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Zika virus (ZIKV) infection is a global public health concern linked to adult neurological disorders and congenital diseases in newborns. Host lipid metabolism, including lipid droplet (LD) biogenesis, has been associated with viral replication and pathogenesis of different viruses. However, the mechanisms of LD formation and their roles in ZIKV infection in neural cells are still unclear. Here, we demonstrate that ZIKV regulates the expression of pathways associated with lipid metabolism, including the upregulation and activation of lipogenesis-associated transcription factors and decreased expression of lipolysis-associated proteins, leading to significant LD accumulation in human neuroblastoma SH-SY5Y cells and in neural stem cells (NSCs). Pharmacological inhibition of DGAT-1 decreased LD accumulation and ZIKV replication in vitro in human cells and in an in vivo mouse model of infection. In accordance with the role of LDs in the regulation of inflammation and innate immunity, we show that blocking LD formation has major roles in inflammatory cytokine production in the brain. Moreover, we observed that inhibition of DGAT-1 inhibited the weight loss and mortality induced by ZIKV infection in vivo. Our results reveal that LD biogenesis triggered by ZIKV infection is a crucial step for ZIKV replication and pathogenesis in neural cells. Therefore, targeting lipid metabolism and LD biogenesis may represent potential strategies for anti-ZIKV treatment development.
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Neuroblastoma , Infecção por Zika virus , Zika virus , Animais , Humanos , Camundongos , Gotículas Lipídicas , Replicação ViralRESUMO
Lipid droplets (LD) are evolutionarily conserved lipid-enriched organelles with a diverse array of cell- and stimulus-regulated proteins. Accumulating evidence demonstrates that intracellular pathogens exploit LD as energy sources, replication sites, and part of the mechanisms of immune evasion. Nevertheless, LD can also favor the host as part of the immune and inflammatory response to pathogens. The functions of LD in the central nervous system have gained great interest due to their presence in various cell types in the brain and for their suggested involvement in neurodevelopment and neurodegenerative diseases. Only recently have the roles of LD in neuroinfections begun to be explored. Recent findings reveal that lipid remodelling and increased LD biogenesis play important roles for Zika virus (ZIKV) replication and pathogenesis in neural cells. Moreover, blocking LD formation by targeting DGAT-1 in vivo inhibited virus replication and inflammation in the brain. Therefore, targeting lipid metabolism and LD biogenesis may represent potential strategies for anti-ZIKV treatment development. Here, we review the progress in understanding LD functions in the central nervous system in the context of the host response to Zika infection.
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Introduction: Epilepsy affects about 50 million people worldwide, 80% of whom live in low- and middle-income countries. In Brazil, epidemiological studies are outdated and restricted to specific regions, mostly due to the continental size of country. Objective: We aimed to present the first evidence-based study on the epidemiological aspects of individuals with epilepsy, mapping the characteristics of this disease in a referral center in a region of Southeast Brazil. Methods: A retrospective study was carried out from January 2010 to March 2021. Patients were selected according to the International League Against Epilepsy Criteria. Results: From a total of 618 selected patients, 317 (51.3%) were men and 301 (48.7%) were women with an average age of 34.03 ± 20.66 years. The average age at the first seizure was 15.16 ± 17.61 years. The prevalence ratio was 1.30 cases/1,000 habitants. Childhood febrile seizure was present in 44 patients (7.9%) and family history of epilepsy in 231 (37.4%) patients. The predominant type of seizure was focal in 401 (64.9%) patients. The most frequent etiologies were structural in 254 (41.1%) patients and unknown in 238 (38.5%) patients. Most of the patients' treatments were based on anti-seizure drugs in monotherapy [389 (62.9%)] with 398 (64.4%) drug-responsive patients. Conclusions: Our epilepsy prevalence rate was lower than other studies in the Southeast Region of Brazil. In addition, the structural epilepsy type was predominant in our study compared with unknown causes, which is more frequent in other Brazilian regions and worldwide studies. The differences may be attributed to our region, which presents a high prevalence of neuroinfection, specially neurocysticercosis, and a referral center for traumatic brain injury. Moreover, the contrasting results reinforce the need for an adequate epidemiological assessment of epilepsy incidence in a region of Southeast Brazil.
