Immunoblot with cerebrospinal fluid from patients with neurocysticercosis using antigen from cysticerci of Taenia solium and Taenia crassiceps.

A comparative study was conducted on membrane (M) and vesicular fluid (VF) from cysticerci of Taenia solium (Tso) obtained from naturally infected swine and the Taenia crassiceps ORF strain (Tc) maintained by experimental infection of female BALB/c mice. The study was carried out using immunoblotting to detect antibodies in cerebrospinal fluid (CSF) from patients with neurocysticercosis. No reactivity was observed in the 32 samples from a control group. Of the 23 CSF fluid samples from patients with neurocysticercosis, 22 (95.6%) were reactive in the M-Tso blot and 21 (91.3%) were reactive in the other three blots (VF-Tso, M-Tc, and VF-Tc). Immunodominant peptides in each antigen were 98-92 kD, 56-52 kD, and 72-68 kD in M-Tso; 72-68 kD, 120 kD, 155 kD, 98-94 kD, 76 kD, and 115-108 kD in VF-Tso: 72 kD, 62 kD, and 42 kD in M-Tc; and 72-68 kD and 95-92 kD in VF-Tc. The cross-reactivity observed in the immunoblots performed on CSF samples from patients with neurocysticercosis indicates that the parasites share important epitopes present at sufficient concentrations for use in immunologic tests.

Diffusion-weighted MRI in two cases of familial Creutzfeldt--Jakob disease.

Diffusion-weighted magnetic resonance imaging (DWI) has been described as a useful tool for the diagnosis of sporadic Creutzfeldt--Jakob disease (CJD). To our knowledge, DWI abnormalities have not previously been reported in familial CJD. In two patients with familial CJD associated with distinct mutations at codon 183 and at codon 210 of the prion protein gene, DWI showed a high signal in the basal ganglia and in the cerebral cortex. These abnormalities are similar to those described in sporadic CJD. This observation expands the value of DWI for the diagnosis of some forms of familial CJD. It remains to be investigated whether this finding also holds for CJD associated with other mutations of the prion protein gene.

Erythro-lectin immuno test (Erythro-LIT) in the immunodiagnosis of neurocysticercosis.

1. The effectiveness of the Erythro-Lectin Immuno Test (Erythro-LIT) to detect anticysticercus antibodies was tested using cerebrospinal fluid (CFS) from patients with neurocysticercosis. 2. Both Erythro-LIT and complement fixation (CF) were used to detect antibodies in 36 CSF samples from cysticercotic patients. Erythro-LIT detected anticysticercus antibodies in 35 CSF samples (97%) and CF in 26 (72%). The antibody titers ranged from 1:4 to 1:4096 for Erythro-LIT (mean geometric titer = 282.65) and 1:1 to 1:64 in CF (mean geometric titer = 7.92). 3. When greater than or equal to 1:16 Erythro-LIT titer was used as a significant diagnostic cut-off value, the sensitivity and specificity of Erythro-LIT were 92% and 100%, respectively, for CFS. 4. The high sensitivity and specificity demonstrated here, together with the simplicity and low cost of the test, make the Erythro-LIT a potentially useful method for screening for specific antibodies in neurocysticercosis.

Coagglutination test (COA) for Cryptococcus neoformans circulating antigen detection in cerebral spinal fluid (CSF).

We tested 82 CSF of 24 renal transplanted patients (RT) with cerebral cryptococcosis, 8 CSF of asymptomatic RT patients, 43 CSF of proven cryptococcosis cases (positive control) and 35 CSF of patients with other diseases (histoplasmosis, paracoccidioidomycosis and bacterial infections) as negative control. The RT CSF were cultured in Sabouraud agar slant added with sunflower seeds and both control and RT CSF were qualitatively examined by cryptococcosis latex test (Crypto-LA test). The COA test was developed both qualitatively and quantitatively. The highest titre encountered was 1:2048. No false reactions appeared among the controls. The diagnostic value demonstrated by Galen and Gambino's method was: sensitivity--92.1%; specificity--92.6% and efficiency--92.3%. Besides that, the COA proved to be quick, exact and cheap, but it depends on CSF and sera pre-treatment, in order to avoid autoagglutination and increase its sensibility.

Total IgE detection in paired cerebrospinal fluid and serum samples from patients with neurocysticercosis.

