Regional variation in knowledge and practice regarding common zoonoses among livestock farmers of selective districts in Nepal

BACKGROUND

The majority of Nepalese people are involved in farming. However, due to limited knowledge of zoonoses and poor preventive practices on the part of livestock farmers, vulnerabilities to zoonotic diseases are very high. The main objective of this study was to assess the regional variation in zoonoses-related knowledge and preventive practices of livestock farmers in different ecological regions of Nepal.

MATERIAL AND METHODS

Descriptive cross-sectional quantitative research design was followed in the study. The total sample size was 380 livestock farmers from randomly selected three ecological regions of Nepal. Systematic sampling techniques were applied for data collection. Data were entered into an excel sheet and then imported into Statistical Package for Social Sciences (SPSS) software. The data were calculated using descriptive statistics. Univariate, and bivariate analyses were performed, and the result of the study was presented in the form of text and tables based on their nature.

RESULTS

Of the studied six zoonotic diseases, most of the respondents (95.8%) knew about zoonotic bird flu; 90.7% of them, were about rabies; and 54.2% knew about swine flu. However, a few respondents knew about bovine tuberculosis, neurocysticercosis, and brucellosis. Ecologically, the highest number of respondents in Nawalpur had knowledge of rabies (95.3%), and swine flu (61.6%), whereas 98.3% of them had knowledge of avian influenza in Tanahun; and 12.5% of neurocysticercosis in Manang. Regarding zoonoses preventive practices such as regular hand washing with soap water, mask-wearing, gloves, boots, the respondents' representation of 60.8%, 6.6%, 1.8%, and 1.3% respectively in such practices show that although these are easy and cost-effective, personal protective equipment (PPE), such preventive practices were extremely underperformed. Not only that, only 12% of respondents maintain a standard distance (>15m.) between their house and shed. Similarly, 17% still consumed meat from sick animals, and vaccination of livestock was also found poor coverage (36%) in the study.

CONCLUSIONS

Livestock farmers need to be more knowledgeable about many common zoonotic diseases, and their preventive practices still need improvement, with significant regional variation in the study. This has invited various zoonosis threats for them. Therefore, it is recommended that the interventional programs related to common zoonoses be conducted for livestock farmers to solve the problem.

Complex neurocysticercosis lesions on imaging: Explained through correlative histomorphology

OBJECTIVES

Neurocysticercosis, the commonest neuro-parasite, sometimes presents as complex ring enhancing lesion causing diagnostic dilemma. We aim to establish radio-histo-morphological equivalents of early events in degeneration of the parasite to explain such imaging phenotypes.

METHODS

We compared patterns of degeneration in 23 randomly selected complex NCC on MRI with histo-morphology in 30 cysts obtained from an unrelated post mortem brain.

RESULTS

The anatomy of the parasite and the degenerative patterns of the scolex (hydropic changes, calcification, evagination, and fragmentation) and the cyst wall (undulation, accessory loculi, and frank disruption) were well demonstrated on both. The intact scolex remarkably resembled head of intestinal Taenia. The complex lesions were conglomeration of multiple communicating cysts with a single parent cyst and multiple daughter cysts. The parent cysts contained a solitary variably degenerated scolex, had thicker walls and associated chronic inflammation. The remaining cysts of the lesion complex contained no scolex, had poorly organized walls, turbid contents, and florid perilesional enhancement with leakage of contrast. Three lesions assumed a multi-cystic pseudo-tumorous pattern, of which two resolved into solitary calcific remnants on follow up.

CONCLUSION

Complex lesion in NCC result from degeneration of solitary parasite with perilesional gliosis, surrounded by multiple non-larval daughter cysts inciting acute intra and perilesional inflammation due to enhanced antigenic challenge. Possibly, attempted abortive asexual reproduction by the cellulose cyst as a preterminal event results in a "limited Racemose like transition." Correct interpretation has diagnostic and therapeutic implications as active lesions and their fibrocalcific residue may have greater epileptogenic potential.