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Ocular infection with Toxoplasma gondii causes toxoplasmosis in mice. However, following ocular infection with tachyzoites, the cause of the accompanying progressive changes in hippocampal-dependent tasks, and their relationship with the morphology and number of microglia, is less well understood. Here, in 6-month-old, female BALB/c mice, 5 µl of a suspension containing 48.5 × 106 tachyzoites/ml was introduced into the conjunctival sac; control received an equal volume of saline. Before and after instillation, all mice were subject to an olfactory discrimination (OD) test, using predator (cat) feces, and to an open-field (OF) task. After the behavioral tests, the animals were culled at either 22 or 44 days post-instillation (dpi), and the brains and retinas were dissected and processed for immunohistochemistry. The total number of Iba-1-immunolabeled microglia in the molecular layer of the dentate gyrus was estimated, and three-dimensional reconstructions of the cells were evaluated. Immobility was increased in the infected group at 12, 22, and 43 dpi, but the greatest immobility was observed at 22 dpi and was associated with reduced line crossing in the OF and distance traveled. In the OD test, infected animals spent more time in the compartment with feline fecal material at 14 and at 43 dpi. No OD changes were observed in the control group. The number of microglia was increased at 22 dpi but returned to control levels by 44 dpi. These changes were associated with the differentiation of T. gondii tachyzoites into bradyzoite-enclosed cysts within the brain and retina. Thus, infection of mice with T. gondii alters exploratory behavior, gives rise to a loss in predator's odor avoidance from 2 weeks after infection, increased microglia number, and altered their morphology in the molecular layer of the dentate gyrus.
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Toxoplasma , Toxoplasmose Animal , Animais , Gatos , Túnica Conjuntiva/patologia , Feminino , Camundongos , Camundongos Endogâmicos BALB C , Neuropatologia , Toxoplasmose Animal/patologiaRESUMO
Background: Histoplasmosis is a fungal disease endemic in some regions of the United States of America, Canada, and Latin America. The geographic characteristics, humidity, soil, and climate are responsible for such distribution. In Brazil, there are case reports of histoplasmosis throughout its territory, being considered an endemic region. It is considered an opportunistic disease, affecting mostly immunocompromised patients. To the present date, scientific publications dealing with pediatric cases of histoplasmosis are restricted to case series. Spinal cord injuries caused by histoplasmosis are rare, even in the adult population, being described in few studies. Case Description: The present report deals with a 4-year-old patient, from the southeast region of Brazil, who started a condition of fever, weight loss, cervicobrachialgia, and symmetrical tetraparesis, with evolution over 2 months. In the diagnostic investigation, she was found to have primary immunodeficiency and neuroimaging examinations showed a cervical spinal cord lesion at the level of C4-C6. The anatomopathological diagnosis of histoplasmosis was possible after surgery for decompression and biopsy of the lesion. Conclusion: According to our research, there are no reports in the literature that address the situation of spinal cord compression syndrome due to histoplasmosis in the pediatric population.
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This article addresses the relationship between human herpesviruses (HHVs) and neuroinfections. Alphaherpesviruses, betaherpesviruses and gammaherpesviruses are neurotropic viruses that establish latency and exhibit reactivation capacity. Encephalitis and meningitis are common in cases of HHV. The condition promoted by HHV infection is a purported trigger for certain neurodegenerative diseases. Ongoing studies have identified an association between HSV-1 and the occurrence of Alzheimer's disease, multiple sclerosis and infections by HHV-6 and Epstein-Barr virus. In this review, we highlight the importance of research investigating the role of herpesviruses in the pathogenesis of diseases that affect the nervous system and describe other studies in progress.
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Oropouche virus (OROV) is an emerging arbovirus in South and Central Americas with high spreading potential. OROV infection has been associated with neurological complications and OROV genomic RNA has been detected in cerebrospinal fluid from patients, suggesting its neuroinvasive potential. Motivated by these findings, neurotropism and neuropathogenesis of OROV have been investigated in vivo in murine models, which do not fully recapitulate the complexity of the human brain. Here we have used slice cultures from adult human brains to investigate whether OROV is capable of infecting mature human neural cells in a context of preserved neural connections and brain cytoarchitecture. Our results demonstrate that human neural cells can be infected ex vivo by OROV and support the production of infectious viral particles. Moreover, OROV infection led to the release of the pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-α) and diminished cell viability 48 h post-infection, indicating that OROV triggers an inflammatory response and tissue damage. Although OROV-positive neurons were observed, microglia were the most abundant central nervous system (CNS) cell type infected by OROV, suggesting that they play an important role in the response to CNS infection by OROV in the adult human brain. Importantly, we found no OROV-infected astrocytes. To the best of our knowledge, this is the first direct demonstration of OROV infection in human brain cells. Combined with previous data from murine models and case reports of OROV genome detection in cerebrospinal fluid from patients, our data shed light on OROV neuropathogenesis and help raising awareness about acute and possibly chronic consequences of OROV infection in the human brain.
