Asunto(s)
Antígenos Helmínticos , Calcinosis/diagnóstico por imagen , Cysticercus/inmunología , Lóbulo Frontal/diagnóstico por imagen , Neurocisticercosis/diagnóstico por imagen , Convulsiones/diagnóstico por imagen , Corticoesteroides/uso terapéutico , Adulto , Animales , Anticonvulsivantes/uso terapéutico , Calcinosis/complicaciones , Calcinosis/inmunología , Calcinosis/parasitología , Cysticercus/patogenicidad , Electroencefalografía , Femenino , Lóbulo Frontal/inmunología , Lóbulo Frontal/parasitología , Humanos , Inyecciones Intravenosas , Neurocisticercosis/complicaciones , Neurocisticercosis/inmunología , Neurocisticercosis/parasitología , Neuroimagen , Convulsiones/complicaciones , Convulsiones/inmunología , Convulsiones/parasitologíaRESUMEN
BACKGROUND: Neurocysticercosis is a common helminthic infection of the central nervous system and an important cause of adult-onset epilepsy in endemic countries. However, few studies have examined associations between neurologic symptoms, serology and radiographic findings on a community-level. METHODOLOGY: We conducted a population-based study of resident's ≥2 years old in a highly endemic village in Peru (pop. 454). We applied a 14 -question neurologic screening tool and evaluated serum for antibodies against Taenia solium cysticercosis using enzyme-linked immunoelectrotransfer blot (LLGP-EITB). We invited all residents ≥18 years old to have non-contrast computerized tomography (CT) of the head. PRINCIPAL FINDINGS: Of the 385 residents who provided serum samples, 142 (36.9%) were seropositive. Of the 256 residents who underwent CT scan, 48 (18.8%) had brain calcifications consistent with NCC; 8/48 (17.0%) reported a history of headache and/or seizures. Exposure to T. solium is very common in this endemic community where 1 out of 5 residents had brain calcifications. However, the vast majority of people with calcifications were asymptomatic. CONCLUSION: This study reports a high prevalence of NCC infection in an endemic community in Peru and confirms that a large proportion of apparently asymptomatic residents have brain calcifications that could provoke seizures in the future.
Asunto(s)
Infecciones Asintomáticas/epidemiología , Enfermedades Endémicas , Neurocisticercosis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Anticuerpos Antihelmínticos/sangre , Encéfalo/parasitología , Encéfalo/patología , Niño , Preescolar , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Neurocisticercosis/sangre , Neurocisticercosis/diagnóstico por imagen , Neurocisticercosis/inmunología , Perú/epidemiología , Prevalencia , Salud Rural , Convulsiones/epidemiología , Convulsiones/etiología , Convulsiones/parasitología , Taenia solium/inmunología , Taenia solium/aislamiento & purificación , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
BACKGROUND: Randomized controlled trials have found an inconsistent effect of anthelmintic treatment on long-term seizure outcomes in neurocysticercosis. The objective of this study was to further explore the effect of albendazole treatment on long-term seizure outcomes and to determine if there is evidence for a differential effect by seizure type. METHODS: In this trial, 178 patients with active or transitional neurocysticercosis cysts and new-onset symptoms were randomized to 8 days of treatment with albendazole (n=88) or placebo (n=90), both with prednisone, and followed for 24 months. We used negative binomial regression and logistic regression models to determine the effect of albendazole on the number of seizures and probability of recurrent or new-onset seizures, respectively, over follow-up. RESULTS: Treatment with albendazole was associated with a reduction in the number of seizures during 24 months of follow-up, but this was only significant for generalized seizures during months 1-12 (unadjusted rate ratio [RR] 0.19; 95% CI: 0.04-0.91) and months 1-24 (unadjusted RR 0.06; 95% CI: 0.01-0.57). We did not detect a significant effect of albendazole on reducing the number of focal seizures or on the probability of having a seizure, regardless of seizure type or time period. CONCLUSIONS: Albendazole treatment may be associated with some symptomatic improvement; however, this association seems to be specific to generalized seizures. Future research is needed to identify strategies to better reduce long-term seizure burden in patients with neurocysticercosis.
