Detecção de IgE total em amostras pareadas de líquido cefalorraquiano e soro de pacientes com neurocisticercose

Neurocysticercosis (NC), the presence of Taenia solium metacestodes in tissues, is the most frequent and severe parasitic infection of the central nervous system. We investigated the presence of total IgE by an automated chemiluminescence assay in 53 paired cerebrospinal fluid (CSF) and serum samples from patients with NC (P) and in 40 CSF samples from individuals with other neurological disorders as the control group (C). Total IgE concentration ranged from 1.2 to 6.6 IU/ml (mean = 1.4 IU/ml, standard deviation-sd = 1.1 IU/ml) in 28.3% of CSF samples from the P group, a value significantly higher than for the C group (£1.0 IU/ml). The serum samples from the P group showed concentrations ranging from 1.0 to 2330.0 IU/ml (mean = 224.1 IU/ml, sd = 452.1 IU/ml), which were higher than the normal value cited by the manufacturer (<100.0 IU/ml) in 32.1% of the samples. A significant difference was observed in CSF samples from the P and C groups (p = 0.005) and in serum samples from the P group compared to the normal value (p = 0.005), with sera showing more frequent abnormal results.Neurocisticercose (NC), causada pela presença da forma larvária de Taenia solium em tecidos, é a mais frequente e grave infecção parasitária que acomete o sistema nervoso central. Nós investigamos a presença de IgE total por quimiluminescência em 53 amostras pareadas de líquido cefalorraquiano (LCR) e soro de pacientes com NC (P) e 40 amostras de LCR de indivíduos portadores de outras desordens neurológicas como grupo controle (C). A detecção de IgE total mostrou 28,3% das amostras de LCR do grupo P com concentrações entre 1,2 UI/ml e 6,6 UI/ml (média = 1,4 UI/ml, desvio padrão-sd = 1,1 UI/ml), maiores que o grupo C (£1,0 UI/ml). As amostras de soro do grupo P mostraram concentrações entre 1,0 UI/ml e 2330,0 UI/ml (média = 224.1 UI/ml, sd = 452,1 UI/ml), e 32,1% das amostras apresentaram valores maiores que o valor normal citado pelo fabricante (<100,0 UI/ml). Diferença significativa foi encontrada entre as amostras de LCR dos grupos P e C (p = 0,005) e entre as amostras de soro do grupo P e valor de referência (p = 0,005), sendo os resultados dos soros mais frequentemente alterados

2 nd Brazilian Consensus on Chagas Disease, 2015

Abstract Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research

Cysticercosis Immunodiagnosis Using 18- and 14-Kilodalton Proteins from Taenia crassiceps Cysticercus Antigens Obtained by Immunoaffinity Chromatography

Monoclonal antibodies (MAb) against Taenia crassiceps and Taenia solium cysticerci were produced and showed cross-reactivity with a 14-kDa protein from T. solium and with 18- and 14-kDa proteins from T. crassiceps. These MAbs and antibodies from cerebrospinal fluid (CSF) as well as serum samples from patients with neurocysticercosis (NC) reacted with 18- and 14-kDa T. crassiceps proteins purified by immunoaffinity chromatography using a Sepharose column coupled with MAbs (anti-excretory/secretory or anti-vesicular fluid antigens). Immunoaffinity-purified 18- and 14-kDa proteins were used in the design of a diagnostic enzyme-linked immunosorbent assay (ELISA) to detect antibodies in 23 CSF and 20 serum samples from patients with NC, showing 100% sensitivity. The test specificity was determined using 42 noninflammatory CSF samples and 70 inflammatory CSF samples from patients with other neurological disorders (OND), showing 100% and 99.1% (confidence interval, 97.3% to 100%) specificity, respectively. A false-positive CSF sample result in the OND group was from a human immunodeficiency virus-positive patient with meningoencephalitis. By using serum samples from 194 healthy individuals, the specificity was 100%. Analysis of an additional 16 serum samples from individuals with other parasitic diseases (13 with intestinal parasitosis and 3 with schistosomiasis) showed negative results. Three (10%) serum samples from patients with hydatidosis were positive in our ELISA and in ELISA with T. solium cysticerci antigens. Two of them were also positive by immunoblotting. The use of 18- and 14-kDa T. crassiceps immunoaffinity-purified proteins for detection of anti-cysticercus antibodies in CSF and/or serum samples using an ELISA system showed a good performance and high specificity for serum samples, dispensing with the use of confirmatory tests, such as immunoblotting, for checking specificity