Neurocysticercosis (NC), the presence of Taenia solium metacestodes in tissues, is the most frequent and severe parasitic infection of the central nervous system. We investigated the presence of total IgE by an automated chemiluminescence assay in 53 paired cerebrospinal fluid (CSF) and serum samples from patients with NC (P) and in 40 CSF samples from individuals with other neurological disorders as the control group (C). Total IgE concentration ranged from 1.2 to 6.6 IU/ml (mean = 1.4 IU/ml, standard deviation-sd = 1.1 IU/ml) in 28.3% of CSF samples from the P group, a value significantly higher than for the C group ( pound1.0 IU/ml). The serum samples from the P group showed concentrations ranging from 1. 0 to 2330.0 IU/ml (mean = 224.1 IU/ml, sd = 452.1 IU/ml), which were higher than the normal value cited by the manufacturer (<100.0 IU/ml) in 32.1% of the samples. A significant difference was observed in CSF samples from the P and C groups (p = 0.005) and in serum samples from the P group compared to the normal value (p = 0. 005), with sera showing more frequent abnormal results.

Hemagglutination test for the diagnosis of human neurocysticercosis: development of a stable reagent using homologous and heterologous antigens.

A hemagglutination (HA) test was standardized using formalin- and tannin-treated gander red blood cells sensitized with a total salt extract of C. cellulosae (HA-Cc) and an antigenic extract of Cysticercus longicollis (HA-Cl) vesicular fluid. A total of 61 cerebrospinal fluid (CSF) samples were assayed, 41 from patients with neurocysticercosis and 20 from a control group which were, respectively, reactive and non-reactive to ELISA using C. cellulosae. The CSF samples from the control group did not react and 35 (85.4%) and 34 (82.9%) CSF samples from patients were reactive to the HA-Cc and HA-Cl tests, respectively. The reagents ready for use were stable up to 6 months when stored at 4 degrees C in 50% glycerol. The present results confirm that the reagent using Cysticercus longicollis stabilized with glycerol can be used as an alternative in the immunological diagnosis of neurocysticercosis.

[Cryptococcus neoformans chemotyping. Review of the literature. New epidemiologic data on cryptococcosis. Our experience with the use of C.G.B. media in the study of this yeast]. / Quimiotipagem do Cryptococcus neoformans. Revisão da literatura. Novos dados epidemiológicos sobre a criptococose. Nossa experiência com o emprego do meio de C.G.B. no estudo daquela levedura.

The purpose of this work was to collect the main information from the literature about the biotyping of Cryptococcus neoformans. The more up-to date research concerning the epidemiology of cryptococcosis comprising quite a few articles, mainly after the advent of AIDS, was also reviewed. The Cryptococcus neoformans varieties neoformans and gattii are well defined biochemically nowadays chiefly through the C.G.B. medium, according to Kwon-Chung et al. (1982). The isolation of C. neoformans var. gattii from flowers and leaves of Eucalyptus camaldulensis and Eucalyptus tereticornis, specially in Australia, through the works of Ellis & Pfeiffer (1990) and Pfeiffer & Ellis (1992) permitted very interesting epidemiological investigations on C. neoformans, a capsulated yeast by which Sanfelice, in Italy (1894; 1895) attracted attention of medical class. Busse, in 1894, described the first human case of cryptococcosis under the presentation of a bone lesion simulating sarcoma. In this paper, the Brazilian researchers focused on this subject were pointed out, followed by the Author's experience with the C.G.B. medium (L-canavanine, glycine and bromothymol blue) proposed by Kwon-Chung et al. (1982) with very good results. It was possible with such medium the study of 50 C.N.S. liquor samples, being 39 from AIDS patients (78%) and 11 from non-AIDS ones (22%). Thirty-seven out of the 39 HIV-positive patients (74%) were identified as C. neoformans var. gattii. From the negative HIV, 8 (16%) were classified as C. neoformans var. neoformans and 3 (6%) as C. neoformans var. gattii. We could not perform the serotyping of the above referred samples. It is evident anyway that in Brazil there exist both varieties gattii and neoformans, agents of neurocryptococcosis, including AIDS patients. The importance of neurocryptococcosis, mainly among AIDS patients, is stressed here, showing once more the value of C.G.B. medium in the typing of C. neoformans in its two varieties. Also, it is of relevant importance the demonstration that some species of eucalyptus may act as "host-trees" of C. neoformans var. gattii.

[Immunoglobulins of the normal cerebrospinal fluid]. / Imunoglobulinas do líquido cefalorraqueano normal.

