IFN-gamma role in granuloma formation in experimental subcutaneous cysticercosis.

Cysticercosis is an infection caused by the metacestode larval stage of Taenia parasites in tissues and elicits a host-parasite reaction in which the immune response may be decisive in the disease development. The aim of this study was to evaluate the role of IFNγ (IFN-gamma) in the experimental model of subcutaneous infection with Taenia crassiceps (T. crassiceps) cysticerci using IFNγ knockout mice. Male C57BL/6 and C57BL/6 KO IFNγ mice 8-12 weeks of age were inoculated with T. crassiceps cysticerci into the subcutaneous tissue of the dorsum. At 7 and 30 (acute phase), 60 and 90 (chronic phase) days post infection, animals from each group had their blood and the subcutaneous tissues collected for serologic and pathological studies. IFNγ and IL-4 were dosed and the histopathological analysis was performed. In the presence of IFNγ there was the establishment of a mixed Th1/Th2 systemic immune profile. This profile also locally induced the granuloma formation which was constituted by cells that played important roles in the parasitary destruction and that were likely associated to the Th1 axis of mixed immune response. On the other hand, the absence of IFNγ appears to favor the parasitary growth which may be related to the development of a systemic Th2 immune response. This profile influenced the granuloma formation with immunoregulatory properties and appears to be important in the collagen synthesis.

Neurocisticercosis. Hallazgos radiológicos / Imaging findings in neurocysticercosis

La neurocisticercosis es una parasitosis humana causada por las larvas de la Taenia solium, que es la que con mayor frecuencia afecta el sistema nervioso central. Esta infección es endémica en prácticamente todos los países en vías de desarrollo, pero debido a la globalización y a las migraciones humanas su frecuencia ha aumentado en países desarrollados como los de Europa Occidental. Las manifestaciones clínicas más frecuentes son la epilepsia, signos neurológicos focales e hipertensión intracraneal. Los hallazgos radiológicos dependen del estadio larvario de la Taenia solium, número y localización de los parásitos (parenquimatosa, subaracnoidea e intraventricular), así como de la respuesta inmune del huésped (edema, gliosis, aracnoiditis) y del desarrollo de lesiones secundarias (arteritis, infartos o hidrocefalia). El diagnóstico de esta parasitosis debe establecerse en función de los hallazgos clínicos y radiológicos, especialmente en un contexto epidemiológico adecuado, con apoyo de la serología(AU)

Neurocysticercosis, caused by the larvae of Taenia solium, is the parasitic infection that most commonly involves the central nervous system in humans. Neurocysticercosis is endemic in practically all developing countries, and owing to globalization and immigration it is becoming more common in developed countries like those in western Europe. The most common clinical manifestations are epilepsy, focal neurologic signs, and intracranial hypertension. The imaging findings depend on the larval stage of Taenia solium, on the number and location of the parasites (parenchymal, subarachnoid, or intraventricular), as well as on the host's immune response (edema, gliosis, arachnoiditis) and on the development of secondary lesions (arteritis, infarcts, or hydrocephalus). The diagnosis of this parasitosis must be established on the basis of the clinical and radiological findings, especially in the appropriate epidemiological context, with the help of serological tests(AU)

Terminology and practice in control of some parasitic zoonoses.

Some terminology, based on tradition and still widely used in practice, is still scientifically incorrect.

Detección de antígenos dominantes para el diagnóstico de cisticercosis por inmunoelectrotransferencia (Eitb) / Detection of dominants antigens to diagnosis of cisticercosis for immunoelectrotransference (Eitb)

Se emplearon quistes liofilizados de Cisticerco cellullosae para preparar un extracto antigénico, el cual se utilizó en la identificación de antígenos de Taenia soliumreconocidos por inmunoglobulinas G de pacientes con cisticercosis, por medio de la prueba de inmunoelectrotransferencia (EITB). Se estudiaron 193 muestras (105 líquidos cefalorraquídeos - LCR y 88 sueros) de individuos con diagnóstico de cisticercosis por hallazgos clínicos, epidemiológicos y serológicos mediante el inmunoensayo enzimático (ELISA). El análisis de las proteínas antigénicas por electroforesis, permitió identificar polipéptidos de 29, 45, 66, 96 y 116 kDa principalmente, así como también algunos menores de 29 kDa. Los de mayor frecuencia de aparición en muestras de suero y LCR fueron los de 29, 45 y 66 kDa. Por lo tanto, estos antígenos inmunodominantes, podrían emplearse con predilección en estudios epidemiológicos y clínicos de cisticercosis por western blot

Cysticercosis. Clinical classification based on imaging studies.

