RESUMO
Angiostrongylus cantonensis is a zoonotic pathogen that occasionally causes human angiostrongyliasis; its main clinical manifestation is eosinophilic meningitis. This report defines the concept of intrathecal activation of complement as evidence of intrathecal synthesis of major immunoglobulins during this disease. Details are presented of the activation of complement system components in cerebrospinal fluid, and their application to our understanding of this tropical disease, which is emerging in the Western hemisphere. Intrathecal synthesis of at least one of the major immunoglobulins and a wide spectrum of patterns may be observed. Although intrathecal synthesis of C3c is always present, C4 intrathecal synthesis does not occur in every patient. The diversity of intrathecal synthesis and activation of the different complement pathways enables their division into three variant groups (A, B, and C). Variant group A includes the classical and/or lectin pathway and involves two or more major immunoglobulins with C3 and C4 intrathecal synthesis. Variant group B involves C4 in cerebrospinal fluid that comes from blood in the intrathecal activation of the classical pathway. Variant group C includes the alternative pathway.
Assuntos
Sistema Nervoso Central/imunologia , Sistema Nervoso Central/parasitologia , Infecções por Strongylida/imunologia , Angiostrongylus cantonensis/isolamento & purificação , Angiostrongylus cantonensis/patogenicidade , Animais , Complemento C3c/líquido cefalorraquidiano , Complemento C3c/imunologia , Complemento C4b/líquido cefalorraquidiano , Complemento C4b/imunologia , Eosinofilia/líquido cefalorraquidiano , Eosinofilia/imunologia , Eosinofilia/parasitologia , Humanos , Imunoglobulinas/líquido cefalorraquidiano , Imunoglobulinas/imunologia , Meningite/líquido cefalorraquidiano , Meningite/imunologia , Meningite/parasitologia , Fragmentos de Peptídeos/líquido cefalorraquidiano , Fragmentos de Peptídeos/imunologia , Infecções por Strongylida/líquido cefalorraquidiano , Infecções por Strongylida/parasitologiaRESUMO
UNLABELLED: Meningitis caused by Angiostrongylus cantonensis has recently been reported in patients resulting from the first outbreaks in subtropical regions of Ecuador. METHOD: Eight young adult patients from the two outbreaks were studied. IgA, IgM, IgG and albumin in cerebrospinal fluid and serum were quantified and plotted in cerebrospinal fluid/serum quotient diagrams (Reibergrams). The anamnesis on the patients included asking about any consumption of raw snails, symptoms and harm caused. RESULTS: Mean eosinophilia of 7.5% and 26% in serum and cerebrospinal fluid respectively was observed, as well as a moderate increase in total proteins. The most frequent pattern of intrathecal synthesis was observed in three classes of immunoglobulins. Intrathecal synthesis of IgM was observed in all cases two weeks after the first symptoms appeared. CONCLUSION: The intrathecal synthesis patterns of eosinophilic meningitis due to Angiostrongylus cantonensis, facilitated by cerebrospinal fluid analysis, were similar to those of previous cases from abroad.
Assuntos
Angiostrongylus cantonensis/imunologia , Eosinofilia/imunologia , Meningite/imunologia , Infecções por Strongylida/imunologia , Adolescente , Adulto , Albuminas/análise , Animais , Surtos de Doenças , Equador/epidemiologia , Eosinofilia/epidemiologia , Eosinofilia/parasitologia , Humanos , Imunoglobulinas/análise , Meningite/epidemiologia , Meningite/parasitologia , Infecções por Strongylida/epidemiologia , Infecções por Strongylida/parasitologia , Adulto JovemRESUMO
Meningitis caused by Angiostrongylus cantonensis has recently been reported in patients resulting from the first outbreaks in subtropical regions of Ecuador. METHOD: Eight young adult patients from the two outbreaks were studied. IgA, IgM, IgG and albumin in cerebrospinal fluid and serum were quantified and plotted in cerebrospinal fluid/serum quotient diagrams (Reibergrams). The anamnesis on the patients included asking about any consumption of raw snails, symptoms and harm caused. RESULTS: Mean eosinophilia of 7.5 percent and 26 percent in serum and cerebrospinal fluid respectively was observed, as well as a moderate increase in total proteins. The most frequent pattern of intrathecal synthesis was observed in three classes of immunoglobulins. Intrathecal synthesis of IgM was observed in all cases two weeks after the first symptoms appeared. CONCLUSION: The intrathecal synthesis patterns of eosinophilic meningitis due to Angiostrongylus cantonensis, facilitated by cerebrospinal fluid analysis, were similar to those of previous cases from abroad.
