RESUMO
Abstract Development of ceftriaxone loaded nanostructured lipid carriers to increase permeability of ceftriaxone across uninflamed meninges after parenteral administration. Lipids were selected by theoretical and experimental techniques and optimization of NLCs done by response surface methodology using Box-Behnken design. The Δδt for glyceryl monostearate and Capryol90 were 4.39 and 2.92 respectively. The drug had maximum solubility of 0.175% (w/w) in glycerol monostearate and 2.56g of Capryol90 dissolved 10mg of drug. The binary mixture consisted of glyceryl monostearate and Capryol90 in a ratio of 70:30. The optimized NLCs particle size was 130.54nm, polydispersity index 0.28, % entrapment efficiency 44.32%, zeta potential -29.05mV, and % drug loading 8.10%. In vitro permeability of ceftriaxone loaded NLCs was 5.06x10-6 cm/s; evidently, the NLCs pervaded through uninflamed meninges, which, was further confirmed from in vivo biodistribution studies. The ratio of drug concentration between brain and plasma for ceftriaxone loaded NLCs was 0.29 and that for ceftriaxone solution was 0.02. With 44.32% entrapment of the drug in NLCs the biodistribution of ceftriaxone was enhanced 7.9 times compared with that of ceftriaxone solution. DSC and XRD studies revealed formation of imperfect crystalline NLCs. NLCs improved permeability of ceftriaxone through uninflamed meninges resulting in better management of CNS infections.
Assuntos
Ceftriaxona/agonistas , Triagem/classificação , Lipídeos/análise , Difração de Raios X/instrumentação , Técnicas In Vitro/métodos , Infecções do Sistema Nervoso Central/patologiaRESUMO
Central nervous system (CNS) infection by Histoplasma capsulatum is a rare disease in immunocompromised individuals in endemic areas. About one quarter of cases result from hematogenous dissemination. A 23-year-old upholsterer with chronic occipital headache had developed intracranial hypertension and dizziness, incoordination with ataxic gait, and acute confusion 5 months prior to admission. Laboratory examinations and chest roentgenogram were normal. Postcontrast T1-weighted MRI of the brain revealed a multiple ring-enhancing cerebellar, brain stem and parietal lobe lesions, and meningeal contrast enhancement. Cerebrospinal fluid culture was positive for H. capsulatum species complex, which was confirmed by phylogenetic analysis. Thirteen years after the diagnosis and treatment, there was no H. capsulatum recurrence; sequels related to complications due to the ventriculoperitoneal shunt. This case shows a primary neurological presentation of cerebral histoplasmosis, without meningitis or disseminated disease in nonimmune-compromised patient. The authors propose a categorization of the diagnosis of CNS histoplasmosis. Routine diagnostics of sibling species within the H. capsulatum complex proved to be difficult.
Assuntos
Infecções do Sistema Nervoso Central/microbiologia , Histoplasma , Histoplasmose/diagnóstico , Adulto , Infecções do Sistema Nervoso Central/patologia , Líquido Cefalorraquidiano/microbiologia , DNA Espaçador Ribossômico/genética , Genes Fúngicos , Histoplasma/genética , Histoplasma/isolamento & purificação , Histoplasmose/patologia , Humanos , Masculino , Filogenia , Adulto JovemRESUMO
Bartonella henselae infection is a prevalent illness in Chile. It presents generally as a cat scratch disease or as a prolonged fever syndrome. There are atypical manifestations, which include central nervous system, bone, cardiac and hepato-esplenic compromised. We present an adolescent case with a history of fever, vomiting and ataxia, whose diagnosis was a central nervous system infection by Bartonella henselae associated with a choroid plexus papilloma. This case corresponds to an unusual presentation, with a challenging diagnosis. It is controversial whether to treat this patient, which antimicrobial is the right choice and how long the treatment should be.
Assuntos
Doença da Arranhadura de Gato/diagnóstico por imagem , Infecções do Sistema Nervoso Central/microbiologia , Papiloma do Plexo Corióideo/diagnóstico por imagem , Adolescente , Biópsia , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/patologia , Infecções do Sistema Nervoso Central/diagnóstico por imagem , Infecções do Sistema Nervoso Central/patologia , Feminino , Humanos , Papiloma do Plexo Corióideo/complicações , Papiloma do Plexo Corióideo/patologia , Tomografia Computadorizada por Raios XRESUMO
Resumen La infección por Bartonella henselae es una enfermedad prevalente en nuestro país. En general, se presenta como la enfermedad por arañazo de gato o un síndrome febril prolongado. Existen manifestaciones atípicas dentro de las cuales está el compromiso óseo, cardíaco, hepatoesplénico y del sistema nervioso central. Se presenta el caso de una adolescente con historia de vómitos, fiebre y ataxia, en que se diagnosticó una infección por Bartonella henselae con compromiso del sistema nervioso central, asociada a un papiloma del plexo coroídeo. Este caso corresponde a una presentación inusual, de difícil diagnóstico. Su tratamiento es motivo de controversia, tanto en si es necesario tratar, la elección del antimicrobiano, como su duración.