Asunto(s)
Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Antiinflamatorios/uso terapéutico , Encéfalo/parasitología , Neurocisticercosis/tratamiento farmacológico , Convulsiones/parasitología , Animales , Encéfalo/patología , Quistes/parasitología , Quimioterapia Combinada , Ecuador/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neurocisticercosis/complicaciones , Neurocisticercosis/fisiopatología , Prednisona/uso terapéutico , Recurrencia , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
UNLABELLED: Neurocysticercosis is a parasitic disease that affects the central nervous system. The objective of this study was to investigate the correlation between neuronal death evaluated by the quantification of Fas apoptotic factor and the different evolutive forms of neurocysticercosis accompanied or not by epileptic seizures. METHODS: Cerebrospinal fluid samples from 36 patients with a diagnosis of neurocysticercosis divided into the following groups: active cystic form (n=15), 9 patients with and 6 without seizures, and calcified form (=21), 9 with and 12 without seizures. Fourteen patients comprised the control group. Fas protein concentrations were determined by ELISA. RESULTS: Only the group of patients with calcified cysts without seizures presented cerebrospinal fluid levels of Fas similar to those of the control group. Higher levels were observed for the other groups. CONCLUSIONS: The present finding suggests high cerebrospinal fluid levels of soluble Fas protein, except for patients with calcified cysts without seizures. Significant differences were observed for the group with calcified cysts and seizures, suggesting greater neuronal damage in these patients. Replacement of the term inactive cyst with reactive inactive cyst is suggested.
Asunto(s)
Calcinosis/líquido cefalorraquídeo , Proteína de Dominio de Muerte Asociada a Fas/líquido cefalorraquídeo , Neurocisticercosis/líquido cefalorraquídeo , Convulsiones/líquido cefalorraquídeo , Adulto , Biomarcadores/líquido cefalorraquídeo , Calcinosis/parasitología , Muerte Celular , Ensayo de Immunospot Ligado a Enzimas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Convulsiones/parasitología , Adulto JovenRESUMEN
Neurocysticercosis is a parasitic disease that affects the central nervous system. The objective of this study was to investigate the correlation between neuronal death evaluated by the quantification of Fas apoptotic factor and the different evolutive forms of neurocysticercosis accompanied or not by epileptic seizures. METHODS: Cerebrospinal fluid samples from 36 patients with a diagnosis of neurocysticercosis divided into the following groups: active cystic form (n=15), 9 patients with and 6 without seizures, and calcified form (=21), 9 with and 12 without seizures. Fourteen patients comprised the control group. Fas protein concentrations were determined by ELISA. RESULTS: Only the group of patients with calcified cysts without seizures presented cerebrospinal fluid levels of Fas similar to those of the control group. Higher levels were observed for the other groups. CONCLUSIONS: The present finding suggests high cerebrospinal fluid levels of soluble Fas protein, except for patients with calcified cysts without seizures. Significant differences were observed for the group with calcified cysts and seizures, suggesting greater neuronal damage in these patients. Replacement of the term inactive cyst with reactive inactive cyst is suggested.
Neurocisticercose é uma doença parasitária que afeta o sistema nervoso central. O objetivo deste estudo foi investigar a correlação entre morte neuronal por meio da quantificação do fator apoptótico Fas e a presença de neurocisticercose nas suas diferentes fases evolutivas, acompanhadas ou não de crises epilépticas. MÉTODOS: Foram analisadas amostras de líquido cefalorraquidiano em 36 pacientes com diagnóstico de neurocisticercose, determinando-se as concentrações da proteína Fas pelo método ELISA. Foram considerados os seguintes grupos: forma cística ativa n=15 (9 com crises, 6 sem crises), forma calcificada n=21 (9 com crises, 12 sem crises) e 14 pacientes (grupo controle). RESULTADOS: Apenas o grupo com calcificações sem crises apresentou níveis de Fas semelhantes ao controle. Maiores níveis foram observados nos outros grupos. CONCLUSÕES: As formas ativa e calcificada apresentam níveis elevados da proteína Fas, exceto para as formas calcificadas sem crises. No grupo de calcificações com crise, observamos diferenças mais expressivas, sugerindo maior dano neuronal. Sugerimos a substituição da denominação "cisto inativo" por "cisto inativo reagente".
