[AF-FORUM-ESP] 114E Cisticercosis diseminada. Perez Riera

[ATRIAL FIBRILLATION SYMPOSIUM]

Estimado Prof. Foyaca, del Hospital Académico Nelson Mandela de Sudáfrica:
Ud. tiene una paciente con enfermedad sistémica: compromiso subcutáneo,
neurológico y cardíaco todo junto.
1) Cisticercosis subcutánea: Los quistes subcutáneos tienen la forma de
nódulos firmes y movibles, que ocurren principalmente en el tronco y
extremidades. Los nódulos subcutáneos a veces son dolorosos. Entre los
pacientes con cisticercosis cutánea, el 65% sufre manifestaciones
neurológicas.
2) Neurocisticercosis incluyendo el lóbulo insular: Las características
clínicas de la neurocisticercosis (NCC) depende en gran parte de la 
cantidad,
tipo, magnitud y localización y etapa del desarrollo de los cisticercos, 
así
como de la respuesta inmune del huésped contra el parásito. Se informa
ampliamente sobre convulsiones como el síntoma más común, que ocurre en 
el 70-
90% de los pacientes, mientras que la NCC está considerada como la causa
principal de epilepsia de inicio tardío en áreas endémicas.
Cuando los cisticercos se alojan dentro del sistema ventricular, se puede
desarrollar hipertensión intracraneal aguda riesgosa para la vida, 
secundaria
a hidrocefalia. Los quistes en el espacio subaracnoideo pueden invadir la
cisura de Silvio y crecer hasta un gran tamaño (quistes gigantes) que 
causan
hipertensión intracraneal con hemiparesia, convulsiones parciales u otros
signos neurológicos focales. Los quistes racemosos en las cisternas basales
pueden causar una intensa reacción inflamatoria, fibrosis y engrosamiento
progresivo de la leptomeninge en la base del cerebro. En aproximadamente el
60% de los casos, hay una obstrucción de la circulación del fluido
cerebroespinal, que resulta en hidrocefalia e hipertensión intracraneal.
Cuando la hidrocefalia secundaria a la meningitis cisticercótica se 
presenta,
el índice de mortalidad es alto (50%) y la mayoría de los pacientes 
muere en 2
años luego de desvío de fluido cerebroespinal. Por lo tanto, las 
ubicaciones
de las cisternas ventricular y basal son consideradas formas malignas de 
NCC.
El diagnóstico de NCC se basa en estudios de neuroimagen, análisis de
laboratorio del fluido cerebroespinal y detección de anticuerpos en 
suero. En
la actualidad, el albendazol es considerado la medicación de elección 
para la
terapia de NCC. Su uso principal es para pacientes sintomáticos que 
muestran
múltiples cisticercos viables en el parénquima cerebral.
3) Cardiocisticercosis: Región ventricular cardíaca con ataque en ambos
ventrículos. ¿El diagnóstico se hizo por imagen de resonancia cardíaca? 
¿O por
eco? Necesitamos saber el estado de la función cardíaca. La IRM puede 
detectar
quistes intraventriculares, mientras que la tomografía no puede.
Los quistes tienen 4 etapas, importantes para el enfoque terapéutico:
1) Etapa 1: etapa de quiste inmaduro
2) Etapa 2: quistes vesiculares o viables
3) Etapa 3: etapa de quistes coloides
4) Etapa 4: quistes calcificados muertos.
Se puede obtener información sobre el tratamiento correcto en sus
instituciones con el Dr. Thomas MB, del Departamento de Medicina Internat,
Complejo Académico Nelson Mandela, E Cape:
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]
¿Conoce al Dr. Thomas?
Además puede obtener información sobre el tratamiento correcto en los
siguientes artículos:

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 en 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 en 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 en 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 en 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]

Saludos para todos,
Andres Ricardo Perez 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 en uol.com.br