In vitro system for the growth and asexual multiplication of Taenia crassiceps cysticerci

Taenia solium is the aetiological agent of cysticercosis, a zoonosis that causes severe health and economic losses across Latin America, Africa and Asia. The most serious manifestation of the disease is neurocysticercosis, which occurs when the larval stage (cysticercus) establishes in the central nervous system. Using Taenia crassiceps as an experimental model organism for the study of cysticercosis, we aimed to identify the in vitro conditions necessary to allow parasite development at the short- and long terms. First, cysticerci were incubated for 15 days in different media and parasite densities. The number of buddings and cysticerci diameter were measured to evaluate asexual multiplication and parasite growth, respectively. Vitality was determined by trypan blue staining and morphology analysis. As a result, high cysticerci density and medium containing FBS and the excretion/secretion (E/S) products of feeder cells induced parasite survival, growth and multiplication. Then, the long-term (5 weeks) incubation of the parasites in co-culture with feeder cells was evaluated. Consequently, the mammalian cell lines induced a significant increase in total parasite volume while axenic cultures did not show any statistically significant change over time. In this study, the proper conditions to maintain T. crassiceps in vitro are described for the first time in a simpler and more controlled setting other than experimental infections. In addition, it was shown that cysticerci growth, survival and asexual multiplication depend on a complex network of secreted factors from both parasite and host.

Experimental animal models and their use in understanding cysticercosis: A systematic review

BACKGROUND

Cysticercosis and Neurocysticercosis (NCC) can be studied using several animal species in experimental models which contributes to the understanding of the human form of the disease. Experimental infections of Taenia spp. are vital in explaining the modes of transmission of the parasite and helps the understanding of transmission of the parasite in humans and thus may be useful in designing therapeutic and immune-prophylactic studies to combat the disease. Thus, this systematic review aims to explore the existing experimental animal models to the understanding of cysticercosis in both humans and animals and elucidate the risk factors of cysticercosis and identify the Taenia spp. used in these models.

METHODOLOGY

We systematically identified all publications from the Web of Science, Google Scholar, and Pubmed regarding experimental animal models using Taenia spp. that cause cysticercosis in both humans and animals. 58 studies were identified for eligibility. Of these, only 48 studies met the inclusion criteria from which data extraction was done and presented descriptively.

RESULTS

Pigs, cattle, gerbils, mice, rats, voles, monkeys, cats, dogs, and goats were used in which T. solium, T. saginata, T. saginata asiatica, T. crassiceps and T. asiatica were studied. The routes used to induce disease were; oral, intravenous, subcutaneous, intramuscular, intraperitoneal, intraarterial, intracranial, intraduodenal, and surgical routes using eggs, oncospheres, and proglottids. Besides, the establishment of infection using eggs and oncospheres was affected by the route used to induce infection in the experimental animals. The cysticerci recovery rate in all the experimental studies was low and the number of animals used in these experiments varied from 1 to 84. Although not analysed statistically, sex, age, and breed of animals influenced the cysticerci recovery rate. Additionally, the cysticerci recovery rate and antibody-antigen levels were shown to increase with an increase in the dose of oncospheres and eggs inoculated in the animals. Contrasting results were reported in which the cysticerci recovery rate decreased with an increase in the dose of eggs inoculated.

CONCLUSION

This review describes the various animal experiments using Taenia species that cause cysticercosis highlighting the animals used, age and their breed, the routes of infection used to induce disease and the sample size used, and the cysticerci recovery rate in these animal models.

