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Infectious diseases The importance of local singularities in an increasingly interconnected world Latin America experience Leandro Tavares Lucato1,2 [email protected] 1 Clinics Hospital, Faculty of Medical Sciences, University of Sao Paulo Centro de Medicina Diagnóstica SAO PAULO, BRAZIL 2 Fleury Background • Interconnected world – 2.1 billion airline passengers (2006) • