Meningomielorradiculopatia na esquistossomose mansônica: avaliação clínica e do líquido cefalorraqueano em 16 casos

Salum, P N B; Machado, L. R.; Spina-França, A.

doi:10.1590/s0004-282x1981000300004

Cited by 14 publications

(3 citation statements)

References 6 publications

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“…Com relação ao sexo, observa-se, na literatura consultada, nítida predominância do sexo masculino em relação ao feminino 5,10,14,18 . Em nossa série, observou-se proporção de 3,6:1 (78,6% masculino e 23,4% feminino).…”

Section: Métodounclassified

“…Observação: O estudo do líquor, que deve ser realizado de rotina, pode apresentar alterações 18,20,24,26,27 que, para alguns autores, sugerem a etiologia esquistossomótica, tais como pleocitose linfomononuclear, aumento de proteína, eosinofilorraquia e, hipergamaglobulinorraquia 24 . Com relação à reatividade de reações imunológicas específicas para esquistossomose (imunofluorescência, ELISA, hemoaglutinação e/ou Western Blot), são poucos os estudos realizados, com casuística escassa, rescindindo-se, ainda, de padronização e normatização de valores normais e patológicos 14,17,24,28,29 .…”

Section: Diagnóstico Possívelunclassified

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Perfil clínico e critérios diagnósticos da mielorradiculopatia esquistossomótica

Santos

Campos

Diniz

et al. 2001

Arq. Neuro-Psiquiatr.

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RESUMO -Durante período de 20 anos , 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) comprovação laboratorial de esquistossomose através de exame parasitológico de fezes ou biópsia retal; e 4) exclusão 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 são apresentados neste artigo. Reconhecendo os vários problemas no diagnóstico da mielorradiculopatia esquistossomótica, enfatizamos a importância de se pensar nesta entidade e sugerimos critérios para definição diagnóstica.PALAVRAS-CHAVE: esquistossomose mansoni, radiculopatia, mielite. Clinical profile and criteria for the diagnosis of schistosomotic myeloradiculopathyABSTRACT -During 20 year period 56 patients with a diagnosis of schistosomotic myeloradiculopathy were admitted in three hospitals of Belo Horizonte -Minas Gerais. Data from pacients 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 schistosomotic myeloradiculopathy in this sample and are presented in this paper. In recognizing the many problems in diagnosis of schistosomotic myeloradiculopathy we emphasize how important is thinking about this entity and criteria to improve diagnostic evaluation are suggested. O comprometimento do sistema nervoso no curso da esquistossomose mansoni vem ganhando, paulatinamente, importância cada vez maior na literatura especializada. As dificuldades no seu reconhecimento provavelmente limitam seu diagnóstico. Com relação ao sistema nervoso, não se conhece a frequência do seu envolvimento. Scrimgeour & Gajdusek (1981) relatam que, na Tanzânia, a esquistossomose foi responsável por 1% dos casos de paraplegia não traumática e que, em 5% de outros casos, estabeleceu-se o seu diagnóstico presuntivo 4 . A neuroesquistossomose pode resultar numa grande variedade de complicações. Seu diagnóstico é difí-

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Section: Métodounclassified

Section: Diagnóstico Possívelunclassified

Perfil clínico e critérios diagnósticos da mielorradiculopatia esquistossomótica

Santos

Campos

Diniz

et al. 2001

Arq. Neuro-Psiquiatr.

