RESUMO
BACKGROUND: Human T-lymphotropic virus type 1 (HTLV-1) has been discovered in 1980 and has been linked to tropical spastic paraparesis (HAM/TSP) in 1985 in Martinique. There is no data on HAM/TSP incidence trends. We report, in the present work, the temporal trends incidence of HAM/TSP in Martinique over 25 years. METHODS: Martinique is a Caribbean French West Indies island deserved by a unique Neurology Department involved in HAM/TSP diagnosis and management. A registry has been set up since 1986 and patients diagnosed for a HAM/TSP were prospectively registered. Only patients with a definite HAM/TSP onset between 1986 and 2010 were included in the present study. The 25-year study time was stratified in five-year periods. Crude incidence rates with 95% confidence interval (95%CI) were calculated using Poisson distribution for each period. Age-standardized rates were calculated using the direct method and the Martinique population census of 1990 as reference. Standardized incidence rate ratios with 95% CIs and P trends were assessed from simple Poisson regression models. Number of HTLV-1 infection among first-time blood donors was retrospectively collected from the central computer data system of the Martinique blood bank. The HTLV-1 seroprevalence into this population has been calculated for four 5-year periods between 1996 and 2015. RESULTS: Overall, 153 patients were identified (mean age at onset, 53+/-13.1 years; female:male ratio, 4:1). Crude HAM/TSP incidence rates per 100,000 per 5 years (95%CI) in 1986-1990, 1991-1995, 1996-2000, 2001-2005 and 2006-2010 periods were 10.01 (6.78-13.28), 13.02 (9.34-16.70), 11.54 (8.13-14.95), 4.27 (2.24-6.28) and 2.03 (0.62-3.43). Age-standardized 5-year incidence rates significantly decreased by 69% and 87% in 2001-2005 and 2006-2010 study periods. Patients characteristics did not differ regarding 1986-2000 and 2001-2010 onset periods. Between 1996-2000 and 2011-2015 study periods, the HTLV-1 seroprevalence significantly decreased by 63%. CONCLUSION: Martinique faces a sudden and rapid decline of HAM/TSP incidence from 2001 in comparison to 1986-2000 periods. Reduction of HTLV-1 seroprevalence, that may result from transmission prevention strategy, could account for HAM/TSP incidence decrease.
Assuntos
Anticorpos Anti-HTLV-I/sangue , Infecções por HTLV-I/epidemiologia , Paraparesia Espástica Tropical/epidemiologia , Doenças da Medula Espinal/epidemiologia , Adulto , Idoso , Feminino , Infecções por HTLV-I/virologia , Vírus Linfotrópico T Tipo 1 Humano/imunologia , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Humanos , Incidência , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Paraparesia Espástica Tropical/imunologia , Paraparesia Espástica Tropical/virologia , Distribuição de Poisson , Saúde Pública , Fatores de Risco , Estudos Soroepidemiológicos , Doenças da Medula Espinal/imunologia , Doenças da Medula Espinal/virologia , Fatores de TempoRESUMO
STUDY DESIGN: This study examined the diagnostic accuracy of significant changes of somatosensory evoked potentials (SSEPs) to evaluate and predict postoperative neurological deficits after posterior cervical fusions (PCF). Eight hundred forty six eligible patients underwent PCF at the University of Pittsburgh Medical Center (UPMC), from 2010 to 2012. OBJECTIVE: To assess the specificity and sensitivity of intraoperative monitoring in predicting postoperative neurological deficits during PCF. SUMMARY OF BACKGROUND DATA: We calculated the predictive value, including sensitivity and specificity, of changes in SSEPs to identify neurological deficits postoperatively. We used a receiver operating characteristic (ROC) curve with SSEP categories as cutoff values to further evaluate the diagnostic accuracy of change in SSEPs and postoperative neurological deficit. METHODS: All patients had preposition baselines and continuous SSEP monitoring throughout the surgery. Statistical analysis was completed using SPSS version 22 (IBM Corp., Armonk, NY). RESULTS: Age and sex did not influence outcomes. Obesity affected patient outcome. The SSEP categories of significant changes and loss of responses resulted in a sensitivity/specificity of 0.30/0.96 and 0.16/0.98, respectively. The receiver operating characteristic curve has an area under the curve for significant change in/loss of SSEPs of 0.62/0.65 with a 95% confidence interval of 0.525 to 0.714/0.509 to 0.797. CONCLUSION: Significant SSEP changes during PCF are a very specific but poorly sensitive indicator of postoperative neurological deficits. The odds ratio for significant changes in SSEPs and loss of waveforms was 9.80 and 11.82, respectively, with a 95% confidence interval of 4.695 to 20.46 and 4.45 to 31.41, respectively. LEVEL OF EVIDENCE: 1.