Impact of a 3-year mass drug administration pilot project for taeniasis control in Madagascar

Taenia solium is endemic in Madagascar and presents a significant burden on the population and the health system. The parasite cycles through humans who host the adult tapeworm, and pigs that host the larval stages. Accidental infection of humans may occur with the larval stages which encyst in the nervous central system causing neurocysticercosis, a major cause of seizure disorders and a public health problem. One of the interventions to facilitate the control of the disease is mass drug administration (MDA) of the human population with taeniacide. Here we describe a pilot project conducted in Antanifotsy district of Madagascar from 2015 to 2017 where three annual rounds of MDA (praziquantel, 10mg/Kg) were undertaken in 52 villages. Changes in the prevalence of taeniasis were assessed before, during and after the treatments. A total of 221,308 treatments were given to all eligible people above 5 years of age representing a 95% coverage of the targeted population. No major adverse effects were notified related to the implementation of the MDA. The prevalence of taeniasis was measured using Kato-Katz and copro-antigen techniques. Analyses undertaken combining the results of the Kato-Katz with copro-antigen, or using the Kato-Katz results alone, showed that there was a significant reduction in taeniasis 4 months after the last MDA, but 12 months later (16 months after the last MDA) the taeniasis prevalence had returned to its original levels. Results of the pilot project emphasize the need of a multi-sectorial One-Health approach for the sustained control of T. solium.

The parasite Taenia solium causes neurocysticercosis in humans in its larval stage and is the main cause of seizure disorders in poor communities that keep pigs (the intermediate host). Diagnosis and treatment of neurocysticercosis remains beyond the reach of the general population in Madagascar. Prevention is therefore the most suitable strategy for combating this disease. Mass drug administration (MDA) is used to treat communities for several parasitic diseases such as schistosomiasis. Infection with the T. solium tapeworm in people can be treated with MDA using praziquantel. Here, we conducted a pilot project in Madagascar, giving over 220,000 treatments to people in 52 villages once per year, for 3 consecutive years. The effects on taeniasis seemed to be encouraging when assessed 4 months after finishing the treatment, but 16 months later, the parasite’s prevalence had returned to its original level. MDA was effective in providing temporary control of taeniasis, but parasite transmission was not interrupted. With respect to T. solium, this highlights the need of incorporating other interventions such as vaccination and medication in pigs, improved pig husbandry and meat inspection to tackle the whole cycle of the parasite.

[Racemose neurocysticercosis: Neuroimaging guides the diagnosis]

Neurocysticercosis is the leading cause of parasitosis of the central nervous system and acquired epilepsy in developing countries. The clinical manifestations of neurocysticercosis, especially its racemose variant, are pleomorphic and unspecific, characteristics that hinder the diagnosis and make it a challenge for the clinician.The objective of this report was to describe two cases of racemose neurocysticercosis in which neuroimaging led to the definitive diagnosis. The first case involved a patient with persistent headache and focal neurological signs. She required multiple paraclinical tests that led to the definitive diagnosis of racemose neurocysticercosis with secondary cerebral vasculitis. Despite medical and surgical treatment the patient died after multiple complications.The second case involved a patient with a history of neurocysticercosis, who consulted for chronic intractable vomiting. She required multiple paraclinical tests that led to the diagnosis of vomiting of central origin secondary to racemose neurocysticercosis and entrapment of the fourth ventricle. After medical and surgical treatment the patient showed slight improvement. In these two cases it was evident how proper interpretation of neuroimages is essential for the diagnosis of racemose neurocysticercosis.

Taenia crassiceps injection into the subarachnoid space of rats simulates radiological and morphological features of racemose neurocysticercosis

PURPOSE

Neurocysticercosis is a major public health concern. Although its eradication appears feasible, the disease remains endemic in developing countries and has emerged again in Europe and in the USA. Basic studies on neurocysticercosis are needed to better understand the pathophysiologic mechanisms and, consequently, to improve treatment perspectives. Much has been published on experimental parenchymal neurocysticercosis, but there are no experimental models of racemose neurocysticercosis.