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BACKGROUND: The new coronavirus disease 2019 pandemic has spread throughout most of the world. Cerebral venous thrombosis is a rare thromboembolic disease that can present as an extrapulmonary complication in coronavirus disease 2019 infection. CASE PRESENTATION: We report the case of a Hispanic woman with Down syndrome who has coronavirus disease 2019 and presents as a complication extensive cerebral venous thrombosis. CONCLUSIONS: Cerebral venous thrombosis is a rare thromboembolic disease that can present as an extrapulmonary complication in coronavirus disease 2019 infection. In the absence of clinical and epidemiological data, it is important to carry out further investigation of the risk factors and pathophysiological causes related to the development of cerebrovascular thrombotic events in patients with Down syndrome with coronavirus disease 2019 infection.
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COVID-19 , Síndrome de Down , Trombose Venosa , Síndrome de Down/complicações , Feminino , Humanos , Pandemias , SARS-CoV-2RESUMO
La encefalitis es una entidad rara con manifestaciones clínicas variables. En los niños es usualmente leve y autolimitada. En 30 a 75% se desconoce la etiología y cuando el patógeno se identifica por PCR (reacción en cadena de la polimerasa), el 80% son enterovirus. En América Latina no están disponibles métodos específicos de diagnóstico. En nuestro país muy pocos centros realizan el examen y tampoco están disponibles estadísticas reales de su incidencia. Objetivo: correlacionar la etiología con los síntomas, resultados de laboratorio, imagen y electroencefalograma. Métodos: estudio transversal; de enero a diciembre de 2016 se revisaron las historias clínicas de 63 niños de 0 a 18 años hospitalizados con sospecha de encefalitis. Una vez identificado el enterovirus por PCR, se correlacionó con los hallazgos de los exámenes de laboratorio e imagen. Resultados: se confirmó encefalitis viral en 35 pacientes, enterovirus en 49%, predominio en la edad preescolar. Síntomas más comunes: fiebre, cefalea, signos meníngeos y síntomas digestivos, 24% alteraciones de la conciencia. Biometría hemática normal en 71%, proteina C reactiva alterada en 71%. De los pacientes con estudios de imagen, 6% tuvo resultado anormal y en aquellos con electroencefalograma 80% fue anormal. Se utilizó la U de Mann Whitney para el análisis estadístico, la relación entre enterovirus y alteración de estado de conciencia y síntomas digestivos fue significativa (p=0.029). Conclusión: en los pacientes con diagnóstico de encefalitis que presenten síntomas digestivos y alteración del estado de conciencia, se debe sospechar que el enterovirus es el agente etiológico.
Encephalitis is a rare entity with variable clinical manifestations. In children it is usually mild and self-limited. In 30-75% of cases, the etiology is unknown and when the pathogen is identified by PCR (polymerase chain reaction), 80% are enteroviruses. In Latin America specific diagnostic methods are not available. In our country very few centers carry out the specific test, real statistics of their incidence are not available Objective: To correlate etiology with symptoms, laboratory results, imaging and electroencephalogram. Methods: Cross-sectional study, clinical records of 63 children between 0 and 18 years hospitalized with suspected encephalitis from January to December 2016 were reviewed. Once Enterovirus was identified by PCR, it was correlated with the findings of laboratory and imaging tests. Results: Viral encephalitis was confirmed in 35 patients, Enterovirus in 49%, predominance in pre-school age. Most common symptoms: fever, headache, meningeal signs and digestive symptoms, 24% alterations of consciousness. Normal blood count in 71%, Protein C Reactive altered in 71%. In patients with imaging studies, 6% had an abnormal result and in those who underwent electroencephalography, 80% were abnormal. The Mann Whitney U was used for the statistical analysis, the relationship between enterovirus and alteration of consciousness and digestive symptoms was significant (p: 0.029) Conclution: In patients with a diagnosis of encephalitis presenting digestive symptoms and altered state of consciousness, Enterovirus should be suspected as an etiologic agent.