Assuntos
Vértebras Cervicais/cirurgia , Potenciais Somatossensoriais Evocados/fisiologia , Monitorização Intraoperatória/normas , Doenças do Sistema Nervoso/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Fusão Vertebral/efeitos adversos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/fisiopatologia , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/tendênciasRESUMO
Non-traumatic myelopathies represent a heterogeneous group of neurological conditions. Few studies report clinical and epidemiological profiles regarding the experience of referral services. Objective To describe clinical characteristics of a non-traumatic myelopathy cohort. Method Epidemiological, clinical, and radiological variables from 166 charts of patients assisted between 2001 and 2012 were compiled. Results The most prevalent diagnosis was subacute combined degeneration (11.4%), followed by cervical spondylotic myelopathy (9.6%), demyelinating disease (9%), tropical spastic paraparesis (8.4%) and hereditary spastic paraparesis (8.4%). Up to 20% of the patients presented non-traumatic myelopathy of undetermined etiology, despite the broad clinical, neuroimaging and laboratorial investigations. Conclusion Regardless an extensive evaluation, many patients with non-traumatic myelopathy of uncertain etiology. Compressive causes and nutritional deficiencies are important etiologies of non-traumatic myelopathies in our population.
Assuntos
Doenças da Medula Espinal/etiologia , Brasil/epidemiologia , Estudos de Coortes , Eletromiografia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/epidemiologiaRESUMO
ABSTRACT Non-traumatic myelopathies represent a heterogeneous group of neurological conditions. Few studies report clinical and epidemiological profiles regarding the experience of referral services. Objective To describe clinical characteristics of a non-traumatic myelopathy cohort. Method Epidemiological, clinical, and radiological variables from 166 charts of patients assisted between 2001 and 2012 were compiled. Results The most prevalent diagnosis was subacute combined degeneration (11.4%), followed by cervical spondylotic myelopathy (9.6%), demyelinating disease (9%), tropical spastic paraparesis (8.4%) and hereditary spastic paraparesis (8.4%). Up to 20% of the patients presented non-traumatic myelopathy of undetermined etiology, despite the broad clinical, neuroimaging and laboratorial investigations. Conclusion Regardless an extensive evaluation, many patients with non-traumatic myelopathy of uncertain etiology. Compressive causes and nutritional deficiencies are important etiologies of non-traumatic myelopathies in our population.