Cysticercosis is a pleomorphic disease in which the diagnosis, treatment, and prognosis greatly vary in relation to the location, number, and stage of the lesions. A new classification is proposed that includes the information gathered by magnetic resonance imaging and computed tomography, supplemented by immunodiagnostic studies and clinical data. The different clinical entities produced by cysticercosis are grouped by the frequency and location of the parasites, including valuable data as the number and stage of the lesions as well as the degree of the inflammatory response from the host to the parasite. In this way, the disease can be individualized to define the reliability of diagnostic studies and to design specific therapeutic approaches that depend on the characteristics that the disease acquires in every location.

Neurocisticercosis / Neurocysticercosis

La neurocisticercosis es la parasitosis del sistema nervioso central (SNC) producida por la forma larval de la taenia solium. En 1950 Parnolus encontró un cisticerco en el cuerpo calloso, pero sólo en 1985 Kuchen Meister asoció afección con la taenia solium. La forma muscular fue descubierta por primera vez por Priets en 1926 y subsecuentemente también la comunicaron M Gill, Jacob y Mathews. En Estados Unidos la neurocisticercosis se describió por primera vez en 1927 por Walter Dandy

Use of enzyme-linked immunosorbent assay and enzyme-linked immunoelectrotransfer blot for the diagnosis and monitoring of neurocysticercosis.

A total of 70 proven cases of neurocysticercosis from la Réunion (Indian Ocean) were studied with enzyme-linked immunoassay (ELISA) and immunoelectrotransfer blot (EITB) to detect specific antibodies in serum and cerebrospinal fluid (CSF). Absorbance levels of antibody to crude Taenia solium cyst extract as an antigen were compared with EITB banding-pattern and computed tomography-scan results. The EITB analysis of sera and CSF from patients with active neurocysticercosis, confirmed with characteristic brain-scan imaging and highest ELISA absorbance, regularly revealed two bands with molecular weights of 13 and 14 kDa, respectively. These low-molecular-weight fractions are potential markers of active cerebral cysticercosis, a result obtained in the simple epidemiological situation of La Réunion (Indian Ocean). A parallel study is underway in Madagascar, where cross-reactivities with other parasitic diseases, including Schistosoma infections, may interfere.

A proposal for classification of neurocysticercosis.

The complicated pathophysiological and immunological changes in the central nervous system of patients with neurocysticercosis produce a variety of signs and symptoms, which complicate the clinical and surgical management of this disease. A complete and objective classification is needed, to improve the medical approach as a whole. We studied 336 patients, in whom we classified neurocysticerosis according to criteria of viability and location of the parasite in the CNS: active form (37.2%) when the cysticercus is alive, transitional form (32.8%) when it is in the degenerative phase, and inactive form (30%) when the parasite is dead. This classification establishes the correlation between the different forms of neurocysticerosis and its clinical manifestations, and can be used for planning therapeutic strategies.

Active neurocysticercosis, parenchymal and extraparenchymal: a study of 38 patients.

In this retrospective study we have analysed a series of 38 patients seen from 1983 to 1992 (mean follow-up, 4.5 years) with active neurocysticercosis (NCC), 23 (60.5%) with parenchymal and 15 (39.5%) with extraparenchymal NCC. Classification into these two forms of NCC was based on computed tomography and magnetic resonance imaging criteria. The enzyme-linked immunosorbent assay performed in cerebrospinal fluid, for anti-Taenia solium antibodies, was positive in 18 of 23 (78%) cases. Epilepsy and/or intracranial hypertension were the most common clinical presentation (92%). Twenty-three (60.5%) of 38 patients were treated with praziquantel and/or albendazole. In parenchymal NCC, the efficacy of medical therapy was complete in 13 of 16 (81%) and partial in 3 of 16 (19%) patients. In contrast, in all cases of extraparenchymal NCC treated with cysticidal drugs the results were disappointing. A ventriculoperitoneal shunt was performed in 9 of 13 patients with extraparenchymal NCC and hydrocephalus. Severe complications, including two deaths, associated with the natural evolution of the disease or with surgery, occurred only in extraparenchymal NCC. Therefore, we confirm the existence of the two forms of active NCC, parenchymal and extraparenchymal, which are strikingly different in clinical presentation, medical therapy response, complications, morbidity and mortality.

