Encefalomielite aguda disseminada: relato de caso

To describe the case of a child diagnosed with Acute Disseminated Encephalomyelitis who presented recurrence. Child, from Belém, female, 10-years-old, started symptoms of hypoactivity and vomiting, evolving with altered level of consciousness, loss of sphincter control, decreased muscle strength, hemiparesis and aphasia. The cerebrospinal fluid was collected and meningitis was discarded. Was performed a computed tomography scan of the skull with a hypodense image in the deep parietal region. Corticosteroid therapy was started in low doses, showing a slight improvement. She was transferred to a referral hospital in pediatric neurology, with hypoactivity and altered neurological examination on the left. Magnetic resonance imaging of the brain and spinal cord showed images suggestive of Acute Disseminated Encephalomyelitis, and pulse therapy (methylprednisolone) was started. Afterwards, clinical progress was observed: improved speech, motor skills and sphincter control. Patient was discharged from hospital with corticosteroid maintenance and multidisciplinary rehabilitation. She remained clinically well, with good recovery. After five months, she evolved again with neurological manifestations, being considered a re-acute demyelinating condition, starting pulse therapy with methylprednisolone. She showed only partial improvement in symptoms. A new neuroimaging showing lesions still active. Chosen to perform immunoglobulin, evolving with significant clinical improvement. This disease starts with nonspecific prodromes and afterwards neurological symptoms will appears. The diagnosis is made through the neurological clinic and neuroimaging with classic alterations of the disease. Treatment is based on pulse therapy with methylprednisolone, followed by prednisolone. Intravenous human immunoglobulin is used as an option for cortic-resistant or relapsing patients

Environmental influences on antibody-enhanced dengue disease outcomes

Because an enriched environment (EE) enhances T-cell activity and T-lymphocytes contribute to immunopathogenesis during heterologous dengue virus (DENV) infections, we hypothesised that an EE increases dengue severity. To compare single serotype (SS) and antibody-enhanced disease (AED) infections regimens, serial intraperitoneal were performed with DENV3 (genotype III) infected brain homogenate or anti-DENV2 hyperimmune serum followed 24 h later by DENV3 (genotype III) infected brain homogenate. Compared AED for which significant differences were detected between the EE and impoverished environmental (IE) groups (Kaplan-Meyer log-rank test, p = 0.0025), no significant differences were detected between the SS experimental groups (Kaplan-Meyer log-rank test, p = 0.089). Survival curves from EE and IE animals infected with the AED regimen were extended after corticoid injection and this effect was greater in the EE than in the IE group (Kaplan-Meyer log-rank test, p = 0.0162). Under the AED regimen the EE group showed more intense clinical signs than the IE group. Dyspnoea, tremor, hunched posture, ruffled fur, immobility, pre-terminal paralysis, shock and death were associated with dominant T-lymphocytic hyperplasia and presence of viral antigens in the liver and lungs. We propose that the increased expansion of these memory T-cells and serotype cross-reactive antibodies facilitates the infection of these cells by DENV and that these events correlate with disease severity in an EE