RESUMO As mielopatias não-traumáticas representam um grupo heterogêneo de doenças neurológicas. Poucos estudos descrevem os perfis clínico e epidemiológico sobre a experiência de serviços de referência. Objetivo Descrever as características clínicas de uma coorte de mielopatia não-traumática. Método Os registros clínicos de 166 pacientes atendidos entre 2001 e 2012 foram revisados e variáveis epidemiológicas, clínicas e radiológicas foram compiladas. Resultados O diagnóstico mais prevalente foi o de degeneração combinada subaguda (11,4%), seguido por mielopatia espondilótica cervical (9,6%), doenças desmielinizantes (9%), paraparesia espástica tropical (8,4%) e paraparesia espástica hereditária (8.4%). Aproximadamente 20% dos pacientes apresentaram mielopatia não-traumática de etiologia indeterminada, apesar da ampla investigação clínica, laboratorial e de neuroimagem. Conclusão Independentemente da ampla avaliação, muitos pacientes com mielopatia não-traumática apresentam etiologia incerta. Causas compressivas e deficiências nutricionais permanecem como etiologias importantes de mielopatias não-traumáticas.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/epidemiologia , Índice de Gravidade de Doença , Brasil/epidemiologia , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Estudos de Coortes , EletromiografiaRESUMO
Se realizó un estudio retrospectivo y descriptivo en 210 pacientes hospitalizados con lesión medular del Instituto Nacional de Rehabilitación (INR), Callao-Perú (2000-2006) para conocer la etiología, características clínicas y socio-demográficas de los pacientes con lesiones medulares no traumáticas (LMNT). Se encontró una prevalencia de 27 por ciento para LMNT siendo la edad promedio al inicio de la lesión 32,0 años; siendo varones el 50,5 por ciento, y el 41,9 por ciento tuvieron educación secundaría, el nivel de pobreza alcanzó el 90,5 por ciento. Predominó la etiología infecciosa (viral y bacteriana) en 37,6 por ciento, con un 11,9 por ciento de infección por HTLVI. No obstante ser el INR un centro de referencia, nuestros resultados son preliminares, siendo necesario realizar mayores estudios para proponer estrategias de prevención y control, dado el alto costo del tratamiento integral de rehabilitación en estos pacientes.
We performed a retrospective and descriptive cross-sectional; study in 210 hospitalized patients with spinal cord injury at the National Institute of Rehabilitation (INR), Callao, Peru from 2000-2006. The goal was to describe etiology, and clinical and socio-demographic characteristics of non traumatic spinal cord injuries (LMNT). We found a prevalence of 27 percent for LMNT, average age at onset of 32.0 years, male gender 50.5 percent, and secondary education completed in 41.9 percent, poverty 90.5 percent. The infectious etiology (viral and bacterial) was predominant in 37.6 percent, with 11.9 infected with HTLVI. Although the INR is a reference center, the findings cant be generalized because it isnt a representative sample of the Peruvian population, further studies are necessary to propose strategies for prevention and control, considering the high cost of integral rehabilitation treatment in these patients.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Medula Espinal , Estudos Transversais , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/etiologiaRESUMO
Human T-cell leukemia virus type 1 (HTLV-1) is the ethiologic agent of the neurological disorder HTLV-1- associated myelopathy/tropical spastic paraparesis (HAM/TSP). Although the majority of HTLV-1-infected individuals remain asymptomatic during their lifetime, approximately one percent of this population develops a myelopathy consisting of a chronic inflammation of the white and gray matter of the spinal cord. Glucocorticoids are widely used for treatment because of their anti-inflammatory properties, improving symptoms mainly in those patients with only a few years from onset of the disease, when inflammation is more prominent. Interferon-alpha and vitamin C are other therapies presenting some benefits in clinical practice, probably due to their anti-viral and immunomodulatory activities observed ex vivo. Furthermore, inhibitors of histone deacetylase, which increase virus expression but result in a substantial decline in the proviral load, have also been proposed. This review is intended to bridge the gap between clinical and basic science by presenting recent findings on HAM/TSP disease, mechanisms of drug action, and benefits of these therapies in HAM/TSP patients.
