Neurocisticercose: contribuição da necrópsia na consolidação da notificação compulsória em Ribeirão Preto-SP, Brazil

Abstract

RESUMO -O presente estudo tem como objetivo a apresentação dos achados de cisticercose nas necrópsias realizadas no Serviço de Patologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, no período de 1992 a 1997. Das 2522 necrópsias, a neurocisticercose foi detectada em 38 (1,5%) dos casos. Destes, 22 (57,9%) foram diagnosticados apenas na necrópsia enquanto 16 (42,1%) apresentavam exames complementares consistentes com cisticercose. A análise dos prontuários médicos evidenciou que 21 (55,2%) eram neurologicamente assintomáticos e a frequência das diversas manifestações clínicas estava de acordo com os dados da literatura. A elevada frequência de indivíduos assintomáticos detectados apenas através da necrópsia demonstra a importância desta como fonte complementar de dados para a consolidação da notificação compulsória da cisticercose. Embasado nos dados do presente estudo, o atual coeficiente de prevalência da cisticercose no município de Ribeirão Preto é 67 casos/100000 habitantes. PALAVRAS-CHAVE: cisticercose, necrópsia, Taenia solium, epidemiologia, tomografia, líquido cefalorraquidiano. Neurocysticercosis: contribution of autopsies to consolidation of the compulsory notification in Ribeirão Preto-SP, BrazilABSTRACT -Neurocysticercosis is a serious public health problem in several countries of Asia, Africa and Latin America. The objective of the present study is to present autopsy findings of neurocysticercosis in the Pathology Division of the University Hospital, Medical School of Ribeirão Preto, University of São Paulo, from 1992 to 1997. Neurocysticercosis was detected in 38 (1.5%) of 2522 autopsies. In twenty two (57.9%) of these, the diagnosis was made post-mortem, while 16 (42.1%) had a previous diagnosis of cysticercosis based on laboratory and imaging studies. Reviewing the medical records, we found that 21 patients (55.2%) were neurologically asymptomatic, while the various clinical manifestations in the others were in accordance with the literature. The high frequency of asymptomatic individuals detected only post-mortem indicates the importance of autopsies as an additional source of data to consolidate the compulsory notification of cysticercosis. Considering the results of this study, the new coefficient of prevalence of cysticercosis in Ribeirão Preto is 67 cases/100000 inhabitants.KEY WORDS: cysticercosis, autopsy, Taenia solium, epidemiology, computed tomography, cerebrospinal fluid.A cisticercose humana, infestação pela forma larvária da Taenia solium, é grave problema de saúde pública em várias regiões da Ásia, África e América Latina, particularmente nos países em desenvolvimento, onde a precariedade das condições sanitárias e o baixo nível sócio-econômico-cultural aliam-se na persistência de sua disseminação.

Cysticercosis-related mortality in the State of São Paulo, Brazil, 1985-2004: a study using multiple causes of death

“…Cysticercosis prevalence is unknown, because reporting the disease is not officially mandatory. Moreover, various authors agree that there is a lack of knowledge on the factors accounting for the high endemicity of cysticercosis in some regions of the State 4,5,7 . It is reasonable to posit that nonspecific sanitation measures and improved schooling and socioeconomic conditions may have caused this drop in incidence.…”

“…Almost 50,000 deaths attributable to neurocysticercosis occur every year. The severity of cysticercosis can also be illustrated by its case-fatality rate, varying from 16.4% to 25.9% 1,2,3,4,5,6 .…”

“…One study that attempted to compile the available research from the Brazilian literature on human neurocysticercosis presented data on hospital deaths and autopsy observations 7 . However, although such studies with limited criteria provide valuable information, they can underestimate the impact of cysticercosis as a cause of death 4,8 . Neurocysticercosis as cause of death may be an incidental finding, an underlying cause, or an associated cause of death 9 .…”

Ocorrência de cisticercose (Cysticercus cellulosae) encefálica e cardíaca em necropsias

“…Em pesquisa realizada próxima à região estudada, encontrou-se um coeficiente de prevalência de neurocisticercose de 67 casos/100.000 habitantes através de notificação compulsória 5 .…”

Neurocysticercosis in a preschool-age child: case report

“…The highest prevalence rates of NC in Brazil has been reported to vary from 4 to 18%, in association with hyperendemic areas of T. solium infestation 6 . However, based upon large series of cases and using various diagnostic methods, several Brazilian authors [7][8][9] have reported a NC prevalence rate of 1-1.5%. It is estimated that there are 50 million carriers of T. solium cysticerci worldwide 10 .…”