La meningitis provocada por Angiostrongylus cantonensis ha sido reportada recientemente en pacientes procedentes de los primeros brotes reportados en regiones subtropicales de Ecuador. MÉTODO: Ocho adultos jóvenes procedentes de dos brotes fueron estudiados. Se cuantificó IgA, IgM, IgG y albúmina en suero y líquido cefalorraquídeo y fueron colocados en los gráficos de las razones líquido cefalorraquídeo/suero (reibergramas). La anamnesia incluía ingestión de caracoles crudos, los síntomas y los daños provocados. RESULTADOS: Una eosinofílica promedio de 7,5 y 26 por ciento en suero y líquido cefalorraquídeo fue observada al igual que un moderado incremento en las proteínas totales. El patrón de síntesis intratecal predominante fue de tres clases de inmunoglobulinas. La síntesis intratecal de IgM se observó en todos los casos a las dos semanas después del inicio de los síntomas. CONCLUSIÓN: El patrón de síntesis intratecal de la meningitis eosinofílica por Angiostrongylus cantonensis facilitado por el análisis del líquido cefalorraquídeo fue similar a los casos previos reportados fuera del país.
Assuntos
Adolescente , Adulto , Animais , Humanos , Adulto Jovem , Angiostrongylus cantonensis/imunologia , Eosinofilia/imunologia , Meningite/imunologia , Infecções por Strongylida/imunologia , Albuminas/análise , Surtos de Doenças , Equador/epidemiologia , Eosinofilia/epidemiologia , Eosinofilia/parasitologia , Imunoglobulinas/análise , Meningite/epidemiologia , Meningite/parasitologia , Infecções por Strongylida/epidemiologia , Infecções por Strongylida/parasitologiaRESUMO
Angiostrongylus cantonensis meningitis was first reported in Cuba in 1981, and it was recently reported in South America. The aim of this paper is to evaluate the intrathecal immunoglobulin synthesis patterns from Cuba's and Ecuador's patients with angiostrongyliasis; 8 Ecuadorian patients from two different outbreaks and 28 Cuban patients were studied. Simultaneous blood and cerebrospinal fluid samples were taken. Immunoglobulin (Ig) A, IgM, IgG, and albumin were quantified by radial immunodiffusion. Corresponding Reibergrams were applied. A three-Ig pattern was the most frequent in the two groups, but IgM was presented in all Ecuadorian young mature patients; however, in the Cuban children, only 12 of 28 patients had intrathecal IgM, but about 90% had an IgA and IgG synthesis at time of later puncture. This indicates that, with a larger amount of parasites ingested, clinical symptoms are more severe, and a higher frequency of intrathecal IgM synthesis could be observed. This is discussed as a similarity with the intrathecal IgM synthesis in African trypanosomiasis.
Assuntos
Imunoglobulinas/líquido cefalorraquidiano , Meningite/líquido cefalorraquidiano , Meningite/parasitologia , Criança , Pré-Escolar , Cuba/epidemiologia , Equador/epidemiologia , Humanos , Imunoglobulinas/metabolismo , Meningite/epidemiologia , Meningite/imunologia , Infecções por Strongylida/líquido cefalorraquidiano , Infecções por Strongylida/epidemiologia , Infecções por Strongylida/imunologia , Infecções por Strongylida/metabolismo , Adulto JovemRESUMO
Angiostrongylus cantonensis produces eosinophilic meningitis in humans and is endemic in Thailand, Taiwan, China, and the Caribbean region. During infection with this parasite, it is important to know if the complement system may be activated by the classical or lectin pathway. Cerebrospinal fluid and serum samples from 20 patients with meningitic angiostrongyliasis were used to quantify C4 levels and albumin. Results were plotted on a C4 CSF/serum quotient diagram or Reibergram. Twelve patients showed intrathecal synthesis of C4. Antibody-dependent complement cytotoxicity should be considered as a possible mechanism that destroys third-stage larvae of this helminth in cerebrospinal fluid of affected patients.