Assuntos
Vírus Linfotrópico T Tipo 1 Humano/patogenicidade , Paraparesia Espástica Tropical/terapia , Paraparesia Espástica Tropical/virologia , Doenças da Medula Espinal/terapia , Doenças da Medula Espinal/virologia , Animais , Doença Crônica , Glucocorticoides/uso terapêutico , Infecções por HTLV-I/epidemiologia , Infecções por HTLV-I/terapia , Infecções por HTLV-I/virologia , Humanos , Inflamação/epidemiologia , Inflamação/terapia , Inflamação/virologia , Paraparesia Espástica Tropical/epidemiologia , Doenças da Medula Espinal/epidemiologiaRESUMO
We performed a retrospective and descriptive cross-sectional; study in 210 hospitalized patients with spinal cord injury at the National Institute of Rehabilitation (INR), Callao, Peru from 2000-2006. The goal was to describe etiology, and clinical and socio-demographic characteristics of non traumatic spinal cord injuries (LMNT). We found a prevalence of 27 % for LMNT, average age at onset of 32.0 years, male gender 50.5 %, and secondary education completed in 41.9 %, poverty 90.5 %. The infectious etiology (viral and bacterial) was predominant in 37.6 %, with 11.9 infected with HTLVI. Although the INR is a reference center, the findings can't be generalized because it isn't a representative sample of the Peruvian population, further studies are necessary to propose strategies for prevention and control, considering the high cost of integral rehabilitation treatment in these patients.
Assuntos
Doenças da Medula Espinal , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/etiologiaRESUMO
OBJECTIVE: Because human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) may occur in some children infected with HTLV-1, we sought to determine the prevalence of neurologic abnormalities and any associations of neurologic abnormalities with infective dermatitis in these children. STUDY DESIGN: We enrolled 58 children infected with HTLV-1 and 42 uninfected children (ages 3 to 17) of mothers infected with HTLV-1 in a family study in Lima, Peru. We obtained medical and developmental histories, surveyed current neurologic symptoms, and conducted a standardized neurologic examination without prior knowledge of HTLV-1 status. RESULTS: HTLV-1 infection was associated with reported symptoms of lower extremity weakness/fatigue (odds ratio [OR], 6.1; confidence interval [CI], 0.7 to 281), lumbar pain (OR, 1.7; 95% CI, 0.4 to 8), and paresthesia/dysesthesia (OR, 2.6; CI, 0.6 to 15.8). HTLV-1 infection was associated with lower-extremity hyperreflexia (OR, 3.1; CI, 0.8 to 14.2), ankle clonus (OR, 5.0; CI, 1.0 to 48.3), and extensor plantar reflex (OR undefined; P = .2). Among children infected with HTLV-1, a history of infective dermatitis was associated with weakness (OR, 2.7; CI, 0.3 to 33), lumbar pain (OR, 1.3; CI, 0.2 to 8), paresthesia/dysesthesia (OR, 2.9; CI, 0.5 to 20), and urinary disturbances (OR, 5.7; CI, 0.5 to 290). CONCLUSIONS: Abnormal neurologic findings were common in Peruvian children infected with HTLV-1, and several findings were co-prevalent with infective dermatitis. Pediatricians should monitor children infected with HTLV-1 for neurologic abnormalities.
Assuntos
Infecções por HTLV-I/epidemiologia , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Paraparesia/epidemiologia , Doenças da Medula Espinal/epidemiologia , Adolescente , Distribuição por Idade , Idade de Início , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Intervalos de Confiança , Feminino , Infecções por HTLV-I/diagnóstico , Infecções por HTLV-I/transmissão , Humanos , Transmissão Vertical de Doenças Infecciosas , Masculino , Exame Neurológico , Razão de Chances , Paraparesia/diagnóstico , Paraparesia Espástica Tropical/diagnóstico , Paraparesia Espástica Tropical/epidemiologia , Peru/epidemiologia , Prevalência , Probabilidade , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Doenças da Medula Espinal/diagnóstico , Fatores de Tempo , Transtornos Urinários/diagnóstico , Transtornos Urinários/epidemiologiaRESUMO