METHODS

Cysts of Taenia crassiceps were injected into the subarachnoid space of 11 rats. After 4 months, magnetic resonance imaging (MRI) was performed to verify the occurrence of ventricular dilatation and the distribution of cysts in the cerebrospinal fluid compartments. The histologic assessment was done focusing on changes in the ependyma, choroid plexus, and brain parenchyma.

RESULTS

MRI and histologic assessment confirmed the findings similar to those seen in human racemose neurocysticercosis including enlargement of the basal cisterns, hydrocephalus, and inflammatory infiltration through the ependyma and choroid plexus into cerebrospinal fluid spaces.

CONCLUSIONS

We developed a simple model of racemose neurocysticercosis by injecting cysts of T. crassiceps into the subarachnoid space of rats. This model can help understand the pathophysiologic mechanisms of the disease.

[Clinical Analysis of 94 Patients with Neurocysticercosis in Sichuan Province]

OBJECTIVE

To analyze the clinical features of neurocysticercosis（NCC） to provide evidence for clinical diagnosis and treatment of the disease.

METHODS

Medical records of NCC patients in the West China Hospital of Sichuan University received between January 2003 and January 2013 were reviewed retrospectively. The epidemiological data, clinical manifestations, therapeutic procedures and outcomes of the patients were analyzed.

RESULTS

A total of 94 NCC patients met the recruiting criteria, of whom 67.0%（63/94） were male, 59.6%（56/94） ranged 30-55 years old, 73.4%（69/94） had a living history in endemic regions such as Aba, Ganzi and Liangshan prefectures, 80.9%（76/94） lived in rural areas. NCC was clinically characterized by epilepsy, headache and intracranial hypertension. The positive rate for anti-T. solium antibodies by ELISA was 96.8%（91/94）, and the total positive scan rate of neuroimaging including CT and MRI was 95.7%（90/94）. In addition, 73 patients were suspected to have NCC at the first diagnosis, with a misdiagnosis rate of 22.3%（21/94）. Seventy-nine of the patients received albendazole treatment［20 mg/（kg·d）, twice per day for 10 days as one treatment course, 1-3 courses as needed］. Eleven patients received praziquantel（total dose of 120-180 mg/kg, 3 times per day for 3 days as one treatment course, 1-3 courses）, and 4 received a combination of albendazole and praziquantel. Symptoms improved in 77 cases（81.9%）, but 12 of them（12/77, 15.6%） relapsed. The improvement rate of the albendazole group（6/11, 84.8%） was significantly higher than that of the praziquantel group（54.6%）（P<0.05）.

CONCLUSION

NCC more commonly occurs in young males and lacks specific clinical manifestations. Neuroimaging combined with serum specific antibody tests is crucial for diagnosis. Albendazole has better therapeutic effects than praziquantel.

Designating Additions to the Current List of Tropical Diseases in the Federal Food, Drug, and Cosmetic Act. Final order

The Federal Food, Drug, and Cosmetic Act (the FD&C Act) authorizes the Food and Drug Administration (FDA or Agency) to award priority review vouchers (PRVs) to tropical disease product applicants when the applications meet certain criteria. The FD&C Act lists the diseases that are considered to be tropical diseases for purposes of obtaining PRVs, and also provides for Agency expansion of that list to include other diseases that satisfy the definition of ``tropical diseases'' as set forth in the FD&C Act. FDA has determined that Chagas disease and neurocysticercosis satisfy this definition, and therefore is adding them to the list of designated tropical diseases whose product applications may result in the award of PRVs. Sponsors submitting certain applications for the treatment of Chagas disease and neurocysticercosis may be eligible to receive a PRV if such applications are approved by FDA.

Effect of carbamazepine therapy on homocysteine, vitamin B12 and folic acid levels in children with epilepsy

OBJECTIVE

To compare the levels of homocysteine, vitamin B12 and folic acid before and after 6 months of carbamazepine therapy and to correlate them with carbamazepine level at 6 months.

DESIGN

Prospective comparative study.