The most important methods and results found in literature on immunoglobulins of the normal cerebrospinal fluid (CSF) are reviewed. A study was made of immunoglobulins in the CSF of 50 individuals who suffered from chronic migraine but showed normal results for the physical and neurological examinations; electroencephalograph, CSF tests (sub-occipital puncture) and proteinogram of the serum also fell within the limits of normalcy in all of the 50 cases. The study of immunoglobulins was conducted through the radial immunodifusion method. Results obtained as to immunoglobulins of the CSF varied between 1,55 and 3,97 mg/100 ml, or 0,17 and 0,44 for IGG; values lay between 0 and 0,62 mg/100 ml, or 0,37 UI for IGA. Presence of IGM was not detected in any of the cases studied. Analysis of the results showed that, for the CSF of the cisterna magna in normal individuals, IGG is always found at an average concentration of 2,37 mg/100 ml and a standard deviation of 0,59. IGA is mostly found at an average concentration of 0,34 mg/100 ml and a standard deviation of 0,17. IGM is not demonstrable, under normal conditions, by the method chosen by the author.

[Immunoglobulins of the normal cerebrospinal fluid. II. Relations and indices]. / Imunoglobulinas do líquido cefalorraqueano normal. II. Relacões e índices.

Relations and quocientes of cerebrospinal fluid (CSF) immunoglobulins G (IGG) and serum (S) IGG were studied in 50 patients with chronic headache, normal neurological examination and normal electroencephalogram. CSF was normal as to: pressure, cytology, total proteins, protein fractions and immunoglobulins (IGG, IGA and IGM) contents. In all cases the CSF sample studied was collected from cisterna magna. The relations and quocients studied were: CSF IGG/CSF TOTAL PROTEIN, CSF IGG/CSF ALBUMIN, CSF IGG/CSF PRE ALBUMIN+ALBUMIN, (CSF IGG/S IGG) / (CSF ALBUMIN/S ALBUMIN) and (CSF IGG/S IGG) / (CSF PRE ALBUMIN+ALBUMIN) / (S ALBUMIN). It was found that the best index to appraise the behavior of IGG is: (CSF IGG/S IGG) /(CSF PRE ALBUMIN+ALBUMIN/S ALBUMIN) that shows an average of 0.56 and a standard deviation of 0.32 in the material studied.

[A cerebrospinal fluid syndrome in neurocysticercosis]. / Síndrome do líquido cefalorraqueano na neurocisticercose: estudo crítico sobre a evolução da imunidade humoral.

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)

[Contribution of immunofluorescent reactions in the cerebrospinal fluid to the study of neurocysticercosis]. / Contribuição de reações de imunofluorescência no líquido cefalorraqueano ao estudo da neurocisticercose.

The most important immunobiological aspects of neurocysticercosis and the cerebrospinal fluid (CSF) syndrome in this disease are reviewed. A study was made of 1.577 samples of CSF from 1.282 patients who suffered from several diseases of central nervous system. They were divided in 3 groups: 1- 459 patients with normal results of CSF tests; 2- 600 patients with pathological CSF, but with immunological reactions non-reactive; 3- 233 patients divided in 8 sub-groups according the results of the immunological reactions. CSF immunofluorescent reactions for syphilis (FTA-Abs). cysticercosis and toxoplasmosis were analysed. Results obtained showed that immunofluorescent reaction for cysticercosis has the same sensitivity and especificity as the complement fixation test, but, not considering those samples who showed delay in hemolisys of the complement fixation test, the immunofluorescent reaction showed significative, better results, as occurs, with the FTA-Abs in syphilis. The agreement between the results of the immunofluorescent reaction and complement fixation in CSF contributes for a better security to the immunodiagnosis of cysticercosis and is particularly useful in those cases in which the complement fixation test in anti-complementary. The positive of immunofluorescent reaction for cysticercosis in CSF must be incorporated to the CSF syndrome of the disease and contributes to the immunobiological studies of the disease.

[Neurologic evaluation of non-Hodgkin's lymphoma in adult patients: a prospective study]. / Avaliação neurológica de pacientes adultos com linfoma não-Hodgkin. Estudo prospectivo.

This prospective study included 67 adult patients with low, intermediate or high malignancy degrees of non-Hodgkin's lymphomas according to the Working Formulation. Patients with or without anti-HIV antibodies in the serum were considered. All patients were submitted to neurologic evaluation, and 63 of them to examination of the cerebrospinal fluid (CSF). Patients presenting neurologic signs and symptoms were 42 (62.7%). Neurologic findings and CSF changes were correlated. The association of localized thoraco-lumbar pain and CSF changes (presence of neoplastic cells, increased protein concentration and/or increased gamma globulin content) was statistically significant, as the association of abnormal muscle strength in the lower limbs and CSF changes in patients without HIV antibodies in the serum. Cranial nerve dysfunction (III, IV and VI cranial nerves) correlated with the finding of neoplastic cells in the cerebrospinal fluid.