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Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Enterovirus , Encefalite Viral , Viroses do Sistema Nervoso Central , Encefalite , Pediatria , Sinais e Sintomas Digestórios , Estado de ConsciênciaRESUMO
El dengue es la enfermedad viral transmitida por mosquitos más importante en el mundo. Alrededor del 10% de los pacientes con dengue, pueden presentar alteraciones neurológicas durante o después de la infección, asociadas a la replicación viral en el tejido, a la respuesta inmunológica local, a la disfunción endotelial y a signos hemorrágicos en el tejido. En muchos de estos casos se ha detectado virus o anticuerpos en el tejido, sugiriendo la invasión del virus al encéfalo, sin embargo, no siempre es posible hacer esta relación, dando origen a una gran pregunta: ¿son los daños del tejido nervioso producto de una encefalopatía asociada a disfunción extraneural o son debidos a la infección misma del tejido? Como sigue siendo controversial la interpretación de los signos neurológicos durante el dengue, a continuación presentamos algunas generalidades del virus, sus forma clínicas y algunas evidencias clínicas y experimentales que intentan explicar y asociar la neuroinfección y la neuropatogenia por DENV.
Dengue is the most important viral infection transmitted by arthropods in the world. Some studies report that about 10% of dengue or severe dengue patients present neurological symptoms and these signs could be related with nervous system viral replication, immune response and endothelial or metabolic dysfunction in neural or extraneural tissues. These nervous system signs are more frequent in endemic zones and in some patients, viruses or specific antibodies can be detected in the brain, suggesting a direct neural invasion. However, in other cases we cannot establish a direct relationship, begging the question: are the neurological signs and nervous tissue damage secondary to extraneural organ dysfunction or are these changes related to viral replication in the brain? Given the controversy, this review is intended to present some general information on the dengue virus, the clinical characteristics of the disease and current evidence on the neurological manifestations. In addition, we will present experimental evidence to explain the dengue virus neuroinfection and neuropathogenesis.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Dengue , Sinais e Sintomas , Vírus , Dengue Grave , Encefalite , Infecções , Anticorpos , Sistema NervosoRESUMO
Brain abscess (BA) is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA.
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JUSTIFICATIVA E OBJETIVOS: Várias doenças infecciosas e parasitárias foram descritas como possíveis causadoras de prejuízos cognitivos, destacando-se as neuroinfecções que, pela localização no sistema nervoso central (SNC), podem evoluir para quadros demenciais francos (embora passíveis de reversão). As vastas possibilidades etiológicas tem como resultado grande heterogeneidade de sintomas neuropsiquiátricos, o que pode dificultar a avaliação clínica, mas se forem utilizados os recursos de testes neuropsicológicos, aumenta-se as probabilidades de detecção de sintomas cognitivos e comportamentais e consequentemente a precisão diagnóstica. O estudo teve como objetivo estimar a prevalência de alterações cognitivas nas neuroinfecções.MÉTODO: A amostra foi composta por 60 pacientes portadores de infecção do SNC no intuito de identificar possíveis alterações do desempenho no Mini-Exame do Estado Mental (MEEM).RESULTADOS: Através da aplicação do MEEM verificou-se que 20 pacientes (33,3%) apresentaram transtornos cognitivos sem demência e 23 pacientes foram diagnosticados com demências, sendo este o quadro neuropsicológico mais prevalente (38,3). CONCLUSÃO: Observou-se alta prevalência de transtornos cognitivos entre os quadros de neuroinfecções, demonstrando a necessidade de investigação de aspectos cognitivos nos pacientes portadores de infecções do SNC.(AU)