SETTING

Tertiary care centre in North India.

PARTICIPANTS

51 children (2-12 years of age) presenting with motor partial seizures.

INTERVENTION

Carbamazepine (10-20 mg/kg/day) for 6 months.

MAIN OUTCOME MEASURE

Change in serum homocysteine, B12, folic acid level.

METHODS

Fasting venous samples were collected before carbamazepine therapy and after six months. Homocysteine was analyzed using homocysteine enzyme immunoassay. Vitamin B12 and folic acid were estimated using electrochemiluminesence technique. Carbamazepine levels were measured at 6 months.

RESULTS

Of the 51 children, 36 (males-21), were followed up and their data analyzed. Mean homocysteine level was 11.51±3.95 umol/L at recruitment and 11.77±6.65 umol/L at six months (P=0.785). At recruitment 6(16%) children had homocysteine level above 15 umol/L which increased to 10(27%) at 6 months. Mean vitamin B12 at recruitment was 292.1±111.2 pg/mL and 297.8±82.9 pg/mL at 6 months (P=0.764). Mean folic acid at recruitment was 9.98±3.45 ng/mL and 10.66±3.97 ng/mL at 6 months (P=0.358). There was no correlation between carbamazepine levels with homocysteine, vitamin B12 and folic acid (P>0.05). There was no effect of age, sex or dietary pattern on homocysteine levels.

CONCLUSIONS

Hence 6 months of carbamazepine therapy did not cause significant change in serum levels of homocysteine, vitamin B12 and folic acid.

[Neurocysticercosis: a public health perspective]

AIMS

We review the physiopathological aspects of cysticercosis that are highly relevant in public health, in particular as a cause of epilepsy in adults. Cysticercosis is the infection of the central nervous system produced by the larvae of Taenia solium. In countries where cysticercosis is endemic, the prevalence of epilepsy is twice as high as that observed in areas that are free of this parasitic disease.

METHOD

The human carrier of an intestinal Taenia solium is a source of cysticercosis infection, both for others and for him or herself. We propose that all diagnosed cases of neurocysticercosis must be compulsorily reported to the department of epidemiology at the Ministry of Health, in order to enable the control of sources of infection, to search for other possibly infected subjects, as well as to determine the prevalence and geographical distribution of this problem. The aim of this would be to fit, target and optimise the available resources in eradication campaigns.

CONCLUSIONS

Doctors, and more specifically neurologists and neurosurgeons, must remember that behind each patient diagnosed with neurocysticercosis there is a tapeworm carrier within the family environment or at the same table. Cysticercosis is a disease whose transmission mechanism consists in person to person contamination (from the tapeworm carrier to the individual with symptomatic or asymptomatic cysticercosis). Public health campaigns must begin from index cases of neurocysticercosis, which will allow us to reach the sources of infection. Cysticercosis is an eradicable disease that currently exists not only in developing countries but also in industrialised nations, as a result of tourism and immigration from endemic countries

[Considerations about late-onset epilepsy]

OBJECTIVE

To make a revision of the general point of view on late-onset epilepsy, known as epilepsy that starts in the mature age after 25 years old; around 25% of the patients with epilepsy had their first crisis after that age, with an increase in the incidence in the course of the age.

DEVELOPMENT

The main ethiologies are discussed, standing out: alcoholism (22%), stroke (18%), tumors (10%), metabolic imbalances (10%), infections of the CNS, trauma, atrophies and cisticercosis. For the diagnosis is required a complete clinical evaluation, cardiovascular examination, metabolic tests, EEG and neuroimage studies.

CONCLUSIONS

Monotherapy with phenobarbital, carbamazepine and valproate, control 80% of cases and failure related to patients with wide spread cerebral damage.