Neurotoxoplasmosis and AIDS. Cerebrospinal fluid analysis in 96 patients.

The behavior of CSF inflammatory pattern in patients with AIDS and/or toxoplasmosis of the CNS is studied in 176 patients, divided in three groups. In the first group, 96 patients with toxoplasmosis and AIDS are considered; in the second group, 50 patients with toxoplasmosis without AIDS; in the third group, 30 AIDS patients without toxoplasmosis nor any other opportunistic infection. It is possible to conclude that patients with toxoplasmosis associated to AIDS exhibit CSF inflammatory pattern similar to patients with neurotoxoplasmosis without AIDS, except in respect to gamma globulin rates for which a cumulative effect can be detected.

[Trypanosoma cruzi antibodies in the cerebrospinal fluid: a search using complement fixation and immunofluorescence reactions]. / Anticorpos a trypanosoma cruzi no líquido cefalorraqueano: pesquisa pelas reações de fixação do complemento e de imunofluorescência.

Cerebrospinal fluid (CSF) samples of 200 patients who presented central nervous system (CNS) pathologies were evaluated for antibodies to Trypanosoma cruzi (T. cruzi). The evaluation was made through: complement fixation test (CFT) in 69 patients, indirect (IgG) immunofluorescence test (IFT) in 118, and by CFT and IFT in 13. In 50 cases the IFT has been made also in concentrated (20 X) CSF samples. Results were evaluated in report to CNS pathology, CSF cells and proteins, and tests in the CSF for other CNS infections (syphilis, cysticercosis, schistosomiasis, toxoplasmosis). These tests were based on techniques similar to those adopted for the search of antibodies to T. cruzi, and were conducted concomitantly to tests for T. cruzi in the same CSF sample for everyone of the cases. Antibodies to T. cruzi were found in three patients. The first was a patient committed by the acquired immunodeficiency syndrome (AIDS) in whom there occurred exacerbation of the acute stage of Chagas' disease. The second is a patient who is committed by epilepsy, and an acute stroke occurred in the third patient: Chagas' disease had been previously diagnosed in them through the demonstration of antibodies to T. cruzi in the blood serum.

[Detection by the immunoenzymatic test ELISA of IgM anti-Cysticercus cellulosae antibodies in the cerebrospinal fluid in neurocysticercosis]. / Detecção pelo teste imunoenzimático ELISA de anticorpos IgM anti-Cysticercus cellulosae no líquido cefalorraqueano na neurocisticerose.

IgM antibodies against Cysticercus cellulosae in the cerebrospinal fluid (CSF) was demonstrated by ELISA immunoenzymatic assay in neurocysticercosis. CSF samples of 41 patients were analyzed for this purpose. Diagnosis was neurocysticercosis in 26 and neurosyphilis in 5; abnormalities were not registered in the other 10 cases. Neurosyphilis samples and no-abnormalities samples were considered as control groups. ELISA IgM assay for cysticercosis was negative in all CSF samples of control groups and it was positive in 12 of the 26 CSF samples of the neurocysticercosis group (46.2%). Titers ranged from 4 till 32. Positive results were no more obtained after previous treatment of CSF samples by 2-mercaptoethanol. ELISA IgM and IgG titers were compared. IgM titers wee higher than IgG titers in two cases. Results obtained were compared to those found through complement fixation, immunofluorescence and hemagglutination tests for the diagnosis of neurocysticercosis.

[Cerebrospinal fluid signalization in chronic inflammatory diseases of the central nervous system]. / Sinalização do líquido cefalorraqueano em doenças inflamatórias crônicas do sistema nervoso central.

Dynamics of cerebrospinal fluid (CSF) cyto-proteic dual obeys to different models when central nervous system (CNS) inflammatory diseases are considered. In order to evaluate these models data pertinent to multiple sclerosis (20 cases), neurosyphilis (20 cases), neurocysticercosis (20 cases), subacute sclerosing panencephalitis (20 cases), neuroschistosomiasis (18 cases) and neuro-cryptococcosis (20 cases) are compared in report to a control group: chronic vascular headache (50 cases). CSF data on cytology and proteins were considered. Cytology was evaluated as to the total cell count (cumm); the cytomorphological profile (%) and as to lymphocytes subpopulations (B, T, T-active, T-sensitized, and T-avid for T-total and for T-active). Proteins were evaluated as to the total content (mg/dl) and protein fractions (agar gel electrophoresis). Antibodies determinations were studied for comparative purposes and diagnosis. Results were analyzed according to the groups considered and comparatively. Analyses support conclusions on cells and proteins dual interaction. This interaction is expressed by phenomena that obey similar parameters. These parameters permit to consider two models of chronic inflammatory signalization: the continuous model and the repetitive model. Neurosyphilis and subacute sclerosing panencephalitis obey the chronic continuous inflammatory model. Neurocysticercosis and multiple sclerosis obey the repetitive model.

