RESUMO
The adenosine-deaminase (ADA) activity was evaluated in CSF samples from 263 patients with AIDS. An elevated ADA activity in CSF was found in patients with: antibodies to toxoplasmosis, syphilis or cytomegalovirus; Cryptococcus neoformans or their antigens; tuberculous meningitis; lymphoma. There was no statistical difference among all these groups in respect to ADA activity. However, the ADA activity in CSF from AIDS patients without CSF changes other than HIV antibodies, even unspecific changes, was not elevated. This may suggest that ADA is related to AIDS associated pathologies activity rather than to HIV infection itself.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/enzimologia , Síndrome da Imunodeficiência Adquirida/líquido cefalorraquidiano , Adenosina Desaminase/líquido cefalorraquidiano , Infecções Oportunistas Relacionadas com a AIDS/complicações , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/enzimologia , Anticorpos Anti-HIV/líquido cefalorraquidiano , HumanosRESUMO
In this preliminary report the results of PCR for detection of DNA sequences (65 KDa antigen) of Mycobacterium tuberculosis in CSF samples from 20 patients are registered. In 10 patients there were clinical and laboratory findings suggesting the diagnosis of tuberculous meningitis (test group). In the other 10 patients, clinical and laboratory findings suggested meningitis or meningo-encephalitis from other etiologies (control group). In 7 patients from the test group antigenic DNA sequences of Mycobacterium tuberculosis were found in CSF by PCR; positive results were not registered in the control group.
Assuntos
Reação em Cadeia da Polimerase , Tuberculose Meníngea/diagnóstico , HumanosRESUMO
Nesse relato preliminar säo registrados os resultados da pesquisa de PCR para detecçäo de sequências de DNA (antígeno 65 KDa) do Mycobacteruium tuberculosis no LCR. Foram estudadas amostras de LCR de 20 pacientes: em 10 havia suspeita clínica e laboratorial de neurotuberculose (grupo de teste); nos outros 10 havia suspeita diagnóstica de meningite ou menigoencefalite de outras etiologias ( grupo controle). Em 7 dos 10 pacientes do primeiro grupo a pesquisa de sequências antigênicas de DNA do Mycobacterium tuberculosis por PCR foi positiva; em nenhum dos pacientes do grupo controle a pesquisa foi positiva
Assuntos
Humanos , Reação em Cadeia da Polimerase , Tuberculose Meníngea/diagnóstico , Grupos ControleRESUMO
Phenobarbital plasma levels were studied in a group of 25 newborn infants. Phenobarbital was administered i.v. in all cases throughout the study period. The mean loading dose was 19.4 mg/kg, ranging from 16.4 to 20.5, and the mean maintenance dose was 4.0 mg/kg/day, varying from 2.6 to 5.0. We obtained mean plasma levels of 22.9 micrograms/ml, 24 h after administering the loading dose. Mean plasma levels at 4, 7, 14 and 21 days were in the therapeutic range (15-40 micrograms/ml), with only a few cases falling outside of it. There was no difference in plasma phenobarbital levels between term and pre-term infants. Side effects were not seen in infants without a severe neurological impairment prior to drug administration.
Assuntos
Fenobarbital/uso terapêutico , Convulsões/tratamento farmacológico , Causas de Morte , Relação Dose-Resposta a Droga , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Injeções Intravenosas , Masculino , Fenobarbital/efeitos adversos , Fenobarbital/sangue , Convulsões/sangue , Resultado do TratamentoRESUMO
Clinical approach has been made in eight patients with histoplasmosis of the central nervous system. All patients had no evidence of immunodepression. Time disease at diagnosis ranged from 6 to 108 months (median 36 months). Main signs and symptoms were: intracranial hypertension in 6 patients; impairment of memory in 4; confusion in 4; seizures in 2; urinary incontinence in 2; sexual impotency in 1. Meningo-encephalitic form was present in 6 patients, while the granulomatous form was found in 2. Diagnostic confirmation was based on: biopsy, in 1 case; necropsy, in 2 cases; cerebrospinal fluid (CSF) sediment culture, in 1; detection of antibodies against Histoplasma capsulatum in the CSF, in 5 cases. There was, in all patients, an expressive difference between CSF alterations (intense, merging acute and chronic phase elements) and clinical symptomatology (patients in general oligosymptomatic).
Assuntos
Doenças do Sistema Nervoso Central/diagnóstico , Histoplasmose/diagnóstico , Adolescente , Adulto , Doenças do Sistema Nervoso Central/fisiopatologia , Criança , Feminino , Histoplasmose/fisiopatologia , Humanos , Masculino , Meningoencefalite/diagnóstico , Meningoencefalite/fisiopatologia , Pessoa de Meia-IdadeRESUMO
Attention given to prophylaxis of neurocysticercosis (NC) is far beyond minimal needs among several regions of the in-development world, and for this reason incidence of the disease persists high among them. This investigation was carried out to show the extent of the problem by analysing the incidence of NC in a region of Brazil (São Paulo). CSF immunodiagnosis of NC by detecting antibodies to Cysticercus cellulosae in a neurodiagnostics laboratory is evaluated for this purpose. Cases studied in a 63-year period (1929-1992) are reviewed. Total cases in this period is 139,000, and for 1,573 (1.13%) diagnosis is NC. Special characteristics were not detected for colour and sex prevalence. Age bracket prevalence is from 21 to 40 years old (55.3%) high rates occurring for women between 21 to 30 years old, and for men between 31 to 40. Cases distribution in five consecutive decades (1942-1991) shows no decreasing tendency: average incidence is 1% for the 50 years, and it is over this average for the last three decades. Data confirm that incidence continues expressively high throughout the 50 years covered by this study.