Bartonella henselae infection is a prevalent illness in Chile. It presents generally as a cat scratch disease or as a prolonged fever syndrome. There are atypical manifestations, which include central nervous system, bone, cardiac and hepato-esplenic compromised. We present an adolescent case with a history of fever, vomiting and ataxia, whose diagnosis was a central nervous system infection by Bartonella henselae associated with a choroid plexus papilloma. This case corresponds to an unusual presentation, with a challenging diagnosis. It is controversial whether to treat this patient, which antimicrobial is the right choice and how long the treatment should be.
Assuntos
Humanos , Feminino , Adolescente , Doença da Arranhadura de Gato/diagnóstico por imagem , Infecções do Sistema Nervoso Central/microbiologia , Papiloma do Plexo Corióideo/diagnóstico por imagem , Biópsia , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/patologia , Tomografia Computadorizada por Raios X , Infecções do Sistema Nervoso Central/patologia , Infecções do Sistema Nervoso Central/diagnóstico por imagem , Papiloma do Plexo Corióideo/complicações , Papiloma do Plexo Corióideo/patologiaRESUMO
Although computed tomography is often the first line of imaging in the emergency setting, magnetic resonance imaging (MRI) is of increasing importance in the evaluation of central nervous system emergencies in the pediatric population. As such, it is necessary to understand the indications for which MRI may be necessary. This article reviews the unique pathophysiologic entities affecting the pediatric population and the associated MRI findings. Specifically, utility of emergent MRI and characteristic appearances of traumatic brain injury, traumatic spinal injury, nonaccidental trauma, arterial ischemic stroke, cerebral sinovenous thrombosis, stroke mimics, and central nervous system infections are described.
Assuntos
Doenças do Sistema Nervoso Central/patologia , Serviços Médicos de Emergência/métodos , Imageamento por Ressonância Magnética/métodos , Pediatria/métodos , Lesões Encefálicas/patologia , Infecções do Sistema Nervoso Central/patologia , Criança , Pré-Escolar , Emergências , Humanos , Lactente , Trombose Intracraniana/patologia , Acidente Vascular Cerebral/patologiaRESUMO
Nombre y código del CIE-10. Infecciones e infestaciones del sistema nervioso central. Además deberán colocarse en el Código del CIE-10. CIE 10: GO6. GEO: Absceso intracraneal e intraraquideo. GO6.0: Absceso y granuloma intracraneal. GO6.1: Absceso y granuloma intraraquideo. GO6.2: Absceso extradural y subdural no especificado. B69: Cisticercosis. B69.0: Cisticercosis del sistema nervioso central. B69.8: Cisticercosis de otros sitios.
Assuntos
Humanos , Infecções Parasitárias do Sistema Nervoso Central , Infecções do Sistema Nervoso Central , Infecções do Sistema Nervoso Central/diagnóstico , Infecções do Sistema Nervoso Central/etiologia , Infecções do Sistema Nervoso Central/fisiopatologia , Infecções do Sistema Nervoso Central/patologia , Infecções do Sistema Nervoso Central/terapia , Infecções do Sistema Nervoso Central/epidemiologiaRESUMO
INTRODUCTION: Almost three out of every four people in the world who suffer a fatal stroke live in developing countries. A number of different tropical diseases may appear in Europe in the coming years as a consequence of the demographic change that is being brought about by migratory flows. We review the main infectious causes of strokes in the tropics. DEVELOPMENT: There are estimated to be 500 million cases of malaria every year. Cerebral malaria can cause cerebral oedema, diffuse or focal compromise of the subcortical white matter and cortical, cerebellar and pontine infarctions. Chagas disease is an independent risk factor for stroke in South America. At least 20 million people have the chronic form of Chagas disease. The main prognostic factors for Chagas-related stroke are the presence of apical aneurysms, arrhythmia and heart failure. Vascular complications of neurocysticercosis include transient ischemic attacks, ischemic strokes due to angiitis and intracranial haemorrhages. The frequency of cerebral infarction associated with neurocysticercosis varies between 2% and 12%. Gnathostomiasis is a cause of subarachnoid haemorrhage in south-east Asia. Other less common causes of stroke are viral haemorrhagic fevers due to arenavirus and flavivirus. CONCLUSIONS: Several diseases that are endemic in the tropics can be responsible for up to 10% of the cases of strokes in adults.
