[AF-FORUM] 114E全身播散性囊虫病-Perez Riera

[ATRIAL FIBRILLATION SYMPOSIUM]

尊敬的来自南非纳尔逊.曼德拉医院的Foyaca教授：
您的患者有全身性疾病，皮下、神经和心脏同时受累。
1）              皮下囊虫病：皮下囊泡为坚硬、可移动囊泡，主要发生于躯干 
和肢端。皮下囊泡有时伴疼痛。65%的皮肤囊虫病患者有神经系统表现。
2）              神经囊虫病（NCC）发生于岛叶，临床特征主要依赖囊虫数量、 
类型、大小、位置及囊虫病的发生阶段，以及宿主对寄生虫的免疫反应。癫痫是最 
常见的症状，见于70-90%的患者，某些地方，NCC被认为是晚发癫痫的主要原因。 
囊虫寄居于脑室内，可能发生继发于脑水肿的致命性急性颅内高压。蛛网膜下腔的 
囊虫可能会侵入Sylvian水管并长大（大囊泡）引起颅内高压伴偏瘫、部分癫痫或 
其他局限性神经体征。脑池的总状排列囊泡可以引起脑基底部剧烈的炎症反应、纤 
维化和软脑膜进行性增厚。大约60%的患者存在脑脊液（CSF）循环障碍，导致脑水 
肿和颅内高压。如果颅内高压继发于囊虫性脑膜炎，死亡高（50%），大部分患者 
在CSF分流的2年内死亡。因此，寄居于脑室和脑池内的囊泡被认为是NCC的恶性形 
式。NCC的临床诊断依据神经影像学检查、CSF的实验室检查和血清抗体检测。目 
前，阿苯达唑被认为是NCC的治疗药物。其主要用途是提示脑实质多处有囊虫的症 
状性患者。
3）              心脏囊虫病：囊虫可累及双侧心室。该患者的诊断是基于心脏 
磁共振吗？还是心超？我们需要评估患者的心功能状况。MRI可以检测心室内囊 
虫，但CT扫描不会。
    囊虫病有4个阶段，事关治疗方法
阶段1： 未成熟囊泡期；
阶段2： 小泡或可移动囊泡期；
阶段3： 胶状囊泡期；
阶段4： 坏死性钙化囊泡期。
你可以向纳尔逊.曼德拉学院内科的Thomas MB 医生获取正确治疗信息。
Thomas MB, Thomas KM, Awotedu AA, Blanco-Blanco E, Anwary M.
Cardiocysticercosis. S Afr Med J. 2007 Jul; 97(7):504-505.
PMID: 17824138 [PubMed - indexed for MEDLINE]
 
你知道Thomas MB吗？而且，你可以在以下的文章中获取相关正确治疗信息。
1)    Bhalla A, Sood A, Sachdev A.  Heart involvement in disseminated
cysticercosis- a case report and review of literature. Indian Heart J. 
2008 May-Jun; 60: 260-262.
Post Graduate Institute of Medical Education and Research, Chandigarh.
ashish_ritibhalla在yahoo.com
Heart involvement in cysticercosis is uncommon but is well described in
literature. Most of the reports are in the form of autopsy studies. Here 
we describe a young female with asymptomatic involvement of the heart,
diagnosed by echocardiography.
PMID: 19240318 [PubMed - indexed for MEDLINE]
 
