1
|
Miyoshi IC, de Toledo AHN, Pereira FV, Villarinho LDL, Dalaqua M, de Ávila Duarte J, Reis F. Infectious Myelitis. Semin Ultrasound CT MR 2023; 44:424-435. [PMID: 37555684 DOI: 10.1053/j.sult.2023.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Myelitis is an extensive group of pathologies, including inflammatory, demyelinating, and infectious disorders, sometimes mimicking tumors. This article will discuss infectious myelitis, mainly the patterns of spinal cord involvement caused by each infectious agent and the contribution of magnetic resonance imaging as a major tool to establish the specific diagnosis.
Collapse
Affiliation(s)
| | | | | | | | - Mariana Dalaqua
- Departement d'Imagerie Médicale, Réseau Hospitalier Neuchatelois, Pourtalès, Switzerland
| | - Juliana de Ávila Duarte
- Department of Radiology and Diagnostic Imaging, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Fabiano Reis
- Medicine Department of Anesthesiology, Oncology and Radiology, UNICAMP, Campinas, SP, Brazil.
| |
Collapse
|
2
|
Docu Axelerad A, Stroe AZ, Gogu AE, Pusztai A, Jianu DC, Daniel D, Docu Axelerad D. Clinical spectrum of symptoms in cerebral Toxocariasis (Review). Exp Ther Med 2021; 21:521. [PMID: 33815594 PMCID: PMC8014984 DOI: 10.3892/etm.2021.9953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/09/2021] [Indexed: 11/06/2022] Open
Abstract
Human helminth zoonosis is one of the most encountered helminthiases worldwide. Representative diseases include Toxocara canis and Toxocara cati, which are common nematodes prevalent in dogs and cats. The infiltration of these roundworms in the human body through contaminated food or nematode eggs could lead to central nervous system injury as the roundworms can cross the blood-brain barrier leading to neurotoxocariasis. Among the neurological and neuropsychological disturbances produced by Toxocara infection, in humans, the most representative are meningitis, encephalitis, myelitis and cerebral vasculitis, but asymptomatic central nervous system infection is probably the most prevalent. The present review examines the clinical symptomatology of neurotoxocariasis in case reports in the literature in the last 7 decades (1950-2020). The available evidence was retrieved from PubMed and Medline electronic databases. The present review reports the most prevalent clinical symptomatology in the cases of detected and diagnosed Toxocara infection with neuroinvasion. Thus, the present review aims to raise the awareness of neurological cases of Toxocara infection with the potential to at least establish differential diagnosis of neurotoxocariasis.
Collapse
Affiliation(s)
- Any Docu Axelerad
- Department of Neurology, Faculty of General Medicine, ‘Ovidius’ University of Constanta, 900470 Constanta, Romania
| | - Alina Zorina Stroe
- Department of Neurology, Faculty of General Medicine, ‘Ovidius’ University of Constanta, 900470 Constanta, Romania
| | - Anca Elena Gogu
- Department of Neurology, Faculty of General Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, 300041 Timisoara, Romania
| | - Agneta Pusztai
- Department of Anatomy, Faculty of General Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, 300041 Timisoara, Romania
| | - Dragos Catalin Jianu
- Department of Neurology, Faculty of General Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, 300041 Timisoara, Romania
| | - Duta Daniel
- Department of Sports, Faculty of Physical Education and Sports, ‘Ovidius’ University of Constanta, 900470 Constanta, Romania
| | - Daniel Docu Axelerad
- Department of Sports, Faculty of Physical Education and Sports, ‘Ovidius’ University of Constanta, 900470 Constanta, Romania
| |
Collapse
|
3
|
Bakirtzis C, Syntila SA, Grigoriadis N. Encephalomyelitis and Lymphadenopathy in a Man in His Early 40s. JAMA Neurol 2020; 77:1171-1172. [DOI: 10.1001/jamaneurol.2020.1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christos Bakirtzis
- Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Styliani-Aggeliki Syntila
- Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
4
|
Abstract
Human toxocariasis, caused by larvae of the Toxocara spp., is one of the most prevalent zoonosis with a worldwide distribution. Toxocara larvae can cross the blood-brain barrier, invading the central nervous system (CNS), leading to neurotoxocariasis. The clinical presentation consists of a wide spectrum of neurological manifestations such as meningitis, encephalitis, myelitis and cerebral vasculitis, but asymptomatic CNS infection is common. Despite the high seroprevalence, neurotoxocariasis is thought to be rare, even if in many animal models larvae usually migrate to the brain. Indeed, diagnosis of neurotoxocariasis is rarely considered, and the exact prevalence of CNS involvement is still unknown. Diagnosis of neurotoxocariasis is generally based on the detection of specific antibodies to Toxocara excretory-secretory antigens by ELISA in CSF or serum, and clinical and radiological improvement after anthelmintic therapy, but definitive diagnosis is given by histological confirmation, which is rarely available. Treatment is based on anti-helminthic drugs, commonly albendazole, generally administered with concomitant corticosteroids coverage. At the population level, serological studies suggest an association between Toxocara infections and epilepsy, as well as with other neurodegenerative and psychiatric disorders. Nonetheless the possible role of Toxocara spp. in the pathogenesis of these disorders is still matter of debate.