[Value of antibody titers for diagnosis of neuroborreliosis]

Neuroborreliosis is a very frequent subtype of infection with Borrelia burgdorferi. Because of the widely spread inapparent infections finding of diagnosis by analysis of serum antibodies is very difficult. In the years 1990-1994 the serum of 6.775 patients of the Department of Neurology in Homburg, Germany was analysed with regard to Borrelia burgdorferi specific IgG antibodies. 24% showed a positive serum titer and 20% a borderline result. 73 patients showed a specific intrathecal IgG antibody synthesis. In contrast to patients with antibodies in serum these patients showed a significant cumulation during summer. The high percentage of positive serum titers and the season independence support the assumption of widely spread inapparent infections. If a patient shows neurological symptoms the finding of serum antibodies against Borrelia burgdorferi is not sufficient for the diagnosis of Neuroborreliosis. A specific intrathecal synthesis of antibodies, is the most reliable serological indicator for Neuroborreliosis. Intrathecal synthesis usually starts three to four weeks after the first clinical symptoms.

Neurocisticercose: formas clínicas pouco frequentes. II - formas do ângulo pontocerebelar

A localização de cisticercos no recesso lateral da cisterna pontina poderá levar à constituição de uma síndrome do ângulo pontocerebelar, simulando eventualmente um neurinoma do acústico. São revistos os casos dessa forma clínica de neurocisticercose descritos na literatura. O problema do diagnóstico diferencial com os tumores (neurinomas) do acústico é discutido sob os pontos de vista clínico e radiológico. Os autores apresentam 7 casos de cisticercose do ângulo pontocerebelar. O diagnóstico etiológico foi estabelecido pela positividade da reação de fixação do complemento para cisticercose no liqüido cefalorraqueano em 5 casos e, em 2, pela cirurgia e/ou necropsia. Em todos os pacientes havia sintomas de lesão coclear, bilaterais em 2; lesão vestibular foi comprovada em 4 casos. Em 6 pacientes ocorreram sinais indicativos de lesão unilateral do nervo trigêmeo. Comprometimento do nervo facial foi observado em 4 casos. Existia faringoplegia em 3 casos e estrabismo interno em 2. Em 3 casos não foram observados sinais cerebelares, o que faria com que o diagnóstico propendesse para o de tumor do acústico, não fôssem outras características clínicas e subsidiárias. A síndrome de hipertensão intracraniana era nítida em 5 pacientes. Convulsões ocorreram em 2 casos. A propósito do resultado dos exames radiológicos, os autores salientam que, num dos casos, foi verificada amputação da ponta do rochedo ipsolateral à síndrome do ângulo pontocerebelar; outros comemorativos do caso levaram, porém, a rejeitar a hipótese de tumor (neurinoma) do acústico, tendo a cirurgia comprovado o acêrto do diagnóstico clínico.

