ABSTRACT
RESUMEN La neurocisticercosis, como parte del complejo teniasis/cisticercosis, es la helmintiasis que compromete con mayor frecuencia el sistema nervioso central, particularmente en países en vías de desarrollo, en los cuales su transmisión es endémica. Sus manifestaciones clínicas son variables, de acuerdo con su localización en el sistema nervioso central, y resalta la epilepsia como una de sus principales formas de presentación clínica. Los avances en el uso de métodos diagnósticos inmunológicos, así como las neuroimágenes y la introducción hace dos años de nuevos criterios diagnósticos, han mejorado la certeza diagnóstica. La implementación del tratamiento anticestocida asociado con el uso de corticoides y, en algunos casos particulares, la intervención quirúrgica brindan no solo una opción terapéutica, sino también un mejor pronóstico a los pacientes afectados por esta condición. Hoy el reto se centra en implementar medidas de salud pública sobre en el ciclo biológico del CTC para lograr su erradicación.
SUMMARY Neurocysticercosis, as part of the Teniasis / Cysticercosis complex, is helminthiasis that more frequently involves the central nervous system, particularly in countries undergoing development where its transmission is endemic; its clinical manifestations are variable, according to its location in the central nervous system, highlighting epilepsy as one of its main forms of clinical presentation. Advances in the use of diagnostic methods immunological tests, as well as neuroimaging and the introduction two years ago of new criteria diagnoses have improved the diagnostic certainty, with the implementation of anti-treatment cestocide associated with the use of corticosteroids and, in some particular cases, the intervention surgical treatment provides not only a therapeutic option but also a better prognosis for patients affected by this condition. The challenge today is focused on implementing measures of public health on the biological cycle of the CTC to achieve its eradication.
Subject(s)
Transit-Oriented DevelopmentABSTRACT
Introduction: The human T-lymphotropic virus has been associated with human disease, affecting CD4+ T, CD8+ T, and B lymphocytes. It can cause T-cell leukemia/lymphoma and HTLV-associated myelopathy. Case presentation: A 31-year-old woman was admitted after 2 months of cramps, paraparesis, and fecal/urinary incontinence. She was diagnosed with neurosyphilis according to the cerebrospinal fluid analysis. Despite treatment with crystalline penicillin there was no recovery, and anti-HTLV-1/2 tests were positive; therefore, the diagnosis of HTLV-associated myelopathy was made. The patient rejected glucocorticoid treatment; baclofen and carbamazepine were used to treat spasticity and cramps, respectively. The patient has not had progression. Discussion: HTLV-associated myelopathy is generated by an exaggerated inflammatory response in the central nervous system with clonal expansion of CD4+ T and CD8+ T lymphocytes. There is not a specific and useful treatment; glucocorticoids can reduce inflammation, but do not improve clinical functional outcomes. There is a high prevalence of syphilis and human T-lymphotropic virus co-infection in tropical countries; however, myelopathy as the first clinical manifestation is unusual. The treatment of neurosyphilis could reduce the inflammation into the central nervous system and could decrease the progression of sequelae. This is the first case of myelopathy secondary to viral and treponemal co-infection confirmed in Colombia.