HTLV-1 is the etiologic agent of ATL and HAM/TSP. The majority of HTLV-1-infected individuals remain asymptomatic, indicating that the infection alone is not sufficient to cause the diseases. It has been reported that cytokine gene polymorphisms, including polymorphisms at IL-6 and IL-10 gene, might be important. We analyzed SNP in the promoter region of the IL-6: -174, -572, -597, and -634 positions, and IL-10: -592 position to evaluate the role of these polymorphisms in the HAM/TSP pathogenesis in 133 HTLV-1 infected individuals and in 100 healthy individuals from Salvador, Bahia, Brazil. The -634C allele frequencies were higher among HAM/TSP patients (21.2%) than among oligosymptomatic (6.5%; P = 0.038) and asymptomatic (9.5%; P = 0.025) subjects. Similarly, the -174G allele frequencies were higher in HAM/TSP patients than in oligosymptomatic patients (P = 0.02). Moreover, the -634GC/-174GG genotype combination was identified at a higher frequency (38.5%) in the HAM/TSP patients than in subjects with other clinical status (8.7%; P = 0.016 for oligosymptomatic and 15.5%, P = 0.012 for asymptomatic patients). However, the multivariate logistic regression including the genotypes of the three studied loci showed that only -634 C IL-6 carriers remain as significant and independent TSP/HAM predictor (odds ratio [OR] = 5.31; 95% [CI] = 1.60-17.56; P = 0.006). We suggest that -634 G C in IL-6 could contribute to HAM/TSP development and that identification of the collective influence of several cytokine polymorphisms, their prevalence, and their interaction could help to better understand this disease.
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Infecções por HTLV-I/complicações , Interleucina-10/genética , Interleucina-6/genética , Paraparesia Espástica Tropical/epidemiologia , Polimorfismo de Nucleotídeo Único , Regiões Promotoras Genéticas , Doenças da Medula Espinal/epidemiologia , Brasil/epidemiologia , Frequência do Gene , Humanos , Modelos Logísticos , Análise Multivariada , Paraparesia Espástica Tropical/imunologia , Doenças da Medula Espinal/imunologiaRESUMO
BACKGROUND: The progression of neurological disability in human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) remains undefined. OBJECTIVES: To determine the time course of disability scores and to identify predictors of outcome among patients with HAM/TSP. DESIGN: Clinical 14-year follow-up study. SETTING: University hospital. Patients One hundred twenty-three patients with HAM/TSP. MAIN OUTCOME MEASURES: We determined time from onset to the following 4 Kurtzke Disability Status Scale (DSS) end points: scores of 6 (unilateral aid required), 6.5 (bilateral aid required), 8 (wheelchair confinement), and 10 (death related to the disease). Times to reach selected DSS scores were estimated using the Kaplan-Meier method. Univariate and multivariate analyses identified variables related to the rate of progression to DSS 8. The HTLV-1 proviral loads were also assessed. RESULTS: The disability of the cohort progressed throughout the follow-up period. The median times from onset to DSS 6, 6.5, and 8 were 6, 13, and 21 years, respectively. The median time from DSS 6 to DSS 8 was 8 years; DSS 10 was reached by one fourth of the patients within 20 years. Age at onset of 50 years or older and high HTLV-1 proviral load were associated with a shorter time to DSS 8 (P = .01 and P = .02, respectively). A shorter time to DSS 6 significantly adversely affected the time to progression from DSS 6 to DSS 8. CONCLUSIONS: Human T-lymphotropic virus 1-associated myelopathy/tropical spastic paraparesis is a rapidly disabling disease. Monitoring for HTLV-1 proviral load is recommended in future therapeutic trials.