Assuntos
Anticorpos Anti-Helmínticos/líquido cefalorraquidiano , Doenças do Sistema Nervoso Central/diagnóstico , Cisticercose/diagnóstico , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Doenças do Sistema Nervoso Central/líquido cefalorraquidiano , Doenças do Sistema Nervoso Central/epidemiologia , Criança , Pré-Escolar , Cisticercose/líquido cefalorraquidiano , Cisticercose/epidemiologia , Feminino , Humanos , Testes Imunológicos , Incidência , Lactente , Masculino , Prevalência , Estudos Retrospectivos , Estações do Ano , Distribuição por Sexo , Fatores SocioeconômicosRESUMO
One hundred and thirteen samples of CSF from eight patients with chronic meningitis were studied in a 12 years period (September, 1980-August, 1992). None of them had AIDS. In all, CNS histoplasmosis diagnosis was made by CSF examination. All cases tested positive for antibodies to Histoplasma capsulatum in CSF; in one case the yeast grew in Sabouraud culture in three different occasions. The main findings in CSF by the time of the diagnosis were: moderate hypercytosis marked by lymphocytes and monocytes, neutrophils-being present and in some cases eosinophil cells; moderate increase of total proteins content; decrease in the glucose content; and moderate increase of gamma globulins sometimes with oligoclonal reaction. Patients were followed-up from 7 to 102 months, and periodically submitted to CSF examinations according to clinics. Cell number and total protein content of CSF showed marked episodes of exacerbation in the follow-up, with a dissociated profile favoring total protein content which got higher with the chronification of the disease. Changes in the CSF pattern with treatment were: rapid decrease of hypercytosis; disappearence of neutrophil and eosinophil cells; increase in glucose content; and slow reduction of the increased contents of total proteins and gamma globulins.
Assuntos
Encefalopatias/líquido cefalorraquidiano , Histoplasmose/líquido cefalorraquidiano , Adolescente , Adulto , Anticorpos Antifúngicos/isolamento & purificação , Encefalopatias/diagnóstico , Criança , Testes de Fixação de Complemento , Diagnóstico Diferencial , Feminino , Histoplasmose/diagnóstico , Humanos , Masculino , Meningoencefalite/líquido cefalorraquidiano , Meningoencefalite/diagnóstico , Pessoa de Meia-IdadeRESUMO
In an eight years time period (July 1984-June 1992) CSF samples of 40718 patients were studied, and 610 were from patients with AIDS clinically diagnosed and immunologically confirmed through HIV antibodies detection. Among opportunistic infections detected in them 85 were CNS cryptococcosis. For the purpose of this study the CSF of these 85 patients are the AIDS group of CNS cryptococcosis. For comparison, CSF data from 50 patients with CNS cryptococcosis but without AIDS were taken (non-AIDS group); in this group, 22 patients were immunosuppressed after renal transplant. In AIDS group, the more frequent CSF findings were: yeast presence at direct exam (Fuchs-Rosenthal cell counting chamber), growing of the yeast in cultures, and gamma globulins increase. In non-AIDS group were more frequent: hypercytosis, neutrophil cells presence, and total protein increase. Differences between the two groups are discussed taking into account CNS/CSF immune changes induced by HIV infection. It is concluded that in CNS cryptococcosis of patients with AIDS the CSF evidenced more extensive signs of the fungal opportunistic infection than signs of inflammatory response to the infection. The latter were more prominent among patients of the non-AIDS group of CNS cryptococcosis.
Assuntos
Síndrome da Imunodeficiência Adquirida/líquido cefalorraquidiano , Encefalopatias/líquido cefalorraquidiano , Criptococose/líquido cefalorraquidiano , Síndrome da Imunodeficiência Adquirida/complicações , Adolescente , Adulto , Idoso , Encefalopatias/complicações , Criança , Criptococose/complicações , Feminino , Humanos , Transplante de Rim , Masculino , Pessoa de Meia-IdadeRESUMO
The behavior of CSF inflammatory pattern in patients with AIDS and/or toxoplasmosis of the CNS is studied in 176 patients, divided in three groups. In the first group, 96 patients with toxoplasmosis and AIDS are considered; in the second group, 50 patients with toxoplasmosis without AIDS; in the third group, 30 AIDS patients without toxoplasmosis nor any other opportunistic infection. It is possible to conclude that patients with toxoplasmosis associated to AIDS exhibit CSF inflammatory pattern similar to patients with neurotoxoplasmosis without AIDS, except in respect to gamma globulin rates for which a cumulative effect can be detected.