RESUMO
OBJECTIVES: To describe the clinical and CSF findings among patients with presumptive neuroschistosomiasis (NS) and to suggest a classification for the CSF diagnosis of presumptive NS. METHOD: The charts of all patients whose CSF exam was performed at the CSF Lab, Jos Silveira Foundation, Salvador, Brazil, from 1988 to 2002 were reviewed. Those with clinically suspected NS whose indirect fluorescent antibody test (IFA) and or hemagglutination-inhibiting antibodies test (HAI) were positive to S. mansoni were identified. RESULTS: Of 377 patients, 67.9% were males; the median age was 36 years (mean 37 + 16 yrs, range 3-82 yrs). The most frequent complaints were paraparesis (59.9%), urinary retention (36.2%), lower limb pain (22.8%). WBC of CSF (count/mm ) was > 4 in 66.0% (mean 83 + 124, median 40, range 4.3-1,100), protein (mg/dl) was > 40 in 84.6% (mean 185 + 519, median 81, range 41-6,800) and eosinophils were present in 46.9%. IFA and HAI were positive in 75.3%. WBC > 4 and presence of eosinophils were associated with IFA and HAI positive (67.3% versus 51.4%, p 0.014; 49.1% versus 23.0%, p 0.0001, respectively) and protein > 40 was not (85.4% versus 77.0%, p 0.09). Presence of WBC > 4, protein > 40 and eosinophils was associated with IFA and HAI positive (71.6% versus 38.2%, p 0.0003) but presence of eosinophils and any other combination of WBC and protein were not. CONCLUSION: NS should be considered as a possible diagnosis in patients who had had contact with schistosome-infected water and present with spinal cord compromising. Presence of IFA and HAI positive to S. mansoni, WBC > 4, protein > 40 and presence of eosinophils in the CSF may be considered as a criterium of highly probable presumptive diagnosis.
Assuntos
Neuroesquistossomose/líquido cefalorraquidiano , Esquistossomose mansoni/líquido cefalorraquidiano , Doenças da Medula Espinal/líquido cefalorraquidiano , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Testes de Inibição da Hemaglutinação , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neuroesquistossomose/diagnóstico , Valor Preditivo dos Testes , Esquistossomose mansoni/diagnóstico , Sensibilidade e Especificidade , Doenças da Medula Espinal/diagnósticoRESUMO
OBJECTIVES: To describe the clinical and CSF findings among patients with presumptive neuroschistosomiasis (NS) and to suggest a classification for the CSF diagnosis of presumptive NS. METHOD: The charts of all patients whose CSF exam was performed at the CSF Lab, José Silveira Foundation, Salvador, Brazil, from 1988 to 2002 were reviewed. Those with clinically suspected NS whose indirect fluorescent antibody test (IFA) and or hemagglutination-inhibiting antibodies test (HAI) were positive to S. mansoni were identified. RESULTS: Of 377 patients, 67.9 percent were males; the median age was 36 years (mean 37 + 16 yrs, range 3-82 yrs). The most frequent complaints were paraparesis (59.9 percent), urinary retention (36.2 percent), lower limb pain (22.8 percent). WBC of CSF (count/mm ) was > 4 in 66.0 percent (mean 83 + 124, median 40, range 4.3-1,100), protein (mg/dl) was > 40 in 84.6 percent (mean 185 + 519, median 81, range 41-6,800) and eosinophils were present in 46.9 percent. IFA and HAI were positive in 75.3 percent. WBC > 4 and presence of eosinophils were associated with IFA and HAI positive (67.3 percent versus 51.4 percent, p 0.014; 49.1 percent versus 23.0 percent, p 0.0001, respectively) and protein > 40 was not (85.4 percent versus 77.0 percent, p 0.09). Presence of WBC > 4, protein > 40 and eosinophils was associated with IFA and HAI positive (71.6 percent versus 38.2 percent, p 0.0003) but presence of eosinophils and any other combination of WBC and protein were not. CONCLUSION: NS should be considered as a possible diagnosis in patients who had had contact with schistosome-infected water and present with spinal cord compromising. Presence of IFA and HAI positive to S. mansoni, WBC > 4, protein > 40 and presence of eosinophils in the CSF may be considered as a criterium of highly probable presumptive diagnosis
Assuntos
Adolescente , Adulto , Idoso , Animais , Criança , Pré-Escolar , Feminino , Humanos , Pessoa de Meia-Idade , Neuroesquistossomose , Esquistossomose mansoni , Doenças da Medula Espinal , Idoso de 80 Anos ou mais , Líquido Cefalorraquidiano , Eosinófilos , Técnica Indireta de Fluorescência para Anticorpo , Testes de Inibição da Hemaglutinação , Contagem de Leucócitos , Neuroesquistossomose , Valor Preditivo dos Testes , Esquistossomose mansoni , Sensibilidade e Especificidade , Doenças da Medula EspinalRESUMO
Os autores relatam 16 casos de pacientes com forma meningomielorradicular da neuroesquistossomose mansônica, diagnosticados segundo critérios clinicos, laboratoriais e de imagem, acompanhados no Ambulatório de Neurologia-HUPES-UFBA no período de abril/91 a dezembro/93. Eles foram tratados com praziquantel associado a corticoterapia. O objetivo foi avaliar o grau de eficássia e de segurança da droga na regressao dos sinais e sintomas neurológicos.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Meningite/etiologia , Mielite/etiologia , Praziquantel/uso terapêutico , Prednisona/uso terapêutico , Radiculopatia/etiologia , Esquistossomose mansoni/complicações , Meningite/tratamento farmacológico , Mielite/tratamento farmacológico , Radiculopatia/tratamento farmacológico , Esquistossomose mansoni/líquido cefalorraquidiano , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/tratamento farmacológico , Resultado do TratamentoRESUMO
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
