RESUMO
Neurocysticercosis is the most frequent parasitic disease of the central nervous system. It is caused by the larvae of Taenia solium, which can affect different anatomical sites. In Spain there is an increasing prevalence mainly due to immigration from endemic areas. The extraparenchymal forms are less common, but more serious because they usually develop complications. Neuroimaging plays a major role in the diagnosis and follow-up of this disease, supported by serology and a compatible clinical and epidemiological context. First-line treatments are cysticidal drugs such as albendazole and praziquantel, usually coadministered with corticosteroids, and in some cases surgery is indicated. We here report a case of neurocysticercosis with simultaneous intraventricular and giant racemose subarachnoid involvement.
Assuntos
Neurocisticercose/patologia , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Ventrículos Cerebrais/parasitologia , Dexametasona/uso terapêutico , Equador/etnologia , Feminino , Humanos , Hidrocefalia/etiologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neurocisticercose/complicações , Neurocisticercose/diagnóstico , Neurocisticercose/tratamento farmacológico , Neurocisticercose/cirurgia , Neuroimagem , Espanha , Espaço Subaracnóideo/parasitologia , Derivação VentriculoperitonealRESUMO
Adults of Gurltia paralysans were obtained from veins of the spinal cord subarachnoid space from three domestic cats presenting with chronic paraparesis/paraplegia from rural areas of southern Chile. Four adult nematodes were collected (2 males and 2 females) were recovered from cat 1, 14 adult nematodes (12 females and 2 males) from cat 2, and 12 nematodes (10 females and 2 males) were collected from cat 3. Parasite induced lesions that compromised subarachnoid vein microvasculature at the thoracic, lumbar, sacral spinal cord segments extending to conus medularis. Female nematodes measured 25 mm long (range=25-30 mm) and 0.1mm wide. Male measured a mean of 16 mm length (range=13-18 mm) with a body diameter of 0.1mm (range=0.08-0.15 mm). The present study described structural features of G. paralysans, a rare parasite first reported in the 1930s, and provides additional reports on associated clinical and pathological findings in naturally infected domestic cats.
Assuntos
Doenças do Gato/parasitologia , Nematoides/fisiologia , Infecções por Nematoides/veterinária , Paraparesia/veterinária , Paraplegia/veterinária , Animais , Gatos , Chile , Feminino , Masculino , Nematoides/anatomia & histologia , Infecções por Nematoides/complicações , Infecções por Nematoides/parasitologia , Paraparesia/etiologia , Paraparesia/parasitologia , Paraplegia/etiologia , Paraplegia/parasitologia , Medula Espinal/irrigação sanguínea , Medula Espinal/parasitologia , Espaço Subaracnóideo/parasitologiaAssuntos
Hidrocefalia/parasitologia , Ventrículos Laterais/patologia , Ventrículos Laterais/parasitologia , Neurocisticercose/patologia , Espaço Subaracnóideo/patologia , Espaço Subaracnóideo/parasitologia , Idoso , Derivações do Líquido Cefalorraquidiano/métodos , Evolução Fatal , Humanos , Hidrocefalia/cirurgia , Masculino , Neurocisticercose/complicações , Neurocisticercose/terapia , Falha de TratamentoRESUMO
Neurocysticercosis is an endemic disease in Latin America, Asia and Africa with growing occurrence in industrialized countries due to the increase in migration from low- and middle-income to high-income countries. The most severe clinical presentation is when the parasite is located in the subarachnoid space at the base of the brain (NCSAB). Aside from its clinical presentation, the severity of this form of the disease is due to the difficulties in diagnosis and treatment. Although NCSAB frequency is lower than that reported for the parenchymal location of the parasite, its clinical relevance must be emphasized. We provide a critical review of the central epidemiological, clinical, diagnostic and therapeutic features of this particular form of the disease, which is still associated with unacceptably high rates of morbidity and mortality.