Assuntos
Vírus Linfotrópico T Tipo 1 Humano , Paraparesia Espástica Tropical/epidemiologia , Paraparesia Espástica Tropical/virologia , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/virologia , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Análise Multivariada , Paraparesia Espástica Tropical/diagnóstico , Valor Preditivo dos Testes , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Doenças da Medula Espinal/diagnóstico , Fatores de TempoRESUMO
The human T-lymphotropic virus type I (HTLV-I) is a retrovirus associated with a chronic myelopathy known as HTLV-I-Associated Myelopathy or Tropical Spastic Paraparesis (HAM/TSP). The main objective was to assess the frequency of erectile dysfunction (ED) in HTLV-I-infected individuals from Salvador and other cities from Bahia, Brazil, as well as to verify if sexual dysfunction correlates with urinary symptoms and overall neurological impairment. From January 2001 to April 2004, 218 HTLV-I carriers (111 male and 107 female subjects) had complete clinical, neurological, and urological evaluation. They were assessed using standardized questionnaires to determine urinary complaints (Urinary Distress Inventory) and ED (Brief Male Sexual Function Inventory). Neurological impairment was established by Expanded Disability Status Scale (EDSS) from 0 to 10. HAM/TSP was considered as EDSS> or =2. A total of 17 males had clinically defined HAM/TSP (group 1). From the 94 HTLV-I-infected males, 62 were selected (group 2) and paired by age with patients in group 1. A total of 79 individuals were selected for this study. The age ranged from 35 to 81 y (mean=47.9+/-9.65). The percentage of ED in the studied population was 40.5%. In the HAM/TSP group, ED frequency was 88.2%. The associations among sexual dissatisfaction, erectile dysfunction, urinary symptoms (frequency, nocturia, and urgency) and EDSS> or =2 were statistically significant. In HAM/TSP, there is a slow and progressive degeneration of the lateral funiculus of the spinal cord. HTLV-I-infected individuals present a high frequency of ED and it is closely associated to urinary symptoms and the overall neurological picture. The HTLV-I carriers already had prominent compromise of the sexual activity.
Assuntos
Disfunção Erétil/epidemiologia , Disfunção Erétil/virologia , Paraparesia Espástica Tropical/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Prevalência , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/virologia , Transtornos Urinários/epidemiologia , Transtornos Urinários/virologiaRESUMO
To outline through clinical-laboratorial analysis a profile of schistosomiasis of the spinal cord (SSC) that contributes to the diagnosis and treatment of this disease. 80 patients were studied (59 prospectively), and epidemiological, clinical,laboratorial, treatment and outcome data extracted. In 79 patients the diagnosis was presumptive and obeyed rigorous criteria. There was a predominance of male sex (68.7%), age group from 21 to 40 years (63.7%), Northeasterners (85%), building construction workers (31.2%), previous abdominal effort (57.5%), subacute beginning (61.2%), myeloradiculitis form and lesion in conus and cauda equina (72.5%). Cerebral spinal fluid showed lymphomononuclear pleocytosis and protein increase in 100% of the cases as well as gamma globulin in 76.5%, positiveness of immunofluorescence reaction and/or ELISA for schistosomiasis in 100% of the cases with average titles of 1/16 and 61 u/dl, respectively. Corticosteroids and antischistosomal drugs were given to all patients with a satisfactory outcome in 80% of the cases. We emphasize the importance of a precocious treatment to avoid irreversible deficits such as paraplegia or sexual impotence.
Assuntos
Esquistossomose mansoni/diagnóstico , Doenças da Medula Espinal/diagnóstico , Adolescente , Adulto , Idoso , Anti-Inflamatórios/uso terapêutico , Brasil/epidemiologia , Criança , Pré-Escolar , Dexametasona/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxamniquine/uso terapêutico , Praziquantel/uso terapêutico , Prednisona/uso terapêutico , Estudos Prospectivos , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/epidemiologia , Esquistossomicidas/uso terapêutico , Doenças da Medula Espinal/tratamento farmacológico , Doenças da Medula Espinal/epidemiologiaRESUMO
During 20 year period (1972-1992) 56 patients with a diagnosis of schistosomal myeloradiculopathy were admitted in three hospitals of Belo Horizonte-Minas Gerais. Data from patients were collected retrospectively from their medical records. In all cases, the diagnosis was inferred in a presumably way and was based on the following considerations: 1) the finding of low thoracic/upper lumbar neurological symptoms; 2) positive epidemiology for schistosomiasis; 3) demonstration of exposure to schistosomiasis through parasitologic or serologic techniques; and 4) the exclusion of other known causes of transverse myelitis and myeloradiculitis. Several clinical and epidemiological aspects were studied to determine the diagnosis profiles of the schistosomal myeloradiculopathy in this sample and are presented in this paper. In recognizing the many problems in diagnosis of schistosomal myeloradiculopathy we emphasize how important is thinking about this entity and criteria to improve diagnostic evaluation are suggested.