Collapse
Affiliation(s)
- Alessandra Nicoletti
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
| |
Collapse
|
5
|
Sánchez SS, García HH, Nicoletti A. Clinical and Magnetic Resonance Imaging Findings of Neurotoxocariasis. Front Neurol 2018; 9:53. [PMID: 29472889 PMCID: PMC5809457 DOI: 10.3389/fneur.2018.00053] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/19/2018] [Indexed: 01/08/2023] Open
Abstract
Human toxocariasis is one of the most prevalent helminthiases worldwide. Toxocara canis larvae can cross the blood-brain barrier leading to the neurotoxocariasis. The clinical presentation consists of a wide spectrum of neurological manifestations, but asymptomatic infection is probably common. Neurotoxocariasis is not a frequent diagnosis probably due to the non-specific nature of its symptoms as well as the lack of confirmatory diagnostic tests. Diagnosis of neurotoxocariasis is based on the presence of a high titer of anti-Toxocara antibody in the cerebrospinal fluid or in the serum, presence of eosinophilia in the serum or cerebrospinal fluid, and clinical and radiological improvement after anthelmintic therapy; however, universally accepted diagnostic criteria are lacking. Magnetic resonance imaging (MRI) findings include single or multiple, subcortical, cortical or white matter hyperintense lesions, best visualized on FLAIR and T2-weighted imaging, and usually isointense or hypointense on T1. These imaging findings are suggestive but not specific to neurotoxocariasis. Definitive diagnosis is made by histological confirmation, but it is rarely followed. This review provides an overview of the clinical manifestations, management options, and MRI findings of neurotoxocariasis.
Collapse
Affiliation(s)
- Sofia S Sánchez
- Department of Microbiology, School of Public Health (SSS), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Sciences (HHG), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hector H García
- Department of Microbiology, School of Public Health (SSS), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Sciences (HHG), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru.,Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Alessandra Nicoletti
- Department G. F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| |
Collapse
|
6
|
Merigueti YFFB, Santarém VA, Ramires LM, da Silveira Batista A, da Costa Beserra LV, Nuci AL, de Paula Esposte TM. Protective and risk factors associated with the presence of Toxocara spp. eggs in dog hair. Vet Parasitol 2017; 244:39-43. [PMID: 28917315 DOI: 10.1016/j.vetpar.2017.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/26/2022]
Abstract
Toxocariasis is one of the most prevalent parasitic zoonoses in the world. The disease is principally caused by the nematode Toxocara canis, whose definitive host is the dog. The transmission of toxocariasis to humans is mainly caused by accidental ingestion of embryonated eggs of the parasite, present in the soil. Studies have shown that dog hair has the capacity to harbor eggs of the parasite and represents a risk for transmission of the zoonosis. The objective of the present study was to evaluate the frequency and factors associated with the contamination of dog hair by Toxocara spp. of animals attended and/or abandoned at a Veterinary-Teaching Hospital in Southeast Brazil. The hair samples were collected from the perineal region, and upper and lower tail regions. For analysis of the samples and recovery of Toxocara spp., the material was washed in Tween 20 and then filtered through sieves of 300μm, 212μm, and 38μm. Hair samples from 165 dogs were analyzed. Of the analyzed samples, 59 (35.8%) were from puppies and 106 (64.2%) from adult animals. In the sample evaluation, 6.7% of the dogs (11/165) were contaminated, with a mean of 12.2 eggs per animal (1-70 eggs/animal) and 57.5 eggs/gram of hair. All the recovered eggs were not embryonated. There was an influence of age (puppies), breed (without defined breed), and origin (stray) of the dogs. On the other hand, deworming was a protective factor. Our results show that the risk of transmission of toxocariasis by direct contact, mainly in well-cared dogs, is low. Thus, prophylactic anthelmintic treatment and correct care regarding the hygiene of animals, especially puppies, should be recommended to reduce any risk of transmission of toxocariasis.
