Neurocysticercosis in Paraiba, Northeast Brazil. An endemic area?

[Neurocysticercosis in a State of Piauí urban area: case report]

Neurocysticercosis is a serious public health problem that predominantly affects places with poor sanitary and hygiene conditions. The Piaui State is out of the neurocysticercosis map in Brazil but, as this study illustrates, it is just by lack of epidemiologic data. We demonstrate the presence of this pathology in the State of Piaui based on a case report of a 39 years old man, followed for 17 months. The diagnosis was made by CT scan and the patient was treated with albendazol for 10 days. A new CT scan show absence of lesions. He needed to be treated again after a recurrence of clinical manifestations, 6 months after the first treatment, with the disappearance of the new lesions.

Estudo soroepidemiológico da cisticercose humana em um município do Estado do Piauí, Região Nordeste do Brasil

Integrando as pesquisas sobre parasitoses na região do entorno do Parque Nacional Serra da Capivara, Piauí, Brasil, realizadas entre 1999 e 2001, o presente estudo tem como objetivo avaliar a situação epidemiológica da cisticercose humana no Município de João Costa, no Nordeste do Brasil. Foram obtidas informações clínico-epidemiológicas e coletadas amostras de sangue para testes sorológicos imunoenzimáticos (ELISA e Western blot), empregando cisticercos de Taenia crassiceps como antígeno. Na primeira etapa, em 1999, foram investigadas 169 pessoas com história confirmada ou suspeita de infecção/doença pelo complexo teníase-cisticercose, e seus familiares. Na análise, 13,6% das pessoas apresentaram soros reagentes para cisticercose pelo método ELISA. Na segunda etapa, em 2001, foram avaliadas 92 amostras de soro de indivíduos reativos para cisticercose detectados no primeiro momento e seus familiares, sendo que 24,0% das amostras de soro foram reagentes para cisticercose pelo ELISA, e 29,0%, pelo WB. Nessa mesma etapa, realizou-se inquérito coprológico em 701 pessoas, incluindo voluntários. A prevalência de parasitoses intestinais foi de 51,0%, tendo sido observada uma maior prevalência de protozoários (95,0%) em relação aos helmintos (5,0%). Os resultados do estudo indicam o caráter endêmico da cisticercose na área, além da elevada freqüência de protozooses intestinais.

Aspectos clínico-epidemiológicos da neurocisticercose no Brasil: análise crítica

Com o objetivo de mostrar as características da neurocisticercose (NCC) no Brasil, realizou-se análise critica da literatura nacional que mostrou incidência de 1,5% nas necropsias e de 3,0% nos estudos clínicos, correspondendo a 0,3% das admissões em hospitais gerais. Em estudos soroepidemiológicos, a positividade para cisticercose foi de 2,3%. O paciente brasileiro com NCC pode apresentar um perfil clínico-epidemiológico geral (homem, 31-50 anos, procedência rural, manifestações epilépticas parciais complexas, LCR normal ou hiperproteinorraquia, calcificações ao exame de TC, constituindo a expressão da forma inativa da NCC) e outro de gravidade (mulher, 21-40 anos, procedência urbana, manifestações de cefaléia vascular e HIC, típica síndrome do LCR ou alteração de dois ou mais parâmetros, vesículas associadas ou não a calcificações ao exame de TC, constituindo a expressão da forma ativa da NCC). Os coeficientes de prevalência nacionais são muito subestimados, embora em duas cidades do interior de São Paulo tenham sido verificados os valores de 72:100.000 e 96:100.000/habitantes. Discutem-se aspectos relacionados à subestimação da prevalência desta neuroparasitose no Brasil.

Neurocysticercosis in a preschool-age child: case report

Neurocysticercosis is a frequent cause of epilepsy and other neurologic abnormalities in all age groups, however by virtue of its prolonged incubation period as well as young children's nutritional habits, it is rarely seen in preschool-age children. The objective of this study is to report the case of a 2 year-old child who presented with new-onset seizures. Her diagnostic features, including neuroradiologic findings, are described and compared with the literature. No matter how young he or she may be, every child who presents with new-onset seizures or other unexplained neurologic features and whose CT or MRI shows cystic lesions or contrast-enhancing rounded lesions should raise a suspicion of neurocysticercosis.

[Neurocysticercosis: a clinical and pathological study of 27 necropsied cases]

Neurocysticercosis is the most frequent and widespread neuroparasitosis of the human being. The development of brain and leptomeningeal lesions, with subsequent symptoms, are mainly related with the immune status of the host, and to the number and evolutional phase of the parasites. We present the pathological findings in 27 necropsies of patients with neurocysticercosis, which accounted for 3.1% of the necropsies. 77% of the patients were male and the age ranged from 18 to 85 years. In 26% there was previous history of alcoholism. Clinicopathological study showed that 50% of the cases were classified as asymptomatic form, 11% epileptic form, 11% intraventricular form and 11% combined form. 33% of the patients presented seizures as a factor of aggravation of the clinical picture. There was a single cysticercus in 60% of the cases, the cellulosae form present in 82% and the racemous form in 7% of the cases; the remaining 11% had both forms present. In 30% of the patients the cause of death was directly related with the presence of the cysticercus in the central nervous system. Our findings confirm the high morbidity of this disease.

[Prevalence of neurocysticercosis among epileptic in-patients in the west of Santa Catarina--southern Brazil]

Neurocysticercosis (NC) is an endemic condition in several areas of Brazil. It is most likely the major responsible for the high prevalence of epilepsy in our country, estimated in 1-2% of general population. We performed a study to evaluate NC as aetiology of epilepsy in the west of Santa Catarina. This state belong to southern Brazil and it has a very developed economy. However, due the widespread swine farming in the west district, many of them without any sanitary control, the national health authorities have considered all this area at risk to NC. The study was carried out in Chapecó, the main town in that region, where CT Scan service was started in 1995. All patients put on hospital care due epileptic seizures in 1995-96 were considered. Febrile convulsions were excluded of the sample. We found a very expressive prevalence rate of NC among patients suffering from epilepsy. Roughly 24% of these patients, showed unequivocal tomography evidences for the diagnosis of NC. Our data suggest cysticercosis as a real endemic trouble in the area and, overdosis of information in proper language, diffuse to the whole population, seems to be the only remedy to fight against it. Moreover, we should pay special attention to everyone related to swine farming, does not matter how this activity has been classified.