Assuntos
Infecções Parasitárias do Sistema Nervoso Central/fisiopatologia , Neurocisticercose/fisiopatologia , Espaço Subaracnóideo/parasitologia , Adulto , África/epidemiologia , Animais , Ásia/epidemiologia , Infecções Parasitárias do Sistema Nervoso Central/diagnóstico por imagem , Infecções Parasitárias do Sistema Nervoso Central/epidemiologia , Infecções Parasitárias do Sistema Nervoso Central/parasitologia , Criança , Pré-Escolar , Doenças Endêmicas , Humanos , América Latina/epidemiologia , Imageamento por Ressonância Magnética , Neurocisticercose/diagnóstico por imagem , Neurocisticercose/epidemiologia , Neurocisticercose/parasitologia , Radiografia , Espaço Subaracnóideo/diagnóstico por imagem , Taenia soliumRESUMO
BACKGROUND: Conflicting reports have caused controversy on whether cysticidal drugs modify the natural course of neurocysticercosis. PURPOSE: To perform a meta-analysis of randomized trials assessing the effect of cysticidal drugs on neuroimaging and clinical outcomes of patients with neurocysticercosis. DATA SOURCES: Search of MEDLINE, Cochrane Database of Systematic Reviews, and Literatura Latino-Americana y del Caribe en Ciencias de la Salud (LILACS) between 1979 and 2005. There were no language restrictions. STUDY SELECTION: Randomized trials of cysticidal drug therapy for neurocysticercosis that met predefined criteria designed to allow characterization of the disease and objective evaluation of therapy. The authors independently reviewed articles. Abstracted data included study design, number of randomly assigned patients and withdrawals, intervention, adverse events, timing of neuroimaging studies, and outcomes. DATA SYNTHESIS: Eleven studies met the inclusion criteria. Six trials randomly assigned 464 patients with cystic lesions (vesicular cysticerci), and 5 trials randomly assigned 478 patients with enhancing lesions (colloidal cysticerci). Parasites were located in the brain parenchyma or subarachnoid space at the convexity of the cerebral hemispheres. Cysticidal drug therapy was associated with complete resolution of cystic lesions (44% vs. 19%; P = 0.025). Trials on enhancing lesions showed a trend toward lesion resolution favoring the use of cysticidal drugs (72% vs. 63%; P = 0.38) that became statistically significant when an outlier trial was excluded from the analysis (69% vs. 55%; P = 0.006). Risk for seizure recurrence was lower after cysticidal treatment in patients with enhancing lesions (14% vs. 37%; P < 0.001). The single trial evaluating the frequency of seizures in patients with cystic lesions showed a 67% reduction in the rate of generalized seizures with treatment (P = 0.006). LIMITATIONS: Not all studies focused on the control of seizures as an outcome. CONCLUSIONS: Cysticidal drug therapy results in better resolution of colloidal and vesicular cysticerci, lower risk for recurrence of seizures in patients with colloidal cysticerci, and a reduction in the rate of generalized seizures in patients with vesicular cysticerci.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Neurocisticercose/tratamento farmacológico , Praziquantel/uso terapêutico , Albendazol/efeitos adversos , Anti-Helmínticos/efeitos adversos , Humanos , Neurocisticercose/complicações , Neurocisticercose/diagnóstico por imagem , Praziquantel/efeitos adversos , Radiografia , Prevenção Secundária , Convulsões/etiologia , Convulsões/prevenção & controle , Espaço Subaracnóideo/parasitologiaRESUMO
Thirty-six patients with subarachnoid and intraventricular cysticercosis were randomly assigned to receive albendazole at 15 or 30 mg/kg/day plus dexamethasone for 8 days. Results favored a higher dose, with larger cyst reduction on MRI at 90 and 180 days and higher albendazole sulfoxide levels in plasma. An albendazole course at 30 mg/kg/day combined with corticosteroids is safe and more effective than the usual dose. A single treatment was insufficient in intraventricular and giant cysts.
Assuntos
Albendazol/administração & dosagem , Anticestoides/administração & dosagem , Ventrículos Cerebrais/parasitologia , Dexametasona/administração & dosagem , Neurocisticercose/tratamento farmacológico , Espaço Subaracnóideo/parasitologia , Adulto , Albendazol/efeitos adversos , Albendazol/uso terapêutico , Anticestoides/efeitos adversos , Anticestoides/uso terapêutico , Dexametasona/uso terapêutico , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Feminino , Cefaleia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Neurocysticercosis, the infection of the human brain by the larvae of Taenia solium, is a major cause of acquired epilepsy in most low-income countries. Cases of neurocysticercosis are becoming more common in high-income countries because of increased migration and travel. Diagnosis by neuroimaging and serological assessment has greatly improved over the past decade, and the natural progression of the disease and response to antiparasitic drugs is now much better understood. Neurocysticercosis is potentially eradicable, and control interventions are underway to eliminate this infection. Meanwhile, updated information on diagnosis and management of neurocysticercosis is required, especially for clinicians who are unfamiliar with its wide array of clinical presentations.