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Calcinosis/líquido cefalorraquídeo , Proteína de Dominio de Muerte Asociada a Fas/líquido cefalorraquídeo , Neurocisticercosis/líquido cefalorraquídeo , Convulsiones/líquido cefalorraquídeo , Biomarcadores/líquido cefalorraquídeo , Muerte Celular , Calcinosis/parasitología , Ensayo de Immunospot Ligado a Enzimas , Estudios Prospectivos , Convulsiones/parasitologíaRESUMEN
Neuroysticercosis is the most common helminthic infection of the nervous system, and a leading cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of Taenia solium by ingesting its eggs from contaminated food or, most often, directly from a taenia carrier by the fecal-to-oral route. Cysticerci may be located in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that are responsible for the pleomorphism of neurocysticercosis. Seizures are the most common clinical manifestation, but many patients present with focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of neurocysticercosis is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. The introduction of cysticidal drugs have changed the prognosis of most patients with neurocysticercosis. These drugs have shown to reduce the burden of infection in the brain and to improve the clinical course of the disease in most patients. Further efforts should be directed to eradicate the disease through the implementation of control programs against all the interrelated steps in the life cycle of T. solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment.
Asunto(s)
Encéfalo/parasitología , Neurocisticercosis/parasitología , Taenia solium/patogenicidad , Animales , Antihelmínticos/administración & dosificación , Antihelmínticos/uso terapéutico , Anticonvulsivantes/administración & dosificación , Anticonvulsivantes/uso terapéutico , Encéfalo/patología , Trastornos del Conocimiento/parasitología , Trastornos del Conocimiento/patología , Humanos , Hidrocefalia/parasitología , Hidrocefalia/patología , Hipertensión Intracraneal/tratamiento farmacológico , Hipertensión Intracraneal/parasitología , Hipertensión Intracraneal/patología , Estadios del Ciclo de Vida , Neurocisticercosis/diagnóstico , Neurocisticercosis/tratamiento farmacológico , Neuroimagen/métodos , Prevalencia , Pronóstico , Convulsiones/tratamiento farmacológico , Convulsiones/parasitología , Convulsiones/patologíaRESUMEN
BACKGROUND: Neurocysticercosis accounts for 30%-50% of all late-onset epilepsy in endemic countries. We assessed the clustering patterns of Taenia solium human cysticercosis seropositivity and seizures around tapeworm carriers in seven rural communities in Peru. METHODOLOGY: The presence of T. solium-specific antibodies was defined as one or more positive bands in the enzyme-linked immunoelectrotransfer blot (EITB). Neurocysticercosis-related seizures cases were diagnosed clinically and had positive neuroimaging or EITB. PRINCIPAL FINDINGS: Eleven tapeworm carriers were identified by stool microscopy. The seroprevalence of human cysticercosis was 24% (196/803). Seroprevalence was 21% >50 m from a carrier and increased to 32% at 1-50 m (p = 0.047), and from that distance seroprevalence had another significant increase to 64% at the homes of carriers (p = 0.004). Seizure prevalence was 3.0% (25/837) but there were no differences between any pair of distance ranges (p = 0.629, Wald test 2 degrees of freedom). CONCLUSION/SIGNIFICANCE: We observed a significant human cysticercosis seroprevalence gradient surrounding current tapeworm carriers, although cysticercosis-related seizures did not cluster around carriers. Due to differences in the timing of the two outcomes, seroprevalence may reflect recent T. solium exposure more accurately than seizure frequency.
Asunto(s)
Cisticercosis/epidemiología , Convulsiones/epidemiología , Taenia solium/inmunología , Adolescente , Adulto , Animales , Anticuerpos Antihelmínticos/sangre , Portador Sano/parasitología , Niño , Preescolar , Cisticercosis/complicaciones , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Perú/epidemiología , Prevalencia , Población Rural , Convulsiones/parasitología , Estudios SeroepidemiológicosRESUMEN
A large number of helminthic parasites are known to involve the central nervous system (CNS) and produce neurologic symptoms including seizures and epilepsy. Taenia solium (the pork tapeworm) is perhaps most widely prevalent and well known for its association with seizures and epilepsy. Many of the other helminthic disorders have fairly restricted geographic predilections and their occurrence in much of the remaining world is limited to rare cases among travelers and immigrants. Nonetheless, knowledge about the helminthic disorders, the life cycle of their causative agents, and their clinical manifestations and diagnostic features are important in order to recognize them.
