ABSTRACT
We investigate the cytokine profile in the cerebrospinal fluid (CSF) and serum of patients with spinal cord schistosomiasis (SCS). Increased levels of IL-1beta, IL-4, IL-6 and IL-10 and low concentrations of TNF-alpha and IFN-gamma were observed in both CSF and serum. CSF showed higher levels of IL-4 and IL-6 when compared to the paired serum samples. A negative correlation between the concentrations of IL-10 and IFN-gamma was observed in the CSF. These findings suggest an inflammatory as well as a skewed type-2 immune response that probably occur both locally and systemically and may be involved in the pathogenesis of SCS.
Subject(s)
Cerebrospinal Fluid/immunology , Cerebrospinal Fluid/parasitology , Cytokines/cerebrospinal fluid , Neuroschistosomiasis/cerebrospinal fluid , Neuroschistosomiasis/immunology , Spinal Cord Diseases/cerebrospinal fluid , Spinal Cord Diseases/immunology , Animals , Cytokines/analysis , Cytokines/blood , Down-Regulation/immunology , Humans , Interferon-gamma/analysis , Interferon-gamma/blood , Interferon-gamma/cerebrospinal fluid , Interleukins/analysis , Interleukins/blood , Interleukins/cerebrospinal fluid , Myelitis/cerebrospinal fluid , Myelitis/immunology , Myelitis/parasitology , Neuroschistosomiasis/diagnosis , Predictive Value of Tests , Schistosoma mansoni/immunology , Spinal Cord Diseases/parasitology , Tumor Necrosis Factor-alpha/analysis , Tumor Necrosis Factor-alpha/cerebrospinal fluid , Up-Regulation/immunologyABSTRACT
OBJECTIVE: To evaluate the prevalence of diabetic polyneuropathy (DNP) in children and adolescents with type 1 diabetes mellitus (DM1), and to compare the diagnostic criteria for DNP proposed and most widely utilized in the literature. METHODS: Forty-eight patients with DM1 with a mean age of 12.9 years and mean duration of DM1 of 7 years, and 14 controls, were compared. Results of clinical neurological examination and nerve conduction (NC) were compared by means of diagnostic criteria proposed at the San Antonio Conference and by Dyck et al. RESULTS: Twenty-two patients (46%) had DNP by the San Antonio criteria, and 25% according to those of Dyck et al. Three patients (6.3%) presented neurological complaints, such as lower limb pain, paresthesia and hyperhidrosis, and 31 (64.6%) presented peripheral nervous system changes upon clinical examination. Twenty-nine patients (60.4%) presented changes in motor and sensory nerve conduction. Motor NC changes were the most prevalent, above all in the median (86.2%) and fibular (55.2%) nerves. CONCLUSIONS: A high percentage of neurological changes were detected in this young population, with 5-10 years duration of DM1. Prevalence of DNP in the pediatric age group ranges from zero to 54% in published studies, mainly using the criteria of Dyck et al. or similar criteria. In the present study we found that roughly one-quarter of patients would be misdiagnosed according to the criteria utilized. We propose that neurological evaluation must be included in routine care for children with DM. Further studies leading to a more accurate diagnosis of DNP in children and adolescents are still necessary.