Assuntos
Angiostrongylus cantonensis , Complemento C4/líquido cefalorraquidiano , Eosinofilia/parasitologia , Meningite/líquido cefalorraquidiano , Meningite/parasitologia , Infecções por Strongylida/líquido cefalorraquidiano , Adolescente , Adulto , Animais , Anticorpos Anti-Helmínticos , Criança , Pré-Escolar , Complemento C4/metabolismo , Eosinofilia/sangue , Eosinofilia/líquido cefalorraquidiano , Feminino , Humanos , Lactente , Masculino , Meningite/sangue , Infecções por Strongylida/sangue , Adulto JovemRESUMO
OBJECTIVE: There was an increased number of cases of meningoencephalitis caused by Streptococcus pneumoniae, after the successful vaccination campaigns against Neisseria meningitidis and Haemophilus influenzae. This paper aims at describing the clinical characteristics, the laboratory findings, the complications, and the therapeutic management of these patients, who have been suffering from this disease since 1993 to 2006. METHOD: Twelve children with Streptococcus pneumoniae meningoencephalitis admitted to the pediatric hospital of San Miguel del Padron, City of Havana in this period were assessed. RESULTS: Children under one year are the most frequently affected. Septic shock and brain edema were the most severe complications. Three patients died, implying that this disease has a serious course. Early treatment of brain edema is very important to reduce mortality. The elective drugs for treatment of these cases of Streptococcus pneumoniae meningoencephalitis were vancomycin combined with cephalosporin, cefotaxime or ceftriaxone type. CONCLUSION: Patients with Streptococcus pneumoniae meningoencephalitis show clinical characteristics, complications, and sequels that are different to other bacterial meningoencephalitis, meaning that they could be helpful for physicians considering the differential diagnosis of meningoencephalitis.
OBJETIVO: Existe un incremento de la meningoencefalitis producida por Streptococcus pneumoniae, después de las campañas exitosas de vacunación contra Neisseria meningitidis y Haemophilus influenzae. El objetivo de este trabajo es describir las caracteristicas clinicas, los hallazgos de laboratorio, las complicaciones y el manejo terapéutico de los pacientes que sufrieron esta enfermedad desde 1993 a 2006. MÉTODO: Se estudiaron doce niños con meningoencefalitis por Streptococcus pneumoniae ingresados en el Hospital Pediátrico de San Miguel del Padrón, Ciudad de La Habana en este periodo. RESULTADOS: Los niños menores de un año son los más frecuentemente afectados. El shock séptico y el edema cerebral las mayores complicaciones. Tres pacientes fallecieron. Esta enfermedad ha tenido un curso serio. El tratamiento temprano del edema cerebral es muy importante para reducir la mortalidad. Los medicamentos de elección para tratar la meningoencefalitis por Strepcococcus pneumoniae en los casos estudiados fueron la vancomicina combinada con cefalosporina del tipo de la cefatoxima o la ceftriaxona. CONCLUSION: Los pacientes con meningoencefalitis por Streptoccocus pneumoniae exhibieron características clínica, complicaciones y secuelas las cuales se diferencian de otras meningoencefalitis bacterianas. Por eso estos elementos pueden ayudar a los médicos en el diagnóstico diferencial
Assuntos
Criança , Humanos , Lactente , Meningoencefalite/microbiologia , Infecções Pneumocócicas/diagnóstico , Streptococcus pneumoniae , Antibacterianos/uso terapêutico , Estudos Transversais , Cefalosporinas/uso terapêutico , Meningoencefalite/diagnóstico , Meningoencefalite/tratamento farmacológico , Estudos Prospectivos , Infecções Pneumocócicas/tratamento farmacológico , Vancomicina/uso terapêuticoRESUMO
BACKGROUND: Multiple sclerosis (MS) was first reported in Cuba in 1965. The most frequent appearance is observed in the first six months of the year. OBJECTIVE: To determine the seasonal distribution and evolving forms of MS patients diagnosed with the disease between April 2004 and November 2007. METHOD: 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. RESULTS: 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. CONCLUSION: It is recommended to study further weather variables that may be related to the emergence of these outbreaks in our environment.
Assuntos
Surtos de Doenças , Esclerose Múltipla Crônica Progressiva/epidemiologia , Esclerose Múltipla Recidivante-Remitente/epidemiologia , Estações do Ano , Cuba/epidemiologia , HumanosRESUMO
BACKGROUND: Multiple sclerosis (MS) was first reported in Cuba in 1965. The most frequent appearance is observed in the first six months of the year. OBJECTIVE: To determine the seasonal distribution and evolving forms of MS patients diagnosed with the disease between April 2004 and November 2007. METHOD: 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. RESULTS: 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. CONCLUSION: It is recommended to study further weather variables that may be related to the emergence of these outbreaks in our environment.
INTRODUCCIÓN: 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. MÉTODO: 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. RESULTADOS: Solo dos pacientes clasificaron en la forma evolutiva progresiva primaria; los primeros dos trimestres del año fueron los de mayor número de brotes. CONCLUSIÓN: Se recomienda profundizar en las variables climatológicas que pudieran tener vínculo con la aparición de estos brotes en nuestro medio.