BACKGROUND AND OBJECTIVES: Several infectious and parasitics diseases were described as possible causes of cognition losses, mainly neuroinfections, which, due to their location in the CNS, can evolve to dementia (although possible of reversal). The wide etiologic possibilities are a result of a large number of neuropsychiatric symptoms, which may complicate clinical evaluation. However, by using neuropsychological tests, the chances of detecting cognitive and behavioral symptoms are increased as well as precision in diagnosis. The study estimates the prevalence of cognition disorders in neuroinfection.METHOD: We evaluated patients with infection in CNS for identification of possible alterations in Mini Mental State (MMSE).RESULTS: based on MMSE, it was observed that 20 patients (33.3%) presented cognition diseases without dementia, and 23 patients were diagnosed with dementia, which was the most common neuropsychological alteration (38.3%).CONCLUSION: Through this study, high prevalence of cognition disorders was found among neuroinfections, which shows the need of cognitive aspects investigation in infection of the CNS.(AU)
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Humanos , Adulto , Pessoa de Meia-Idade , Perfil de Saúde , Infecções do Sistema Nervoso Central/epidemiologia , Transtornos Cognitivos/etiologia , Estudos RetrospectivosRESUMO
Infections of the central nervous system are uncommon in dogs. Pathogenic fungi such as Aspergillus, Cryptococcus spp, Blastomyces dermatitidis and Coccidioides immitis have been reported. An Aspergillus infection is mainly a respiratory event and very seldom it may become disseminated, the German shepherd seems to be the more prone to this type of aspergillosis specially if an immunological deficiency is present. A 1.5 year old female German Shepherd from Cancun, Quintana Roo, State, in the southeast of Mexico was presented to the small animal hospital, she showed tetraparesis, hiporeflex and deep retarded sensitivity in all four members, loss of sensitivity in the left side of the face, absence of pupil reflex and menace reflex as well as absence of muscular tone of the vulva and anal sphincter. The third day after presentation, she died. At necropsy polyencephalomalace, mielitis and diffuse leucomielitis piogranomalotosus were found. In the cytology of lymph node and other tissues aspergilli like hiphae were observed, this was confirmed by using the highly specific double diffusion test. Then, a PCR test was carried out with tissue fixed in 10% formaldehyde, but it failed probably due to destruction of the DNA.
La infección del sistema nervioso en el perro es poco común; posibles causas son Aspergillus spp, Cryptococcus neoformans, Blastomyces dermatidis y Coccidioides immitis. La infección por Aspergillus spp afecta al aparato respiratorio y en pocas ocasiones se presenta de manera diseminada. Sin embargo, en el Pastor Alemán hay mayor incidencia de éste, pues dicha infección se asocia con una deficiencia inmunológica. Se describe el caso de una perra de raza Pastor Alemán, de 1.5 años de edad, referida de Cancún, Quintana Roo, México, con tetraparesis, hiporreflexia y sensibilidad profunda retardada en los cuatro miembros, disminución de sensibilidad en el lado derecho de la cara y ausencia de reflejo pupilar y de amenaza en ojo derecho; además de ausencia de tono vulvar y de esfínter anal. A los tres días después del ingreso la perra falleció. A la necropsia se encontró polioencefalomalacia, mielitis y leucomielitis piogranulomatosa difusa. En la citología de linfonodo y en la histopatología de diferentes tejidos se identificaron hifas compatibles con Aspergillus spp. Con el fin de dar certeza al diagnóstico, se realizó prueba de doble inmunodifusión, que es altamente específica, la cual confirmó el diagnóstico de Aspergillus spp. Posteriormente se corrió PCR a partir de una muestra de tejido en formalina al 10%, para identificar la especie, en donde no se lograron resultados, probablemente debido a la destrucción del ADN por el formaldehído.
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Neurocysticercosis (NCC) is a common central nervous system infection caused by Taenia solium metacestodes. Objective: To investigate the occurrence of depression in patients with calcified NCC form. The study group consisted of 114 patients subdivided in four groups: NCC with epilepsy, NCC without epilepsy, epilepsy without NCC and chronic headache. Method: Depression was evaluated and quantified by the Hamilton Rating Scale for Depression (HRSD-21). Results: Percentage of patients with depression was as follows: group 1 (83 percent); group 2 (88 percent); group 3 (92 percent); group 4 (100 percent). The majority of patients had moderate depression. Conclusion: Incidence of depression in all groups was higher than in the general population. It is possible that, in a general way, patients with chronic diseases would have depression with similar intensity. NCC is associated with the presence of depression.