Assuntos
Infecções do Sistema Nervoso Central/complicações , Acidente Vascular Cerebral/etiologia , Clima Tropical , Medicina Tropical , Animais , Infecções do Sistema Nervoso Central/patologia , Infecções do Sistema Nervoso Central/fisiopatologia , Infecções do Sistema Nervoso Central/terapia , Doença de Chagas/complicações , Doença de Chagas/patologia , Doença de Chagas/fisiopatologia , Doença de Chagas/terapia , Diagnóstico Diferencial , Gnathostoma/parasitologia , Febres Hemorrágicas Virais/complicações , Febres Hemorrágicas Virais/patologia , Febres Hemorrágicas Virais/fisiopatologia , Febres Hemorrágicas Virais/terapia , Humanos , Malária/complicações , Malária/patologia , Malária/fisiopatologia , Malária/terapia , Neurocisticercose/complicações , Neurocisticercose/patologia , Neurocisticercose/fisiopatologia , Neurocisticercose/terapia , Fatores de Risco , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia , Tripanossomíase/complicações , Tripanossomíase/patologia , Tripanossomíase/fisiopatologia , Tripanossomíase/terapiaRESUMO
The lesions of the central nervous system represent an important cause of morbid-mortality in the neonatal period. This is due to the vulnerability of the brain to several adverse conditions during gestation and after birth. This study analyses the prevalence and pattern of central nervous system lesions in neonates autopsied at Hospital de Clínicas - Curitiba. There were 5743 pediatric autopsies performed in the Sector of Anatomic Pathology from 1960 to 1995 with 2049 cases corresponding to death during neonatal period. These later autopsies were reviewed and all cases with central nervous system lesions were selected and classified according to sex, age and pattern of central nervous system lesion. The central nervous system was affected in 1616 (78,87%) of neonatal autopsies and there was predominance of intracerebral hemorrhages (73,39%), congenital malformations (4,27%) and infections (3,59%). The hypoxic hemorrhages are the most prevalent central nervous system lesions in the neonatal period, affecting mainly premature babies. There was predominance of central nervous system malformations in the female neonates.
Assuntos
Doenças do Sistema Nervoso Central/epidemiologia , Distribuição por Idade , Autopsia , Doenças do Sistema Nervoso Central/congênito , Doenças do Sistema Nervoso Central/patologia , Infecções do Sistema Nervoso Central/epidemiologia , Infecções do Sistema Nervoso Central/patologia , Feminino , Humanos , Recém-Nascido , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/patologia , Masculino , Prevalência , Estudos Retrospectivos , Distribuição por SexoRESUMO
Las infecciones del sistema nervioso central(SNC)pueden presentarse como lesiones ocupantes seudotumorales con efecto de masa,principalmente en pacientes inmunosuprimidos,pudiendo ser la primera manifestación de la enfermedad.La mayoría de los casos publicados corresponden a adultos especialmente dentro de la población HIV.En un contexto clínico adecuado,lesiones de tipo tumoral en las neuroimágenes,deben plantear el diagnóstico diferencial con patología infecciosa.Nuestro objetivo es describir los hallazgos clínicos y de neuroimágenes de 16 pacientes con infecciones intracraneanas a forma seudotumoral que requieren cirugía con presunción diagnóstica de lesión neoplásica.En nuestra serie de 1.0005 lesiones expansivas intracraneales neuroquirúrgicas,excluyendo inmunosuprimidos,trasplantados y HIV conocidos(con riesgo potencial de absceso cerebral)se diagnosticaron en 16 biopsias cerebrales(1,6 por ciento)Infecciones por protozoarios(enfermedad de Chagas:2,toxoplasmosis:3,uno de ellos asociado a Mycobacterium avium intracellulare,amebas de via libre:2)cestodes(Cysticercus cellulosae:2,quiste hidiatídico Echinococcus granulosus:4 y tuberculomas:3.En casos clínicos estudiados y seleccionados algunas observaciones pueden ayudar a evitar procedimientos invasivos del SNC así como modificar la táctica y técnica quirúrgica
Assuntos
Pré-Escolar , Criança , Adolescente , Sistema Nervoso Central/imunologia , Sistema Nervoso Central/patologia , Infecções do Sistema Nervoso Central/cirurgia , Infecções do Sistema Nervoso Central/patologia , PediatriaRESUMO
Las infecciones del sistema nervioso central(SNC)pueden presentarse como lesiones ocupantes seudotumorales con efecto de masa,principalmente en pacientes inmunosuprimidos,pudiendo ser la primera manifestación de la enfermedad.La mayoría de los casos publicados corresponden a adultos especialmente dentro de la población HIV.En un contexto clínico adecuado,lesiones de tipo tumoral en las neuroimágenes,deben plantear el diagnóstico diferencial con patología infecciosa.Nuestro objetivo es describir los hallazgos clínicos y de neuroimágenes de 16 pacientes con infecciones intracraneanas a forma seudotumoral que requieren cirugía con presunción diagnóstica de lesión neoplásica.En nuestra serie de 1.0005 lesiones expansivas intracraneales neuroquirúrgicas,excluyendo inmunosuprimidos,trasplantados y HIV conocidos(con riesgo potencial de absceso cerebral)se diagnosticaron en 16 biopsias cerebrales(1,6 por ciento)Infecciones por protozoarios(enfermedad de Chagas:2,toxoplasmosis:3,uno de ellos asociado a Mycobacterium avium intracellulare,amebas de via libre:2)cestodes(Cysticercus cellulosae:2,quiste hidiatídico Echinococcus granulosus:4 y tuberculomas:3.En casos clínicos estudiados y seleccionados algunas observaciones pueden ayudar a evitar procedimientos invasivos del SNC así como modificar la táctica y técnica quirúrgica