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OBJECTIVE: To study prospectively the clinical features and laboratorial characteristics of 24 patients with central nervous system (CNS) involvement with paracoccidioidomycosis (PCM). PCM is an infectious disease caused by the dimorphic fungus Paracoccidioides brasiliensis, endemic in subtropical areas of Central and South America. METHODS: From 173 cases of PCM, 24 (13.9%) had CNS involvement (NPCM) and were studied prospectively from 1993 to 1997. In all the patients, the diagnosis of systemic PCM was made by the demonstration of the P. brasiliensis organisms or positive serology, DID (double immunodiffusion). In seven cases the diagnosis was made by means of a CNS biopsy. CNS clinical manifestations, neuroimaging (CT or MRI) and CSF cytochemical characteristics were reported. RESULTS: The mean age was 44 years (range 25-72 years); 23 patients were male, only one was female. Neurological symptoms began before systemic symptoms in 21%; simultaneously in 33%, and after systemic symptoms in 46%. Epilepsy was the more frequent neurological presentation (44%). Twenty-three cases had parenchymatous involvement and in two of these cases there was an association with meningitis and one case had spinal cord involvement. Lesions were more frequent in the brain hemispheres (69%), in 65% there were multiple granuloma characterized by hypodense images with annular or nodular enhancing. All cases were treated with sulphamethoxazole-trimethoprin. Four patients died, while 20 patients showed a good therapeutic response. CONCLUSION: NPCM should always be considered in the differential diagnosis of expanding lesions of the CNS and meningoencephalitis. Being alert to this diagnosis depends on knowledge of epidemiology. There was good response to sulphamethoxazole-trimethoprin treatment.

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UNLABELLED: We analyzed cerebrospinal fluid (CSF) and blood serum from 55 patients with neurocysticercosis (NC) at different clinical stages. According to inflammatory activity in the CSF, three stages were identified: (1) reactive, when there was at least an increase in the number of cells; (2) weakly reactive, when significant alterations were found in the CSF, including an increase in gamma globulins, albeit without hypercytosis; (3) non-reactive, when there was neither hypercytosis nor increase in gamma globulins. Nineteen patients had the reactive form; 18 had the weakly reactive form; 18 displayed the non-reactive form. Local immunoproduction was intense in the reactive group, moderate in the weakly reactive group, and absent in the non-reactive group. The specific antibody index was raised in approximately 2/3 of patients with the reactive form, 2/3 in those with the weakly reactive form, and 1/3 in those with the non-reactive form. IN CONCLUSION: (1) the classical CSF syndrome in NC can present both in complete and partial modes; (2) local immunoproduction can occur in weakly reactive forms; (3) a raised specific antibody index can occur in the absence of an inflammatory reaction in the CSF.

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Com o objetivo de verificar se existe mudanças na intensidade da resposta inflamatória do líquido cefalorraqueano (LCR) no curso da paraparesia espastica tropical (PET) associada ao HTLV-1 foram estudados retrospectivamente os exames de LCR de 128 pacientes com PET. Os resultados indicam que embora alteraçöes inflamatórias possam persistir por período superior a 10 anos, existe tendência a diminuiçäo de sua intensidade ou mesmo de normalizaçäo após o segundo ano de evoluçäo da doença

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In order to evaluate if there is variation on the intensity of cerebral spinal fluid (CSF) response during HTLV-I associated tropical spastic paraparesis (TSP) evolution we retrospectively reviewed 128 cases. The results indicate that although CSF inflammatory alterations can persist over a 10-year period, they tend to become slight or even absent after the second year of TSP evolution.

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Sixty-two patients with symptomatic neurosyphilis were treated with 20 or 24 megaunits of intravenous penicillin G daily for 15 to 30 days. The mean follow-up time after the treatment was 30 months. Forty-one patients had pleocytosis in the CSF before treatment. Six months and twelve or more months later, abnormal cell count was observed in 4 (9.8%) and in 3 patients (7.3%), respectively. The CSF protein level and the titers of Wassermann reaction in the CSF decreased slowly after treatment. The gammaglobulin concentration of the CSF and the immunoglobulin production inside the blood-brain barrier were still increased beyond the first year after treatment. The results of the treatment of these patients with high doses of intravenous penicillin G were not different from the results verified with lesser doses of intramuscular penicillin that were reported in the literature.