Neurocisticercose: formas clínicas pouco freqüentes. I - formas hemiplégicas

Os autores salientam a raridade dos déficits motores com distribuição mono ou hemiplégica, conseqüentes a lesões encefálicas de natureza cisticer-cótica. Ressaltam, outrossim, a dificuldade dos problemas diagnósticos que eventualmente se impõem nesses casos. Discutindo a patogenia dêsses processos, apontam dois mecanismos principais: as paralisias determinadas por focos encefálicos, constituídos por granulomas, cisticercóticos ou à distância, e os acidentes cerebrovasculares ocasionadas pelas alterações vasculares, cuja importância é realçada. São apresentados 19 casos de neurocisticercose, incluindo 17 formas hemiplégicas e 2 monoplégicas. Em todos, o diagnóstico etiológico foi estabelecido pela positividade da reação de fixação do complemento para cisticercose no liqüido cefalorraqueano, corroborado, em 2 casos, pela cirurgia e pela necropsia. Convulsões foram registradas em 10 casos (focais em 7 e generalizadas em 3). Sintomas de hipertensão intracraniana foram assinalados em 4 pacientes. A hemiplegia instalou-se sob forma de icto em 14 pacientes. Em 3 casos houve elementos altamente sugestivos de patogenia predominantemente vascular; em 3, a sintomatologia relacionou-se diretamente ao granuloma parasitário, embora deva ter havido participação do processo angiopático; em 1 caso, tratava-se, provavelmente, de paralisia pós-convulsiva; em 3, embora não houvesse suficientes dados complementares, os elementos clínicos levaram a salientar a importância do fator vascular na determinação da hemiplegia. Em 5 pacientes o déficit motor instalou-se de modo lento e progressivo. Em 2 casos foram encontrados e extirpados cisticercos situados no córtex cerebral, tendo a necropsia revelado, em um deles, amolecimento isquêmico na região parietal contralateral à hemiplegia; em 1 havia eisticercose da fossa craniana posterior, associada a lesão cortical traduzida por intensas alterações eletrencefalográficas; 2 casos careciam de elementos subsidiários que pudessem orientar melhor quanto ao mecanismo patogênico da hemiplegia. Os autores salientam a possibilidade de, em alguns dêsses casos, os comemorativos clínicos poderem ter conduzido ao diagnóstico errôneo, ora de tumor cerebral, ora de acidente cerebrovascular de etiologia indeterminada. Em tais eventualidades, os pacientes ficariam privados dos possíveis benefícios do tratamento adequado, cirúrgico ou medicamentoso.

Aspectos biológicos da neurocisticercose: alterações do liqüido cefalorraquidiano

Entre os aspectos biológicos da neurocisticercose, têm sido mais exploradas as alterações do líqüido cefalorraquidiano (LCR) em vista do seu valor diagnóstico. Para analisar os conhecimentos quanto ao quadro liquórico da afecção são apresentados 03 achados referentes a 62 caco3 acompanhados na Clínica Neurológica da Faculdade de Medicina da Universidade de São Paulo. Em todos êstes casos a infestação do sistema nervoso central (SNC) e/ou de seus envoltórios pelo cisticerco foi comprovada pela necropsia ou durante intervenção cirúrgica (biopsia). A análise do material e da literatura sôbre o assunto permite as seguintes conclusões: 1 - Entre os exames complementares, o exame do LCR é aquêle que permite com maior freqüência o diagnóstico em vida da neurocisticercose. A demonstração da presença de anticorpos específicos é o elemento fundamental para o diagnóstico liquórico; a ecsinofilorraquia complementa esse dado e tem valor sugestivo. 2 - Na neurocisticercose, a eosinofilorraquia costuma ser tanto mais intensa quanto mais nítida a pleiocitose liquórica; entretanto, a presença de células eosinófilas no LCR pode decorrer' de outras causas e sua ausência não infirma o diagnóstico. A eosinofilorraquia permite avaliar a intensidade da reação hiperérgica desencadeada pelo parasito e possibilita orientar o diagnóstico em casos duvidosos. 3 - Na cisticercose há formação de anticorpos específicos, demonstráveis por meio de reações de precipitação e de fixação do complemento; esta última é a mais largamente utilizada. Os anticorpos são semelhantes aos que aparecem no parasitismo por outros cestóideos. Quando localizados no SNC e/ou em seus envoltórios, são os cisticercos os cestóideos que, com maior freqüência e em maior intensidade, desencadeiam reações imunitárias, determinando o aparecimento de anticorpos específicos no LCR. 4 - A evolução do quadro liquórico é variável e nem sempre acompanha a evolução clínica. Quando esta é satisfatória, costumam desaparecer progressivamente as alterações do LCR; se estas se mantiverem por longo tempo, o prognóstico é mais reservado, especialmente quando aparece hipoglicorraquia. Em alguns casos, após intervenções cirúrgicas há rápida remissão das alterações do LCR; provavelmente isto ocorre nos casos em que a infestação do encéfalo era discreta, ou mesmo única. Quando ocorre rotura da vesícula parasitária durante a intervenção cirúrgica, o liqüido contido em seu interior acarreta exacerbação transitória das alterações do LCR. 5 - As alterações do proteinograma do LCR na neurocisticercose são do tipo verificado em processos inflamatórios subcrônicos e crônicos do SNC e de seus envoltórios, caracterizando-se especialmente por aumento de γ-globulina. Êste aumento está relacionado à intensidade da reação imunopatológica e provavelmente é devido à produção local dessa globulina, que parece ser a carreadora dos anticorpos específicos. O aumento de γ-globulina é precoce, podendo preceder a formação dos anticorpos específicos e costuma regredir lentamente nos casos de evolução satisfatória. Quando a evolução é má, o teor dessa globulina costuma aumentar progressivamente.