Diagnosis of Alzheimer's disease in Brazil: Supplementary exams

Abstract This article presents a review of the recommendations on supplementary exams employed for the clinical diagnosis of Alzheimer's disease (AD) in Brazil published in 2005. A systematic assessment of the consensus reached in other countries, and of articles on AD diagnosis in Brazil available on the PUBMED and LILACS medical databases, was carried out. Recommended laboratory exams included complete blood count, serum creatinine, thyroid stimulating hormone (TSH), albumin, hepatic enzymes, Vitamin B12, folic acid, calcium, serological reactions for syphilis and serology for HIV in patients aged younger than 60 years with atypical clinical signs or suggestive symptoms. Structural neuroimaging, computed tomography or - preferably - magnetic resonance exams, are indicated for diagnostic investigation of dementia syndrome to rule out secondary etiologies. Functional neuroimaging exams (SPECT and PET), when available, increase diagnostic reliability and assist in the differential diagnosis of other types of dementia. The cerebrospinal fluid exam is indicated in cases of pre-senile onset dementia with atypical clinical presentation or course, for communicant hydrocephaly, and suspected inflammatory, infectious or prion disease of the central nervous system. Routine electroencephalograms aid the differential diagnosis of dementia syndrome with other conditions which impair cognitive functioning. Genotyping of apolipoprotein E or other susceptibility polymorphisms is not recommended for diagnostic purposes or for assessing the risk of developing the disease. Biomarkers related to the molecular alterations in AD are largely limited to use exclusively in research protocols, but when available can contribute to improving the accuracy of diagnosis of the disease

Transtornos depressivos associados à neurocisticercose: prevalência e correlações clínicas Depressive disorders associated with neurocysticercosis: prevalence and clinical correlations

OBJETIVO: Investigar a ocorrência e os fatores de risco para morbidade depressiva em uma amostra de 38 pacientes ambulatoriais com neurocisticercose. MÉTODOS: O diagnóstico psiquiátrico baseou-se nos exames do estado mental atual e pregresso, respectivamente obtidos pelas entrevistas estruturadas do PSE-9 e SADS-L; as funções cognitivas foram avaliadas pelo MMS e pelo roteiro de Strub & Black (Mental Status Examination). RESULTADOS: Transtornos depressivos foram o achado psiquiátrico mais frequente (63,1%) entre os pacientes da amostra. Destes, 20 (52,6%) mostravam-se deprimidos no momento da avaliação e 4 apresentaram depressão no passado. Entre os pacientes deprimidos, 16 preencheram critérios diagnósticos do DSM-III-R para transtorno orgânico do humor (k = 0,4). Antecedentes pessoais de depressão (p = 0,006), sinais de atividade da doença (p = 0,044) e ocorrência de hipertensão intracraniana (p=0,065) foram os parâmetros clínicos que se correlacionaram com a presença de depressão. CONCLUSÕES: Tais achados, aliados à ausência de predomínio do sexo feminino entre os casos de depressão, sugerem etiologia orgânica. Os autores discutem essas observações à luz da literatura sobre outros transtornos mentais orgânicos.<br>OBJECTIVE: To determine the frequency and features of psychiatric morbidity in a cross-section of 38 outpatients with neurocysticercosis. METHODS: Diagnosis of neurocysticercosis was established by CT scan, MRI and CSF analysis. Psychiatric diagnoses were made by using the Present State Examination and the Schedule for Affective Disorders and Schizophrenia - Lifetime version; cognitive state was assessed by Mini-Mental State Examination and Strub & Black's Mental Status Examination. RESULTS: Depression was the most frequent psychiatric diagnosis (52.6%) as shown by PSE. Active disease and intracranial hypertension were associated with higher psychiatric morbidity, and previous history of mood disorders was strongly related to current depression. CONCLUSIONS: Depression syndromes are frequent in patients with neurocysticercosis. The extent to which organic mechanisms related to brain lesions may underlie the observed mental changes is yet unclear, though the similar sex distribution of patients with and without depression, as well as the above mentioned correlations, provide further evidence of the role played by organic factors in the cause of these syndromes. The results of this study are discussed in the light of the data available for other organic psychiatric disorders