Assuntos
Neuroesquistossomose/diagnóstico , Esquistossomose mansoni/diagnóstico , Doenças da Medula Espinal/diagnóstico , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroesquistossomose/complicações , Neuroesquistossomose/epidemiologia , Estudos Retrospectivos , Esquistossomose mansoni/complicações , Esquistossomose mansoni/epidemiologia , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/parasitologiaRESUMO
Durante período de 20 anos (1972-1992), 56 pacientes com diagnóstico de mielorradiculopatia esquistossomótica foram internados em três hospitais de Belo Horizonte -- Minas Gerais. Dados de cada paciente foram coletados retrospectivamente de seus prontuários. Em todos os casos, o diagnóstico foi presumido e baseou-se nos seguintes critérios: 1) quadro de comprometimento medular torácico baixo ou lombossacro (síndrome de cone medular e/ou cauda equina); 2) epidemiologia positiva para esquistossomose; 3) comprovaçäo laboratorial de esquistossomose através de exame parasitológico de fezes ou biópsia retal; e 4) exclusäo de outras patologias que pudessem causar quadro semelhante. Vários aspectos clínicos e epidemiológicos foram estudados para determinar o perfil diagnóstico da mielorradiculopatia esquistossomótica nesta amostra e säo apresentados neste artigo. Reconhecendo os vários problemas no diagnóstico da mielorradiculopatia esquistossomótica, enfatizamos a importância de se pensar nesta entidade e sugerimos critérios para definiçäo diagnóstica
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Neuroesquistossomose/diagnóstico , Esquistossomose mansoni/diagnóstico , Doenças da Medula Espinal/diagnóstico , Brasil/epidemiologia , Diagnóstico Diferencial , Neuroesquistossomose/diagnóstico , Neuroesquistossomose/epidemiologia , Estudos Retrospectivos , Esquistossomose mansoni/complicações , Esquistossomose mansoni/epidemiologia , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/parasitologiaRESUMO
Propósito: Revisar los diferentes aspectos epidemiológicos de la lesión medular traumática en población laboralmente activa, afiliada a la Asociación Chilena de Seguridad (ACHS) y compararla con otros países. Información base. Registro de todos los pacientes con lesión medular, desde 1973 hasta 1999. Resultado: En 16 años se cuantifican 180 casos con lesión medular, de los cuales 171 son hombres y 9 mujeres y han fallecido 9. La edad promedio de los lesionados medulares es 36 años, en tanto que la tasa de incidencia desde 1991 hasta 1999 se ha mantenido entre 7 y 14 por millón de trabajadores. La tasa de prevalencia ha ido aumentando progresivamente, alcanzando 130 por millón en 1999. Con la actual tendencia, el número de pacientes se duplicaría el año 2013. El lugar del accidente ocurrió en el trabajo en 133 pacientes (74 por ciento) y en el trayecto directo a él, en 47 casos (26 por ciento). Los mecanismos de accidente en el lugar de trabajo fueron caídas de altura 62 casos (47 por ciento), impacto directo con troncos, piedras u otros 61 casos (46 por ciento), y otras causas en diez pacientes (7 por ciento). Las caídas de altura fueron más frecuentes en los que trabajaban en los rubros de agricultura y construcción, mientras que el impacto directo fue en aquellos que trabajaban en los rubros minero y forestal. Conclusiones: La incidencia comparativa de la ACHS con otros países de Latinoamérica y del mundo es baja. Las principales causas son impacto directo y caídas que se asocian a ciertas actividades productivas
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Feminino , Doenças da Medula Espinal/epidemiologia , Doenças Profissionais , Doenças da Medula Espinal/classificação , Riscos OcupacionaisRESUMO
