina, IgA, IgM e IgG por nefelometría en suero y líquido cefalorraquídeo. Asimismo, se realizaron los reibergramas y un estudio citoquímico. Resultados. En el estudio citoquímico de líquido cefalorraquídeo hubo un predominio de linfocitos. Diez pacientes exhibieron disfunción en la barrera sangre-líquido cefalorraquídeo y 20 no sintetizaron inmunoglobulinas intratecalmente. Los patrones de síntesis fueron: en cinco pacientes IgM, en dos pacientes IgG, las combinaciones IgA+IgM en dos pacientes y con IgA+IgG e IgG+IgM en sendos pacientes. Dos de ellos cursaron con bajos porcentajes de síntesis o fracción intratecal de IgG. Conclusiones. La ausencia de síntesis intratecal y los patrones de síntesis de inmunoglobulinas difieren respecto a los hallados en pacientes pediátricos con meningoencefalitis producida por otros enterovirus. Estos patrones pueden estar asociados con las características antigénicas modificadas del virus, que también fue encontrado en la epidemia de neuropatía cubana (AU)

Introduction. Simultaneously with the origin and development of the Cuban epidemic neuropathy, cases of viral meningoencephalitis with particular characteristics due to Coxsackie were found. This virus and Inoue-Melnick virus were found too in patients suffering from Cuban epidemic neuropathy. Patients and methods. 31 pediatric patients suffering from viral meningoencephalitis were studied. Albumin, IgA, IgM and IgG were quantified in serum and cerebrospinal fluid by nephelometry. Cytochemical studies and reibergrams were performed. Results. There was a lymphocyte predominance in cerebrospinal fluid. A dysfunction of blood-cerebrospinal fluid barrier was shown in 10 patients. Twenty patients have no immunoglobulins intrathecal synthesis. The synthesis patterns were: five patients with local IgM synthesis, two patients with local IgG synthesis and IgA+IgM. IgA+IgG and IgA+IgM pattern was synthesized in one patient respectively. Two patients with low IgG synthesis percentage or IgG intrathecal fractions were reported. Conclusions. The absence of immunoglobulins intrathecal synthesis and the immunoglobulins synthesis patterns differ from other pediatric patients with enterovirus meningoencephalitis. These patterns may have relationship with modified antigenic characteristics of the virus, also found in Cuban epidemic neuropathy (AU)