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“…There have been few investigations of the serology of patients with NS, and most were limited to the search for antibodies in the cerebrospinal fluid (CSF) of patients with myeloradiculopathy. [9][10][11][12] Serologic techniques such as complement fixation, immunofluorescence, Western blotting, and enzyme-linked immunosorbent assay (ELISA) have been used, but none have yet achieved sufficient levels of sensitivity and specificity to justify their consideration as gold standard techniques. 2,[13][14][15][16] The main objective of this investigation was to verify the existence of specific antibodies against S. mansoni soluble egg antigen (SEA) and soluble worm adult preparation (SWAP) in the CSF of patients suspected of having NS without a history of a disease that could disrupt the blood-brain barrier.…”

Section: Introductionmentioning

confidence: 99%

Antibodies to Schistosoma Mansoni in Human Cerebrospinal Fluid

Magalhães-Santos

Lemaire²,

Andrade-Filho³

et al. 2003

The American Journal of Tropical Medicine and Hygiene

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Cerebrospinal fluid (CSF) and serum samples from patients suspected of having neuroschistosomiasis (NS) were evaluated by an enzyme-linked immunosorbent assay. Monoclonal antibodies of various immunoglobulin isotypes (IgM, IgA, IgE, total IgG, IgG1, IgG2, IgG3, and IgG4) were used to detect antibodies against Schistosoma mansoni soluble egg antigen (SEA) and soluble worm adult preparation (SWAP). Of the 83 CSF samples tested, 55% were reactive to SEA (26% were reactive only to SEA and 29% to both SEA and SWAP), 34% were reactive to SWAP (5% only to SWAP and 29% to both SEA and SWAP), and 40% were not reactive with any antigen. Cases that tested positive for SWAP in CSF and negative in serum were not found. Samples with high specific IgG antibody titers were selected for immunoglobulin isotype profiling. In the CSF samples, the antibodies against SEA and SWAP were mainly IgM, IgG1, and IgG4, although other immunoglobulins were also detected. Interestingly, nine patients had high levels of IgG1 only in the CSF. These results suggest that there is local synthesis of IgG1, and that this isotype could be an important immunologic marker in the diagnosis of NS.

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The value of an enzyme-linked immunosorbent assay for the diagnosis of schistosomiasis mansoni myeloradiculopathy

Ferrari

Moreira

Correa-Oliveira

et al. 1995

Transactions of the Royal Society of Tropical Medicine and Hygi

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The role of serological tests on cerebrospinal fluid (CSF) in the diagnosis of neuroschistosomiasis has not been fully elucidated; the condition is essentially diagnosed on the basis of circumstantial evidence, which may lead to an erroneous diagnosis, especially in highly endemic areas. We therefore carried out a prospective case-control study in which we compared the concentrations of immunoglobulin G (IgG) specific for schistosome soluble egg antigen (SEA) present in the CSF of 54 patients with schistosomiasis mansoni myeloradiculopathy (SMMR) with those observed in a control group consisting of 41 patients with epidemiological and serological evidence of exposure to schistosomes, and with other neurological disorders that result in mild to moderate impairment of the blood-brain barrier. Anti-SEA IgG was estimated by an enzyme-linked immunosorbent assay. The sensitivity, specificity and positive and negative predictive values were 56%, 95%, 94% and 62% respectively. Likelihood ratios and the corresponding post-test probabilities were determined for 4 levels of anti-SEA IgG in CSF. A value below 0.1 micrograms/mL practically excluded the possibility of SMMR (post-test probability < 5%), a value above 1.4 micrograms/mL practically confirmed the diagnosis of SMMR (post-test probability > 96%), values of 0.1 to 0.5 microgram/mL had no diagnostic value (post-test probability approximately 45%), and values of 0.6 to 1.4 micrograms/mL were useful in some situations (post-test probability approximately 70%). We conclude that the estimation of anti-SEA IgG in the CSF is useful for the diagnosis of SMMR.

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Meningomielorradiculopatia na esquistossomose mansônica: avaliação clínica e do líquido cefalorraqueano em 16 casos

Cited by 14 publications

References 6 publications

Perfil clínico e critérios diagnósticos da mielorradiculopatia esquistossomótica

Perfil clínico e critérios diagnósticos da mielorradiculopatia esquistossomótica

Antibodies to Schistosoma Mansoni in Human Cerebrospinal Fluid

The value of an enzyme-linked immunosorbent assay for the diagnosis of schistosomiasis mansoni myeloradiculopathy

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