2)    Eberly MD, Soh EK, Bannister SP, Tavaf-Motamen H, Scott JS. Isolated
cardiac cysticercosis in an adolescent. Pediatr Infect Dis J. 2008 Apr; 
27:369-371.
Section of Infectious Disease, Department of Pediatrics, F. Edward Hebert
School of Medicine, Uniformed Services University of the Health Sciences,
Bethesda, MD 20814, USA. meberly在usuhs.mil
Cardiac cysticercosis is a rare and typically asymptomatic infection. We
report a case of a young man from Cameroon with a left ventricular cyst
discovered during a screening echocardiogram. Computed tomography and 
plain films did not reveal additional cysts. Serology was negative. The 
patient had the cyst surgically removed for suspected echinococcosis. 
Sectioning demonstrated a cysticercus. The literature on cardiac 
cysticercosis is reviewed.
PMID: 18316979 [PubMed - indexed for MEDLINE]
3)    Thomas MB, Thomas KM, Awotedu AA, Blanco-Blanco E, Anwary M.
Cardiocysticercosis. S Afr Med J. 2007 Jul; 97(7):504-505.
Department of Internal Medicine, Nelson Mandela Academic Complex, E Cape.
PMID: 17824138 [PubMed - indexed for MEDLINE]
4)    Developmental characteristics of Cysticercus cellulosae in the 
human brain and heart Rev Soc Bras Med Trop. 2002 Nov-Dec; 35: 617-622.
Disciplina de Patologia Geral, Instituto de Patologia Tropical e Saúde 
Pública, Universidade Federal de Goiás, Goiânia, GO, Brasil.
The present study aimed to evaluate the prevalence of cysticercosis, to
classify the developmental phases of cysticerci found in human brains and
hearts, and differentiate these according to the macro and microscopic
aspects of the general pathological processes, and to compare the process
found in the brains and hearts. Protocols from autopsies performed at the
Hospital of the School of Medicine of the Triângulo Mineiro, Uberaba, MG,
Brazil, in the period from 1970 to 2000 were reviewed. The prevalence of
cysticercosis was verified in 71 cases, of which 53 (74.6%) were 
encephalic cysticercosis and 18 (25.3%) cardiac cysticercosis. Nineteen 
cysticerci were analyzed, from 9 brains and 10 hearts. The cysticerci 
were classified according to their developmental stage: vesicular, 
colloidal vesicular,granular nodular and calcified nodular, with 
similarities between the macroscopic and microscopic diagnoses. Among 
the pathological processes found beta-fibrilosis and endocardial 
fibroelastosis are underscored. In addition, it was demonstrated that 
this classification may be applied both to encephalic and cardiac 
cysticercosis.
PMID: 12612744 [PubMed - indexed for MEDLINE]
5)    Bandón R, Leandro IM. Human cardiac cysticercosis. Rev Med Panama.
2002; 27: 37-40.Hospital Santo Tomás.PMID: 16737198 [PubMed - indexed for
MEDLINE]
Service de cardiologie, centre hospitalier national et universitaire 
Yalgado Ouédraogo (CHNU-YO), 01 BP 3401, Ouagadougou, Burkina Faso.
r.y.niakara在fasonet.bf
Cysticercosis (cysticercus cellulosoe) is a parasitic infestation of 
human by a larval form of Taenia solium. The localisations are mostly 
the central nervous system, skeletal muscles and subcutaneous tissue, 
but other organs can be concerned. Myocardial cysticercosis is an 
extremely rare infection.We report a case of myocardial cysticercosis in 
a 37 year old patient who presented a disseminated form. The myocardium 
involvement is diagnosed by echocardiography. The clinical and 
echographic evolution was favourable after a treatment with albendazole. 
The other cardiovascular manifestations described in the literature are 
discussed.
PMID: 12138821 [PubMed - indexed for MEDLINE]
6)    Niakara A, Cisse R, Traeore A, Niamba PA, Barro F Kabore J.
Myocardial localization of a disseminated cysticercosis. 
Echocardiographic diagnosis of a case. Arch Mal Coeur Vaiss. 2002 Jun; 
95: 606-608.
Service de cardiologie, centre hospitalier national et universitaire 
Yalgado Ouédraogo (CHNU-YO), 01 BP 3401, Ouagadougou, Burkina Faso.
r.y.niakara在fasonet.bf
Cysticercosis (cysticercus cellulosoe) is a parasitic infestation of 
human by a larval form of Taenia solium. The localisations are mostly 
the central nervous system, skeletal muscles and subcutaneous tissue, 
but other organs can be concerned. Myocardial cysticercosis is an 
extremely rare infection.We report a case of myocardial cysticercosis in 
a 37 year old patient who presented a disseminated form. The myocardium 
involvement is diagnosed by echocardiography. The clinical and 
echographic evolution was fabourable after a treatment with albendazole. 
The other cardiovascular manifestations described in the literature are 
discussed.
PMID: 12138821 [PubMed - indexed for MEDLINE]
7)    Lino RS Jr, Reis MA, Teixeira VP.Occurrence of encephalic and
cardiac cysticercosis (Cysticercus cellulosae) in necropsy Rev Saude
Publica. 1999 Oct; 33: 495-498.
Departamento de Ciências Biológicas, Faculdade de Medicina do Triângulo
Mineiro, Uberaba, MG, Brasil.
OBJECTIVE: To review the incidence and pathologic findings of 
cysticercosis diagnosed at autopsies, with emphasis on the most common 
organs affected.METHODS: Reports of 1.596 autopsies performed between 
1974 and 1997 at a school hospital in Uberaba, MG, Brazil were studied. 
The following data were obtained: age, sex, ethnic group, body mass 
index, and the site of the cysticercosis. RESULTS: The study found 
diagnosis of cysticercosis in 53 autopsies (3.3%). The average age of 
patients with cysticercosis was 50 (range: 15 to 86 years); 62.3% were 
male, and 64.1% Caucasian. The most affected organs were: brain (79.2%), 
heart (22.6%), skeletal muscle (11.3%),and other organs (5.7%). No 
statistical differences were found comparing age, gender, ethnic group, 
and body mass index of the affected and the non-affected patients. In 
two cases of neurocysticercosis the lesions were located in the 
ventromedial nucleus of the hypothalamus. CONCLUSION: Both the overall 
incidence of cysticercosis and the incidence of cardiac cysticercosis 
were greater in the study than in other autopsy series from the same 
geographic areas. In two cases there was an association between 
hypothalamic cysticercosis and obesity
PMID: 10576752 [PubMed - indexed for MEDLINE]
 
致
Andrés Ricardo Pérez Riera MD
In Charge of electro-vectorcardiogram sector. Cardiology Discipline. ABC
Medical Faculty.  ABC Foundation. Santo André - São Paulo. Brazil
Sebastião Afonso, 885     CEP: 04417-000
Jardim Miriam – São Paulo - Brazil
Phone: (11) 5621-2390
riera在uol.com.br