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The study is based on 371 cerebrospinal fluid (CSF) samples and 324 serum samples from 40 patients with neurocysticercosis (NC) submitted to treatment with praziquantel. The aim of the study is a critical evaluation on humoral immunity in CSF NC syndrome. The analysis of NC patients at diagnosis and in the follow-up period was performed considering three connected criteria: the clinical one, the CSF examination and the computed tomography. For the study of CSF and serum samples a systematization of collection was scheduled in relation to: diagnosis; period of treatment; follow-up. A total of 13 samples for each case for a follow-up period of two years was scheduled. For the study of humoral immunity a semiquantitative methodology was employed to verify the intra blood-brain barrier (BBB) gamma globulins synthesis. It was based upon electrophoretic profile data on CSF and serum proteins, and relations and indexes. Normal values were previously characterized in a normal control group. This group was formed by 50 patients with chronic headache who presented normal neurological examination, as well as, CSF-examination and serum proteinogram under the safety limits of normality. To verify intra BBB gamma globulins synthesis it was considered the gamma globulin content of the CSF and serum, the gamma globulins/prealbumin + albumin relationship, the Link and Tibbling index, the intra BBB gamma globulins synthesis of Tourtellotte and col., and the appearance of oligoclonal bands in the CSF. Confirmation of the disease was performed by immunological reactions for cysticercosis: complement fixation test in CSF and serum; immunofluorescent test and enzyme-linked immunosorbent assay (ELISA) in CSF. Interference factors in the CSF NC syndrome were analysed at first such as those related to: clinical aspects, time of disease, previous dependence on corticotherapy, ventricular derivation shunts, tomographic findings. It was shown that all of them produce several degrees of interference in the intensity of the CSF NC syndrome. Data on intra BBB gamma globulins synthesis were verified in 37 patients (92.5%). It occurred in a persistent pattern in 18 cases (45%) during all the study phases, and not showed changes that might be related to treatment. On the other hand, it was shown that analysis of the results must always be performed case by case due to large dispersion of events observed and the differences of behavior of data related to humoral immunity, when critically analysed during diagnosis, treatment period and in the follow-up.(ABSTRACT TRUNCATED AT 400 WORDS)

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Eosinophil cells play an important role in the signalization of cerebrospinal fluid (CSF) by inflammatory diseases of central nervous system and its leptomeningeal coverings (CNS), according to present data on neuroimmunology. The extent of their participation in local immunological phenomena is evaluated, and data on other changes in the CSF cytoprotein dual were considered for comparative purposes. CSF of two types of inflammatory diseases of the CNS were studied for this purpose: samples of 35 patients in early stages of acute eosinophilic leptomeningites possibly of viral origin (first group) and 20 samples of 10 patients with neurocysticercosis (second group). Samples of the second group were collected in the early stages of each one of two episodes of exhacerbation in the inflammatory reaction observed at each one of the two series of administration of Praziquantel, a pirazino-isochinoleinic derivate which action upon cysticerci has been reported. Statistical analysis shows that participation of eosinophil cells in the inflammatory response does not differ in the two groups. Their participation is related to changes observed in the CSF cytoprotein dual rather than to the type of the inflammatory model: acute and monophasic in the first group, and chronic an repetitive in the second. Gamma globulins participe in the exhacerbation of CSF inflammatory reaction in neurocysticercosis but their behaviour not always is similar. In some instances it is similar to that found in other chronic and repetitive inflammatory models, as multiple sclerosis for instance.

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Data on cerebrospinal fluid (CSF) cells and proteins (total proteins and gamma globulins content) are reviewed in 287 patients with myelopathies. Clinical data on these patients were reported. Results obtained are distributed according to diagnoses and to time of disease (tables 1 and 2). Informations obtained through the study show that signalization of CSF system is related to the episode responsible by the disease, when the episode is singular. Repeated episodes or a progressive evolution are more apt to produce a maintained signalization of CSF cyto-protein dual. In this way data on infectious myelopathies, multiple sclerosis and neuromyelitis optica are compared to those found in post-vaccination, post-infection and post-intoxication myelopathies, as well as to those found in B-12 deficiency and myelopathies of vascular origin. Primary myelitis are evaluated in report to this comparison. It is shown that changes in the CSF cyto-protein dual are more related to those found in multiple sclerosis and neuromyelitis optica when chronic primary myelitis is considered. In acute and sub-acute primary myelitis they are related to those found in post-vaccination, post-infection and post-intoxication myelopathies.

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