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

[ATRIAL FIBRILLATION SYMPOSIUM]

Estimado Prof. Foyaca, do Hospital Academico Nelson Mandela da Africa do 
Sul:
Você tem uma paciente com doença sistêmica: compromisso subcutáneo, 
neurológico e cardíaco tudo junto.
1) Cisticercosis subcutánea: Os quistes subcutâneos tem a forma de 
nódulos firmes e móveis, que ocorrem principalmente no tronco e 
extremidades. Os nódulos subcutâneos asvezes são dolorosos. Entre os 
pacientes com cisticercosis cutânea, o 65% sofrem manifestações 
neurológicas.
 
2) Neurocisticercosis incluindo o lóbulo insular: As características 
clínicas da neurocisicercosis (NCC) depende em grande part da 
quantidade, tipo, magnitude e localzação e etapa do desenvolvimento dos 
cisticercos, assim como da resposta imune do hóspide contra o parasita. 
Se informa ampliamente sobre convulsões como o sintoma mais comum, que 
ocorre em 70-90% dos pacientes, enquanto que a NCC esta considerada como 
a causa principal de eilepsia de inicio tardio em áreas endêmicas.
Quando os cisticercos se alojam dentro do sistema ventricular, se pode 
desenvolver hipertensão intracraneal aguda com risco para a vida, 
secundaria a hidrocefaleia. Os quistes no espaço subaracnoideo podem 
invadir a cisura de Silvio e crescer até um grande tamanho (quistes 
gigantes) que causam ipertensão intra-craneal com hemiparesia, 
convulsões parciais e outros signos neurológicos focais. Os quistes 
racemosos nas cisternas basais podem causar intensa reação inflamatória, 
fibrosis e engrossamento progressivo d leptomeninge na base do cérebro. 
Em aproximadamente 60% dos casos, há uma obstrução na circulação de 
fluido cerebroespinhal, que resulta em uma hidrocefaleia e hipertensão 
intra-craneal. Quando a hidrocefaleia secundaria e a meningitis 
cisticercótica se apresentam, o índice de mortalidade é alto (50%) e a 
maioria dos pacientes morrem em 2 anos logo do desvio de fluido 
cerebroespinhal. Por tanto as localidades das cisternas ventricular e 
basal são consideradas formas malignas de NCC.
O diagnóstico de NCC se baseia em estudos de neuroimagem, análise de 
laboratório do fluido cerebroespinhal e detecção de anti-corpos em soro. 
Na atualidade, o albendazol é considerado a medicação de eleição para a 
terapia de NCC. Seu uso principal é para pacientes sintomáticos que 
mostram múltiplos cisticercos viaveis em parênquima cerebral.
 
3) Cardiocisticercosis: Região ventricular cardíaca com ataque em ambos 
ventrículos. O diagnóstico se fez por imagem de resonância cardíaca? Ou 
por eco? Precisamos saber o estado da função cardíaca. A IRM pode 
detectar quistes intra-ventriculares, emquanto que a tomografia não pode.
Os quistes têm  4 etapas, importantes para o enfoque terapêutico:
1) Etapa 1: etapa de quiste imaduro
2) Etapa 2: quistes vesiculares ou viaveis
3) Etapa 3: etapa de quistes coloides
4) Etapa 4: quistes calcificados mortos.
Se pode obter informação sobre o tratamento correto em suas instituições 
com o Dr. Thomas MB, do Departamento de Medicina Internat,
Complexo Acadêmico 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]
Conhece ao Dr. Thomas?
Além do mais pode obter informação sobre o tratamento correto nos 
seguintes artigos:
 
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 em 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 em 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 em 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 em 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]
 
Saudações 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 em uol.com.br