Schistosomiasis is an infection caused by digenetic trematode platyhelminths of the genus Schistosoma. These blood flukes use man and other mammals as definitive hosts and aquatic and amphibious snails as intermediate hosts. Of the schistosomal species, S. mansoni, S haematobium and S. japonicum are the most important to man and the most widely distributed. The infection affects about 200 million individuals in 74 countries of Latin America, Africa and Asia. Far less commonly, schistosomes reach the central nervous system (CNS). This may occur at any time from the moment the worms have matured and the eggs have been laid. For this reason, CNS involvement may be observed with any of the clinical forms of schistosomal infection. The presence of eggs in the CNS induces a cell-mediated periovular granulomatous reaction. When eggs reach the CNS during the early stages of the infection or during evolution of the disease to its chronic forms, large necrotic-exudative granulomas are found. In-situ egg deposition following the anomalous migration of adult worms appears to be the main, if not the only, mechanism by which Schistosoma may reach the CNS in these stages. The mass effect produced by the heavy concentration of eggs and the presence of large granulomas in circumscribed areas of the brain and spinal cord explains, respectively, 1) the signs and symptoms of increased intracranial pressure and focal neurological signs; and 2) the signs and symptoms of rapidly progressing transverse myelitis, usually affecting the lumbosacral segments of the spinal cord. Most of the cases of CNS involvement associated with the hepatosplenic and cardiopulmonary chronic forms, or with severe urinary schistosomiasis, though more frequent, are asymptomatic. In the patients with these clinical forms, the random and sparse distribution of eggs in the CNS indicates that the embolization of eggs from the portal mesenteric system to the brain and spinal cord constitutes the main route of CNS invasion by Schistosoma. The discrete inflammatory reaction elicited by the sparsely distributed eggs in the CNS explains the lack of neurological symptoms that could be produced by egg deposition.
Assuntos
Encefalopatias/patologia , Esquistossomose/patologia , Doenças da Medula Espinal/patologia , Animais , Encefalopatias/epidemiologia , Encefalopatias/parasitologia , Interações Hospedeiro-Parasita , Humanos , Schistosoma/crescimento & desenvolvimento , Schistosoma/fisiologia , Esquistossomose/epidemiologia , Esquistossomose/parasitologia , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/parasitologiaRESUMO
Schistosomiasis mansoni is an endemic disease in Brazil. Cases of nervous system schistosomiasis have been referred in our medical literature for the past forty years. In this report five cases of schistosomiasis of the spinal cord are studied. A review of the literature has been made and some clinical, laboratory and therapeutical aspects are discussed.
Assuntos
Esquistossomose mansoni/diagnóstico , Doenças da Medula Espinal/diagnóstico , Adolescente , Adulto , Brasil/epidemiologia , Criança , Feminino , Humanos , Masculino , Esquistossomose mansoni/líquido cefalorraquidiano , Esquistossomose mansoni/epidemiologia , Doenças da Medula Espinal/líquido cefalorraquidiano , Doenças da Medula Espinal/epidemiologiaRESUMO
Tropical myeloneuropathies include tropical ataxic neuropathy and tropical spastic paraparesis. These disorders occur in geographic isolates in several developing countries and are associated with malnutrition, cyanide intoxication from cassava consumption, tropical malabsorption (TM), vegetarian diets, and lathyrism. TM-malnutrition was a probable cause of myeloneuropathies among Far East prisoners of war in World War II. Clusters of unknown etiology occur in India, Africa, the Seychelles, several Caribbean islands, Jamaica, and Colombia. Treponemal infection (yaws) could be an etiologic factor in the last two. Tropical myeloneuropathies, a serious health problem, are multifactorial conditions that provide unsurpassed opportunities for international cooperation and neurologic research.