Síndrome liquórica da neurocisticercose

Foram estudadas as alterações encontradas no liqüido cefalorraquidiano (LCR) de 115 pacientes com neurocisticercose. Em todos, o diagnóstico foi estabelecido pela positividade da reação de fixação do complemento para cisticercose (RFC) no LCR. Os resultados do estudo comprovam que: 1 - ocorrem na neurocisticercose alterações do LCR que são grupadas na síndrome liquórica da neurocisticercose; 2 - a alteração principal é a presença de anticorpos específicos, demonstrada pela positividade da RFC, que permite estabelecer o diagnóstico da afecção; 3 - o achado de células eosinófilas no LCR é comum, completa a demonstração de anticorpos específicos e orienta o diagnóstico em casos duvidosos; 4 - além dessas alterações, podem ocorrer outras, de caráter inespe-cífico, que completam a síndrome liquórica da neurocisticercose (aumento da pressão, pleiocitose, hiperproteinorraquia discreta, alterações de tipo pa-renquimatoso das reações coloidais e hipoglicorraquia); 5 - em seu conjunto o estudo das alterações liquóricas citadas mostram-se úteis para o diagnóstico, para o prognóstico e para o contrôle da evolução da neurocisticercose.

Formas obstrutivas da neurocisticercose ventricular

A incidência da cisticercose cerebral entre os consulentes orientados para o Ambulatório de Neurologia da Faculdade de Medicina de Ribeirão Prêto é muito alta. Trata-se de moléstia que, pela gravidade de seus sintomas, pela facilidade de infestação e pela precariedade dos recursos terapêuticos, representa um probiema individual e social grave nesta região. Muitos aspectos da moléstia já foram esclarecidos, sendo grande a contribuição de autores brasileiros. Certas feições da moléstia, porém, ainda comportam maiores estudos. É nosso objetivo oferecer uma contribuição ao estudo das formas intraventriculares de neurocisticercose. Relatamos as observações de 4 pacientes com queixas de hipertensão intracraniana periódica e com achados liquóricos e radiológicos compatíveis com a suspeita de cisticercose cerebral. Exames subsidiários (pneumencefalografia ou ventriculografia) mostraram que em dois dêstes pacientes havia bloqueio do aqueduto de Sylvius (casos 3 e 4) e que, nos outros dois, havia exclusão de um ventrículo lateral por bloqueio do buraco de Monro (caso 1) e da confluência dos cornos temporal e occipital (caso 2). Nos dois casos em que havia bloqueio na parte alta do aqueduto de Sylvius os pacientes acusavam dificuldade no olhar vertical (síndrome de Parinaud). O tratamento cirúrgico permitiu desfazer o bloqueio em 3 casos (casos 2, 3 e 4); no caso 1 as punções feitas após a intervenção cirúrgica parecem ter agido benèficamente no sentido de restabelecer o trânsito do liqüido cefalorraquidiano. Excluindo um paciente (caso 2) que faleceu em caquexia 3 meses após a operação e no qual o exame necroscópico mostrou lesões pregressas imputáveis apenas à hipertensão aguda sem lesões cisticercóticas, os outros casos evoluíram para a cura.