Abstract: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 dura… Show more
“…Na neurocisticercose a imunidade humoral vem sendo avaliada por diferentes técnicas, com características próprias. Assim, a reação de fixação de complemento (RFC) apresenta resultados que variam de acordo com o antígeno empregado e um resultado seguro depende certamente do antígeno, assim como de uma técnica perfeitamente padronizada para se evitar a baixa sensibilidade e especificidade até agora observadas 20,24,30,31,37,39,40 .…”
Five different antigens from Cysticercus cellulosae, a vesicular fluid, a saline and an alkaline total extracts, an escolex and membrane, were studied in the ELISA immunoenzymatic assay to demonstrate IgG antibodies in cerebrospinal fluid (CSF) and serum samples. For the 5 antigens the 20 micrograms/ml concentration was selected for polyvinyl plates sensitization for CSF and serum assays. The IgG fraction of a sheep anti-human IgG antiserum was labeled with horseradish peroxidase and revealed with hydrogen peroxide-5-aminosalicilic acid. For positive results 10 ELISA Units for sera and 5 EU for CSF were taken. A total of 182 serum samples and 115 CSF samples were tested. The ELISA sensitivity for sera were 88.6% for vesicular fluid, escolex and membrane; 85.7% for saline extract and 62.8% for alkaline extract. The ELISA sensitivity for CSF was 100% for vesicular fluid and saline total extract, 91.7% for membrane, 89.6% for excolex and 77.1% for alkaline. The ELISA specificity for sera was 100% to the 5 antigens studied; to the CSF was 100% for the alkaline and escolex and 98.5% for the other antigens. An ELISA geometric mean titer of sera and CSF was respectively the 121.1 and 27.3 for vesicular fluid, 111.6 and 31.1 for saline total extract, 30.3 and 5.3 for alkaline total extract, 63.2 and 14.8 for escolex and 69.1 and 18.8 for membrane antigen. ELISA was then compared to immunofluorescence, hemagglutination and complement fixation tests in CSF and sera. ELISA immunoenzymatic assay with saline total extract is recommended for the easy preparation and for the high quantity of antigens obtained, for the high sensitivity and great specificity for sera and CSF; we suggest that this test may be used as a substitute for immunofluorescence, hemagglutination and complement fixation in sera or CSF for the diagnosis of neurocysticercosis.
“…Na neurocisticercose a imunidade humoral vem sendo avaliada por diferentes técnicas, com características próprias. Assim, a reação de fixação de complemento (RFC) apresenta resultados que variam de acordo com o antígeno empregado e um resultado seguro depende certamente do antígeno, assim como de uma técnica perfeitamente padronizada para se evitar a baixa sensibilidade e especificidade até agora observadas 20,24,30,31,37,39,40 .…”
Five different antigens from Cysticercus cellulosae, a vesicular fluid, a saline and an alkaline total extracts, an escolex and membrane, were studied in the ELISA immunoenzymatic assay to demonstrate IgG antibodies in cerebrospinal fluid (CSF) and serum samples. For the 5 antigens the 20 micrograms/ml concentration was selected for polyvinyl plates sensitization for CSF and serum assays. The IgG fraction of a sheep anti-human IgG antiserum was labeled with horseradish peroxidase and revealed with hydrogen peroxide-5-aminosalicilic acid. For positive results 10 ELISA Units for sera and 5 EU for CSF were taken. A total of 182 serum samples and 115 CSF samples were tested. The ELISA sensitivity for sera were 88.6% for vesicular fluid, escolex and membrane; 85.7% for saline extract and 62.8% for alkaline extract. The ELISA sensitivity for CSF was 100% for vesicular fluid and saline total extract, 91.7% for membrane, 89.6% for excolex and 77.1% for alkaline. The ELISA specificity for sera was 100% to the 5 antigens studied; to the CSF was 100% for the alkaline and escolex and 98.5% for the other antigens. An ELISA geometric mean titer of sera and CSF was respectively the 121.1 and 27.3 for vesicular fluid, 111.6 and 31.1 for saline total extract, 30.3 and 5.3 for alkaline total extract, 63.2 and 14.8 for escolex and 69.1 and 18.8 for membrane antigen. ELISA was then compared to immunofluorescence, hemagglutination and complement fixation tests in CSF and sera. ELISA immunoenzymatic assay with saline total extract is recommended for the easy preparation and for the high quantity of antigens obtained, for the high sensitivity and great specificity for sera and CSF; we suggest that this test may be used as a substitute for immunofluorescence, hemagglutination and complement fixation in sera or CSF for the diagnosis of neurocysticercosis.
“…In other cases, meningitis may progress slowly and with only mild symptoms, leading to communicating hydrocephalus due to basilar arachnoiditis. The pathogenesis of neurocysticercosis is that of a chronic inflammatory process with an irregular period of activation that occurs when cysticerci die and disintegrate, causing antigen release [54,56].…”
Section: Clinical Manifestations and Diagnosismentioning
“…A importância do LCR no estabelecimento do diagnóstico da NC é reconhecida universalmente, tendo sido considerado, até o advento da TC do crânio, como o cri-tério mais fidedigno. O conceito de síndrome do LCR na NC, introduzido por Lange 2 <> em 1940, compreendendo a eosinofilorraquia e a positividade da reação de Weinberg, persiste até o presente momento 1, 6,9,10,22,24,[38][39][40][41][42][43][44]52,[54][55][56]63.…”
Section: A Ocorrência De Crises Epilépticas Constituiu-se Na Primeiraunclassified
Neurocysticercosis is a serious public health problem in our midst, which accounted for 7.3% of the hospital admissions and 2.7% of all cases of the out patient clinic attendance of the Discipline of Neurology of the School of Medicine--Ribeirão Preto, São Paulo University, from 1979 to 1986. A total of 151 patients with a minimum follow-up of 6 months were selected for the present study including clinical and laboratory evolution, a topic which is rarely considered in the literature. The onset of the disease was characterized by: epileptic seizures in 82 patients (54.3%), increased intracranial pressure (ICP) in 40 (26.5%), meningitis in 21 (13.9%), headache in the absence of increased ICP or meningitic signs in 7 (4.6%), and spinal cord syndrome in 1 (0.6%). In the group with the epileptic form, 36.6% of the patients later developed other neurological syndromes, such as cysticercotic meningitis, mental disorders and increased ICP after a 6 to 7 years interval. In the group with the hypertensive form, 55% of the patients developed other manifestations during the period of evolution, especially meningitis and epileptic seizures, after a significantly shorter interval than for the epileptic form. In the meningitic form, 19% of the patients showed a recurrence of the syndrome after a mean interval of 10.7 weeks: an additional 66.6% developed a combination with other syndromes, especially increased ICP and epileptic seizures. The death rate was 7.9%, the main cause being increased ICP (83.3%). When the abnormalities of the complementary tests were investigated in the various forms of clinical presentation in terms of their predictive value it was concluded that, in the epileptic form, the presence of cysts in CT scan and/or abnormalities in CSF indicates a greater risk of developing other neurologic syndromes. No significant differences in the patterns of abnormalities of these investigations were detected in the remaining clinical forms. Most cystic lesions detected by CT scan (90.9%) were associated with CSF abnormalities, especially pleocytosis and positive complement fixation test. Conversely, this proportion was only 26% in patients with calcifications.
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