Neurocysticercose (NCC) é uma infecção do sistema nervoso central comum causada por metacestodes da Taenia solium. Objetivo: investigar a ocorrência de depressão nos pacientes com NCC forma calcificada. O grupo de estudo é formado por 114 pacientes subdivididos em quatro grupos: NCC com epilepsia, NCC sem epilepsia, epilepsia sem NCC e cefaléia crônica. Método: A presença de depressão foi determinada e quantificada pela Escala de Depressão de Hamilton (HRSD-21). Resultados: A porcentagem de pacientes com depressão foi: grupo 1 (83 por cento); grupo 2 (88 por cento); grupo 3 (92 por cento); grupo 4 (100 por cento). A maioria dos pacientes apresentou depressão moderada. Conclusão: A incidência da depressão em todos os grupos foi mais elevada do que na população geral, contudo não houve diferença entre os grupos estudados. É possível que, de uma maneira geral, os pacientes portadores de doença crônica apresentarem a depressão em intensidade similar. NCC está associada com a presença de depressão.
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Feminino , Humanos , Masculino , Depressão/etiologia , Epilepsia/etiologia , Neurocisticercose/psicologia , Estudos de Casos e Controles , Doença Crônica , Escalas de Graduação PsiquiátricaRESUMO
La infección por VIH es uno de los mayores factores de riesgo para tuberculosis. Presentamos el caso de un paciente de 30 años que ingresó al hospital con datos neurológicos caracterizados por cefalea, alteración del alerta, crisis convulsivas, signos meníngeos y fiebre, a quien subsecuentemente se le diagnosticó VIH y neuroinfección. Los datos clínicos, el examen del líquido cefalorraquídeo y la neuroimagen sustentaron el diagnóstico de neurotuberculosis. La resonancia magnética de cráneo reveló aracnoiditis generalizada de predominio basal, así como encefalitis cortical. Los hallazgos de imagen desempeñan un papel fundamental en el diagnóstico integral de la tuberculosis del sistema nervioso central.
HIV infection is a major risk factor for tuberculosis. We describe the case of a 30-year-old male presenting with headache, compromised mental status, seizures, neck stiffness and fever that was subsequently diagnosed with HlV and neuroinfection. Clinical data, cerebrospinal fluid and brain imaging supported a diagnosis of neurotuberculosis. Cranial magnetic resonance imaging showed diffuse arachnoidal enhancement, mainly at the basal cisterns and cortical encephalitis. Such imaging findings play a key role in the diagnosis of central nervous system tuberculosis.
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Humanos , Masculino , Adulto , Aracnoidite/etiologia , Encefalite/etiologia , Soropositividade para HIV/complicações , Tuberculoma Intracraniano/etiologiaRESUMO
Veinticinco pacientes menores de 2 años fueron estudiados en el Hospital José María Benítez de La Victoria entre Agosto de 2006 y Mayo de 2007, dada la presencia de meningitis asépticas tratadas como bacterianas. Aunque el diagnóstico inicial fue Neuroinfección, 68% egresaron como Meningitis Bacteriana confirmada con Gram y cultivo del Líquido Cefalo Raquideo, mientras que en el resto sólo se pudo comprobar bacterias por estudios citoquímicos. Estreptococo pneumoneae (44%), Estaphilococo aureus (8%),Neisseria meningitidis, Haemophilus influenzae y Estaphilococo Coagulasa negativo (4%), fueron los de mayor incidencia. Ningún paciente presentó inmunización contra neumococo y 16% no presentaban la vacuna pentavalente. La clínica más relevante fue: Fiebre (100%), irritabilidad (64%), hiporexia (56%) y vómitos (48%). Sólo 16% de los menores presentaron complicaciones. Es necesaria una conducta médica precoz, que realice a menores con fiebre, irritabilidad e hiporexia; Punción Lumbar, estudios citoquímicos, Gram, cultivo y antibiograma, además garantizar prevención, mediante la inclusión de la vacuna contra el Neumococo en el esquema de inmunizaciones del Ministerio del Poder Popular para la Salud Venezolano.