Cysticercosis of the central nervous system and cerebrospinal fluid. Immunodiagnosis of 1573 patients in 63 years (1929-1992).

Attention given to prophylaxis of neurocysticercosis (NC) is far beyond minimal needs among several regions of the in-development world, and for this reason incidence of the disease persists high among them. This investigation was carried out to show the extent of the problem by analysing the incidence of NC in a region of Brazil (São Paulo). CSF immunodiagnosis of NC by detecting antibodies to Cysticercus cellulosae in a neurodiagnostics laboratory is evaluated for this purpose. Cases studied in a 63-year period (1929-1992) are reviewed. Total cases in this period is 139,000, and for 1,573 (1.13%) diagnosis is NC. Special characteristics were not detected for colour and sex prevalence. Age bracket prevalence is from 21 to 40 years old (55.3%) high rates occurring for women between 21 to 30 years old, and for men between 31 to 40. Cases distribution in five consecutive decades (1942-1991) shows no decreasing tendency: average incidence is 1% for the 50 years, and it is over this average for the last three decades. Data confirm that incidence continues expressively high throughout the 50 years covered by this study.

[Cerebrospinal fluid abnormalities in 170 cases of AIDS]. / Anormalidades do líquido cefalorraqueano em 170 casos de AIDS.

Cerebrospinal fluid (CSF) was analysed in 170 AIDS patients. All of them showed HIV positive serological tests. All of them showed neurologic syndromes related to AIDS. The time period of the investigation was July 1984-April 1989. In 8 cases (4.7%) CSF composition was normal. Lymphoma cells were observed in three cases. Aseptic meningities occurred in 34 cases (20.1%). Aetiological diagnosis of associated infection was established in 88 cases: cryptococcosis in 28 (35.9%); toxoplasmosis in 20 (25.6%); syphilis in 10; candidiasis in 3; Chagas disease in 2; tuberculosis in 1; nocardiosis in 1; schistosomiasis in 1. Antibodies for other virus were detected in 7. Bacteria were isolated in 5 cases. Anti-HIV antibodies were tested in CSF samples of 55 cases: they were found in 48 (87.3%). Two or more associated infections were observed in 15 cases. Changes of CSF composition in AIDS are discussed taking into account changes reported.

[Adenosine deaminase in the cerebrospinal fluid of patients with acquired immunodeficiency syndrome]. / Adenosino-deaminase no líquido celalorraqueano de pacientes com a síndrome da imunodeficiência adquirida.

The adenosine-deaminase (ADA) activity was evaluated in CSF samples from 263 patients with AIDS. An elevated ADA activity in CSF was found in patients with: antibodies to toxoplasmosis, syphilis or cytomegalovirus; Cryptococcus neoformans or their antigens; tuberculous meningitis; lymphoma. There was no statistical difference among all these groups in respect to ADA activity. However, the ADA activity in CSF from AIDS patients without CSF changes other than HIV antibodies, even unspecific changes, was not elevated. This may suggest that ADA is related to AIDS associated pathologies activity rather than to HIV infection itself.

[Cerebrospinal fluid in the healthy preterm newborn infant]. / Líquido cefalorraqueano no recem-nascido pre-termo sadio.

The cerebrospinal fluid (CSF) composition was studied in 54 premature infants. The pregnancy was normal and the delivery normal and non traumatic in all of them, and the 5 minutes Apgar score ranged from 6 to 9. No abnormalities were found on physical examination including neurological examination. Blood cell countings and blood gasometry were normal. CSF composition was studied as to: total cell count and total protein, glucose, bilirrubin and hemoglobin concentrations. Data found permit to stablish as physiologic the following values: leucocytes, until 16 per cumm; erithrocytes, until 1,280 per cumm; total protein content until 300 mgm/100 ml; bilirrubin until 80 micrometer/1; hemoglobin until 8 micrometer/1; glucose, two thirds of the concentration found in the blood. Protein, bilirrubin and hemoglobin are significantly increased as compared to values found for the CSF of 79 fullterm normal newborn babies evaluated previously. Hemoglobin was not detected in the CSF of any full term newborn baby. The differences found are probably due to a less efficient blood-CSF barrier in premature infants as compared to full-term newborn babies.