Assuntos
Epilepsia/parasitologia , Neurocisticercose/diagnóstico , Neurocisticercose/terapia , Taenia solium/fisiologia , Animais , Antiparasitários/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/parasitologia , Encéfalo/patologia , Países em Desenvolvimento , Diagnóstico por Imagem/normas , Transmissão de Doença Infecciosa , Epilepsia/fisiopatologia , Humanos , Neurocisticercose/prevenção & controle , Radiografia , Espaço Subaracnóideo/parasitologia , Espaço Subaracnóideo/patologia , Espaço Subaracnóideo/fisiopatologiaRESUMO
OBJECTIVE: To evaluate the relevance of exposure and host biological factors in the heterogeneity of the clinical, radiological and inflammatory picture of neurocysticercosis (NCC). METHODS: 105 Mexican symptomatic NCC patients confirmed by imaging were studied before they received any specific treatment. The relationships studied were those between a) the patients' characteristics (gender, age and level of exposure), b) the type of clinical picture and c) the radiological and inflammatory characteristics of the disease (number, aspect, localization of the parasites, and CSF leukocyte counts). RESULTS: Seizures were the most frequent symptom and multiple subarachnoid cysticerci the most frequent localization. Symptomatology related to the developmental stage, number and localization of the parasites as well as the CSF leukocyte-counts. The total number of cysticercal lesions and of vesicular cysticerci increased with age,whereas the number of colloidal cysticerci decreased. CSF leukocyte-counts were higher in women than in men. Levels of exposure did not correlate with the clinical and radiological pictures. CONCLUSIONS: The variability found in the number, stage, localization and inflammation in the parasite lesions is strongly associated with the heterogeneity of NCC symptoms. The increased number of vesicular cysticerci and the decreased number of degenerating cysticerci with aging, as well as the prominence of inflammation in women suggest that immuno-endocrinological factors may play a role in susceptibility and pathogenesis. The data also show that with increasing age and exposure there is no increment in severity, a suggestion that there might be ways of regulating pathogenicity.
Assuntos
Encéfalo/patologia , Encéfalo/parasitologia , Neurocisticercose/epidemiologia , Neurocisticercose/parasitologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Encéfalo/diagnóstico por imagem , Causalidade , Líquido Cefalorraquidiano/citologia , Encefalite/diagnóstico por imagem , Encefalite/parasitologia , Encefalite/patologia , Exposição Ambiental , Feminino , Humanos , Contagem de Leucócitos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Neurocisticercose/líquido cefalorraquidiano , População Rural/estatística & dados numéricos , Distribuição por Sexo , Fatores Sexuais , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/parasitologia , Espaço Subaracnóideo/patologia , Tomografia Computadorizada por Raios X , População Urbana/estatística & dados numéricosRESUMO
Seventeen patients with subarachnoid cysticerci received albendazole at doses of 15 mg/kg/day for eight days. All patients also received corticosteroids during the trial. Evaluation of the therapeutic response consisted of the comparison of the number of cysts shown by CT before and three months after treatment, and the evaluation of the clinical status of the patients before and after the trial. Before treatment, the 17 patients had 30 subarachnoid cysticerci, 11 of which were > 50 mm in diameter. Seventeen cysts were located at the convexity of cerebral hemispheres, seven at the sylvian fissure, five at the ambiens cisterns, and one at the cerebellopontine angle cistern. Fourteen patients had seizures, 10 had hemiparesis, three were demented, one had diminution of visual acuity, and one had hemifacial spasm. Brain CT obtained after therapy showed resolution of 27 cysts (90% effectiveness). Fourteen (82%) patients had total resolution of all cysts. All but three patients were asymptomatic. Remaining deficits included hemiparesis in two patients and diminution of visual acuity in one. It is concluded that albendazole is an effective treatment for subarachnoid cysticerci as it causes disappearance of most lesions on CT, and produces considerable improvement in the clinical manifestations of the patients.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Cisticercose/tratamento farmacológico , Cisticercose/parasitologia , Espaço Subaracnóideo/parasitologia , Adulto , Idoso , Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Cisticercose/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Relato de dois casos de cisticercose medular, sendo o primeiro referente a uma paciente de 13 anos de idade, apresentando a forma intramedular, e o segundo a uma paciente de 51 anos de idade com cisticercose espinhal leptomeníngea. Numa revisäo de literatura (desde 1856), foram encontrados 95 casos publicados de cisticercose medular somados a dois de nossa casuística, mostrando a freqüência da doença. Dentro da patogenia da forma extramedular, os autores defendem a hipótese da migraçäo dos cisticercos do espaço subaracnóide intracranianao para o espinhal, baseando-se na distribuiçäo topográfica dos parasitos na medula