Twenty five under two years old patients were studied in Jose Maria Benitez Hospital, La Victoria, between August 2006 and May 2007, in view of several cases of aseptic meningitis treated as bacterial. Although the initial diagnosis was neuro infection, 68% were discharged as Bacterial Meningitis confirmed with Gram and CRL culture. While among the remainders, presence of bacteria was confirmed only by cytochemical tests Strepfococus pneumoneae (44%), Staphilococus aureus (8%), Neisseria meningitides, Haemophilus influenzae and Staphilococus spp., coagulase negative (4%) showed the highest incidence. None of the patients o reported immunization against neumococi and 16% were not immunized with pentavalent vaccine. Most relevant clinical features were: fever (100%); irritability (64%) hyporexia (56%) and vomits (4%). Only 16% of the children developed complications. An earlier and more assertive approach in front of nursing patients with fever, irritability and hyporexia is recommended. Lumbar puncture, cytochemical tests, Gram culture and antibiogram are also suggested. Prevention through application pentavalent vaccine within the normal scheme of inmunizations of the Ministry of Health must be reinforced.
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Objetivo general. Describir las características clínico-epidemiológicas y etiológicas de la neuroinfección de los pacientes con VIH del departamento del Quindío. Materiales y métodos. Se realizó un estudio de tipo descriptivo prospectivo de los pacientes con VIH y sospecha de neuroinfección de una Empresa Social del Estado de tercer nivel de Armenia. En el departamento del Quindío no se han reportado protocolos diagnósticos que correlacionen el costo-beneficio de los diferentes esquemas de manejo pacientes con VIH y una infección asociada del sistema nervioso central. Todos los pacientes que consultaron a la Empresa Social del Estado de tercer nivel de Armenia con dos pruebas positivas de ELISA anti-VIH o una prueba de Western blot positiva, con sospecha de enfermedad del sistema nervioso central concomitante. Se realizaron las siguientes pruebas de laboratorio en líquido cefalorraquídeo: VDRL, determinación de antígeno criptocococico mediante sistemade aglutinación de latex (Cryptococcal Antigen Latex Agglutination System (CALAS) , tinta china, coloraciónde Ziehl-Neelsen, cultivo de hongos, PCR para citomegalovirus y herpes simple, e IgG anti-Toxoplasmasérica; a todos los pacientes se les practicó tomografía cerebral simple. Resultados. De los 21 pacientes estudiados, 85,7 por ciento eran hombres; el rango de edad fue de 23 a 68 años. Los síntomas más frecuentes fueron: fiebre, compromiso de la conciencia u orientación, paresias, parestesias, compromiso de pares craneanos y reflejos neurológicos alterados. El 89 por ciento de pacientes con lesión que ocupa espacio se encontró IgG anti-Toxoplasma positiva (155-887,2UI/ml.) y los valores de los pacientescon reporte de tomografía cerebral simple normal oscilaron entre 13,8 y 36 UI/ml. Discusión. La tomografía cerebral simple, los anticuerpos séricos IgG anti-Toxoplasma y la coloración con tinta china en líquido cefalorraquídeo, permitieron diagnosticar el 85 por ciento de los pacientes.
ABSTRACTObjective: To describe clinical, epidemiologicaland etiological characteristics of neuroinfection inHIV patients from Quindío department. Materialsand methods: A descriptive-prospective studywas carried out in HIV positive patients withneuroinfection suspicion from a third level ESE ofArmenia.In Quindío department have not beenreported diagnostic protocols that correlate thecost-benefit of the various schemes of handlingpatients with HIV infection associated with thecentral nervous system (CNS).All the patients that consulted the third levelESE of Armenia with two positive anti-HIV ELISAtests or positive a Western Blot test with suspicionof concomitant CNS illness.The following laboratory tests were per-formed in cerebrospinal fluid (CSF): VDRL, Chineseink, Ziehl-Nielsen stain, fungi cultures, CMV andHerpes simplex PCR, serum IgG anti-Toxoplasma,andCryptococcal Antigen Latex AgglutinationSystem (CALAS); a simple cerebral CT scan wastaken to all patients. Results: 85.7% of thepatients were men; the age rank was between23 and 68 years. The most frequently foundsymptoms were: fever, consciousness andorientation compromise, paresis, paresthesia,cranial pairs compromise, and altered neurologicalreflexes.89% of the patients with brain spaceoccupying lesionswere IgG anti-Toxoplasmapositive( values between 155 and 887.2 UI/ml) andthe antibodies values in patients without cerebrallesion in the simple cerebral CT scan oscillatedbetween 13.8 and 36 UI/ml. Discussion: Simplecerebral CT scan, serum IgG anti-Toxoplasma andstaining of CSF with Chinese ink allowed the diag-nosis of 85% of the patients