[Contribution of enzyme-linked immuno-electrotransfer blot assay for the diagnosis of human neurocysticercosis]. / Apport de l'enzyme-linked immunoelectrotransfer blot assay au diagnostic de la neurocysticercose humaine.

An enzyme-linked immunoelectrotransfer blot (EITB) is developed for immunodiagnosing human neurocysticercosis. The assay's efficacy is evaluated in 71 neurocysticercotic patients whose diagnosis of the disease and evaluation of disease activity is based on CT scan findings. We identified eight bands (molecular weigh less than 35 000) that evaluate the disease activity: active disease, calcification in progress, inactive disease. All samples patients with active disease recognized 14 000 band. This band is missing in the others parasitic diseases and in serum of the patients with inactive diseases or calcification in progress. The enzyme-linked immunoelectrotransfer blot is simple to perform and may be used in sero-epidemiology.

Clasificación pronóstica de la cisticercosis cerebral.Implicaciones terapéuticas / Pronostic classification of cerebral cysticercosis. Therapeutic implications

Se propone una nueva clasificación de las diversas formas de cisticercosis cerebral. Esta clasificación está basada fundamentalmente en la historia natural de la enfermedad y utiliza criterios pronosticos. Una clsaificación de esta naturaleza puede ser de gran utilidad para la toma de decisiones terapéuticas. De acuerdo con nuestros hallazgos la cisticercosis cerebral se puede dividir básicamente en formas benignas y malignas. La forma maligna por excelencia es la hidrocefalia. Las formas malignas requieren por lo general tratamiento quirúrgico y medicamentoso. En las formas benignas el tratamiento es básicamente sintomático medicamentoso. El praziquantel ha demostrado su utilidad únicamente en los pacientes con quistes pequeños parenquimatosos o subaracnoideos múltiples sin hidrocefalia

A prognostic classification of cerebral cysticercosis: therapeutic implications.

Cerebral cysticercosis is a parasitic infestation with a highly variable prognosis and diverse clinical manifestations. Over the period of two years 51 patients were studied prospectively with this infestation, paying particular attention to the duration and severity of the illness, clinical course, CT findings and therapeutic modalities. Patients with parenchymal cysts or calcification without hydrocephalus had a benign disorder presenting commonly with seizures. This type of infestation usually is long-standing, almost never requires surgical treatment, responds to praziquantel therapy and has a good prognosis. In contrast, patients who present with hydrocephalus, large supratentorial cysts, multiple granulomata with cerebral oedema or with vasculitis and cerebral infarction, have an aggressive, acute or subacute illness, presenting with raised intracranial pressure, gait disturbances, mental changes, seizures, cranial nerve palsies, hemisphere syndromes, chronic meningitis and stroke. This malignant form usually requires surgical therapy, does not respond to praziquantel and may produce a fatal outcome or serious sequelae.

Neurocysticercosis: a new classification based on active and inactive forms. A study of 753 cases.

Cysticercosis of the central nervous system, because of the combination of inflammatory response, topography of lesions, degree of parasitic infestation, and sequelae of previous infestations produces a most variable clinical picture. The symptomatology may range from a discrete neurological disturbance to the most dramatic brain disorder. Severity of the disease, prognosis, and medical or surgical decision for treatment largely depend on the individual amalgam of the above-referred factors. An improved classification of neurocysticercosis (NCC) that delineates active from inactive forms of the disease will eventually be important in the research of immunodiagnosis and in therapeutic trials. In this report, a classification is presented that separates active from nonactive forms of NCC and is based on our experience with 735 patients studied. Characteristics of each form of NCC, frequency of principal signs and symptoms, and findings in cerebrospinal fluid analysis are discussed.