Collapse
Affiliation(s)
- Yslla Fernanda Fitz Balo Merigueti
- Post-Graduate Program in Animal Science, Laboratory of Veterinary Parasitology, Veterinary Teaching-Hospital (UNOESTE), Presidente Prudente, São Paulo, Brazil
| | - Vamilton Alvares Santarém
- Post-Graduate Program in Animal Science, Laboratory of Veterinary Parasitology, Veterinary Teaching-Hospital (UNOESTE), Presidente Prudente, São Paulo, Brazil.
| | - Lívia Magosso Ramires
- Post-Graduate Program in Animal Science, Laboratory of Veterinary Parasitology, Veterinary Teaching-Hospital (UNOESTE), Presidente Prudente, São Paulo, Brazil
| | - Aline da Silveira Batista
- Post-Graduate Program in Animal Science, Laboratory of Veterinary Parasitology, Veterinary Teaching-Hospital (UNOESTE), Presidente Prudente, São Paulo, Brazil
| | - Layron Vinícus da Costa Beserra
- Laboratory of Veterinary Parasitology, Veterinary Teaching-Hospital, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, São Paulo, Brazil
| | - Amábyle Lopes Nuci
- Laboratory of Veterinary Parasitology, Veterinary Teaching-Hospital, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, São Paulo, Brazil
| | - Talita Mirella de Paula Esposte
- Laboratory of Veterinary Parasitology, Veterinary Teaching-Hospital, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, São Paulo, Brazil
| |
Collapse
|
7
|
A Case of Atopic Myelitis with Cervical Cavernous Angioma. Case Rep Med 2017; 2017:9506275. [PMID: 28757876 PMCID: PMC5512020 DOI: 10.1155/2017/9506275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/01/2017] [Indexed: 11/17/2022] Open
Abstract
Atopic myelitis, a type of myelitis which appears in patients with elevated serum levels of immunoglobulin E (IgE), occurs more commonly in the cervical spinal cord, but this mechanism has not yet been elucidated. Herein, we experienced a case of atopic myelitis developed during the growth of cervical cavernous angioma caused by bleeding. A 37-year-old woman suffered from hand swelling caused by a house cat licking. At the same time when cavernous angioma had grown, she experienced a numbness in her four extremities, and multifocal peritumoral hyperintense spinal cord signals were seen. The diagnosis of atopic myelitis was made because we observed significantly elevated levels of specific IgE antibody to cat dander. Symptoms disappeared immediately after steroid pulse therapy. We subsequently resected a cavernous angioma, and eosinophil invasion was found inside it. This is the first case report of atopic myelitis which developed in association with spinal cord vascular lesions. A local blood-brain barrier breakdown due to hemorrhagic lesions of the spinal cord may have contributed to the onset of atopic myelitis.
Collapse
|
8
|
Abstract
PURPOSE Toxocariasis is a widespread zoonosis, which may result in central nervous system injury. METHODS We conducted a systematic literature review in MEDLINE, SciELO, ScienceDirect and Google Scholar up to April 2015 using a combination of the following search terms: "neurotoxocariasis" or "neurotoxocarosis", "toxocariasis" or "toxocarosis" and "cerebral" or "neurologic". RESULTS One hundred cases of neurotoxocariasis were identified in literature. The majority of patients were male (58 %), with a median age of 42 years. The predominant clinical pictures were myelitis (60 %), encephalitis (47 %) and/or meningitis (29 %). Fever was inconstant (23 %). The suspected mode of transmission, mentioned in only 49 % of cases, was mainly contact with dogs and/or cats (67 %) and ingestion of contaminated food (31 %). Diagnostic imaging examinations found hypodense lesions in cerebral scanner sequences and hyperintense lesions in cerebral MRI T2-weighted sequences in 65 and 57 % of encephalitis cases respectively, and in 92 % of myelitis cases in medullary MRI T2-weighted sequences. The detection of antibodies against Toxocara spp. was almost constant in blood and cerebrospinal fluid (CSF), 99 and 93 %, respectively. The two most commonly used drugs were corticosteroids (72 %) and/or albendazole (68 %) for a period of at least 3 weeks, which often needed to be repeated. Despite a low mortality rate (6 %), complete remission was observed in only 40 % of cases. CONCLUSIONS Neurotoxocariasis, a completely preventable zoonosis, could lead to severe sequelae failing prompt diagnosis. A compatible clinical picture, presence of risk factors, blood eosinophilia and high titers of antibodies against Toxocara spp. in CSF should alert physicians.
Collapse
|