Assuntos
Humanos , Surtos de Doenças , Esclerose Múltipla Crônica Progressiva/epidemiologia , Esclerose Múltipla Recidivante-Remitente/epidemiologia , Estações do Ano , Cuba/epidemiologiaRESUMO
BACKGROUND: Cerebrospinal fluid (CSF)/serum quotient graphs have been used previously to determine local synthesis in brain of immunoglobulins and C3 complement component. The aim of this study was to use the same technique to construct quotient graphs, or Reibergrams, for the beta globulin C4 and to evaluate the method for assessing intrathecal synthesis in neurological disease. METHODS: The constants in the previously-defined Reibergram for immunoglobulin IgA were used to calculate the CSF/serum quotient for C4. CSF and serum were analyzed for C4, IgA and albumin from a total of 12 patients with meningoencephalitis caused by encapsulated microorganisms and 10 subjects without infections or inflammatory neurological disease, some of which had dysfunction of the blood-CSF barrier, RESULTS: The formula and C4 Reibergram with the constants previously found for IgA, determined the intrathecal C4 synthesis in CSF. The intrathecal C4 fraction in CSF (C4 loc in mg/l) was compared to the C4-Index (fraction of CSF: serum for C 4/fraction of CSF: serum for albumin). There was a significant correlation between the two formulae. The CSF/Serum quotient graph was superior for detecting intrathecal synthesis of C4 under variable conditions of blood-CSF barrier permeability. CONCLUSION: The C4 Reibergram can be used to quantify the intrathecal synthesis of this component of the complement system in different infectious diseases of the central nervous system and is especially useful for patients with blood-brain barrier dysfunction.
RESUMO
La enolasa específica de neurona es una isoenzima que se vierte al torrente sanguíneo después de un episodio de daño neuronal. En los procesos de hipoxia neonatal estos valores enzimáticos en suero suelen estar alterados. El objetivo del presente artículo fue estudiar la enolasa específica de neurona en suero de 2 recién nacidos con Apgar bajo y determinar si, en el seguimiento durante un año, dichos pacientes presentaban trastornos del desarrollo psicomotor. MÉTODOS. Se tomaron muestras de suero al momento del nacimiento y a las 72 h siguientes. Se determinaron los niveles de enolasa específica de neurona por un método inmunoenzimá tico de tipo ELISA. Cada muestra fue evaluada por el método de reacción en cadena de la polimerasa para citomegalovirus, en el Instituto de Inmunología de Wuersburg (Alemania). También se cuantificaron anticuerpos contra citomegalovirus de clase IgM e IgG, en el Laboratorio de Neuroquímica de la Universidad Georg August de Goettingen (Alemania). Se recogieron los datos clínicos de interés de cada recién nacido y al a±o se citaron a estos pacientes y se les realizó un examen físico para evaluar su neurodesarrollo. RESULTADOS. Las cifras de enolasa estuvieron incrementadas tanto al nacimiento como a las 72 h, con anticuerpos anticitomegalovirus de clase IgG que fueron transferidos de la madre a través de la placenta. No se encontró presencia de este virus en el momento del nacimiento. En el examen físico y neurológico realizado al año se constató que los niños evolucionaban satisfactoriamente hasta esa fecha. CONCLUSIONES. Se recomienda extender el estudio hasta los 3 años de vida y aumentar el número de pacientes estudiados, con énfasis en aquellos casos cuyo Apgar es menor de 5 a los 5 min del nacimiento.
Neuron-specific Enolase of is an isoenzyme present in blood stream after a neuronal damage episode. In processes of neonatal hypoxia, these enzymatic values in serum may be altered. The aim of present paper was to study Enolase specific of neuron in the serum of two newborns with low Apgar score and to determine if, during a one year follow-up, such patients presented disorders of psychomotor development. METHODS: We took serum samples at birth and at 72 hours. Levels of Enolase specific of neuron by immunoenzymatic method type ELISA were determined. Each sample was assessed by polymerase chain reaction (PCR) to cytomegalovirus in Wuersburg Institute of Immunology (Germany). Also, we quantified antibodies to IgM and IgG cytomegalovirus in Neurochemistry Institute of Georg August of Goettingen University (Germany). Interesting clinical data of each newborn were collected and after a year, all these patients were cited for a physical examination to evaluate tits neurodevelopment. RESULTS: Enolase figures were increased both at birth and at 72 hours, with IgG anticytomegalovirus antibodies from mother through placenta. At birth there was not presence of this virus. At physical and neurological examination performed at 1 year it was possible to confirm that children evolved adequately until now. CONCLUSIONS: Study must to be prolonged until 3 years of life, and to increase number of study patients, emphasizing on those with an Apgar score lower than 5 at 5 minutes post-birth.