Asunto(s)
Helmintiasis/complicaciones , Convulsiones/parasitología , Helmintiasis/diagnóstico , Helmintiasis/epidemiología , Humanos , Prevalencia , Factores de Riesgo , Esquistosomiasis/complicaciones , Esquistosomiasis/diagnóstico , Esquistosomiasis/epidemiología , Convulsiones/epidemiología , Toxocariasis/complicaciones , Toxocariasis/diagnóstico , Toxocariasis/epidemiologíaRESUMEN
BACKGROUND: Schistosoma mansoni is a parasitic trematoid worm that infects humans. Schistosomiasis is endemic in parts of South America, sub-Saharan Africa, the Middle East, and some Caribbean islands. Disorders of the liver and gastrointestinal tract are the most common clinical manifestations. The central nervous system is not usually affected. The most common neurologic manifestation is transverse myelitis. In some circumstances, the eggs of S. mansoni are found in the brain, causing inflammatory reaction. OBJECTIVE: To describe a young Brazilian patient with partial epileptic seizures caused by a granulomatous lesion due to S. mansoni. CONCLUSION: In endemic areas or in patients with a positive epidemiological history, schistosomiasis must be considered as a possible diagnosis of seizures, particularly when they are associated with granulomatous lesions on magnetic resonance imaging.
Asunto(s)
Corteza Cerebral/fisiopatología , Corteza Cerebral/parasitología , Neuroesquistosomiasis/diagnóstico , Neuroesquistosomiasis/fisiopatología , Convulsiones/diagnóstico , Convulsiones/parasitología , Adulto , Humanos , MasculinoRESUMEN
Case sheets of 44 patients with neurocysticercosis, coming from Campina Grande and others cities of Para ba state, examined between 1990 - 2001 were analyzed. The average age (SD +/-) was 20.6 +/- 14.3 years old, of which 54.5% were male. Thirty eight patients (86.2%) came from urban area. The initial symptom was convulsion in 90.9% of the cases and headaches in 9.1%. The epileptical form was present in 63.6% of the cases and the combined form in 22.3%. Computerized tomography of the skull was compatible with neurocysticercosis in 100% of the cases, showing calcification in (59.1%), integral cysts in (18.2%) and in degenerating in (20.4%), isolated or associated. The LCR performed on 29 patients showed alterations in 25 (86.2%) cases, predominating linfomonocitary pleocitose in 100% of the cases and positive immunological reactions in 64.3% of the cases. In conclusion neurocysticercosis is a frequent cause for convulsions in children and young adults in this region, and the ocorrence in urbane and rural areas denote the poor control of the taeniases/cistycercosis complex in this state.
Asunto(s)
Neurocisticercosis/diagnóstico , Adolescente , Adulto , Animales , Antihelmínticos/uso terapéutico , Brasil , Niño , Preescolar , Femenino , Cefalea/parasitología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Neurocisticercosis/complicaciones , Neurocisticercosis/tratamiento farmacológico , Estudios Retrospectivos , Convulsiones/parasitología , Tomografía Computarizada por Rayos XRESUMEN
We investigated the relationship between CT findings - number and the viability phase of the parasites - and the seizure frequency in children with neurocysticercosis before and short-term after antiepileptic drug (AED) introduction. We only found a significant interaction between stage of parasitic infection and number of lesions on seizure frequency after AED treatment. Patients with more than five lesions on active or transitional stages had higher seizure frequency predicting a worse short-term prognosis.
Asunto(s)
Neurocisticercosis/complicaciones , Recuento de Huevos de Parásitos , Convulsiones/parasitología , Adolescente , Análisis de Varianza , Anticonvulsivantes/uso terapéutico , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neurocisticercosis/diagnóstico por imagen , Pronóstico , Convulsiones/diagnóstico por imagen , Convulsiones/tratamiento farmacológico , Taenia solium/aislamiento & purificación , Tomografía Computarizada por Rayos XRESUMEN
Taenia solium cysticercosis is a frequent cause of neurological disease in developing countries. Specific diagnosis of cysticercosis is difficult. We obtained serum and/or CSF samples from 204 consecutive patients admitted to a neurological ward in Lima, Peru, and looked for antibodies specific for T solium with the enzyme-linked immunoelectrotransfer blot (EITB) assay. 21 (12%) of 173 serum samples from these patients were EITB-positive. In contrast, only 2 (1.5%) of 135 patients attending a public endoscopy clinic and 1 (1%) of 88 patients attending a private endoscopy clinic were seropositive. 1 (1%) of 98 pregnant women living in a Lima shanty town was EITB-positive. 15 (58%) of 26 neurology patients diagnosed clinically as having cysticercosis were seronegative. Routine screening by EITB of all patients with neurological symptoms from areas of endemic cysticercosis would avoid misdiagnosis of this common and treatable disease.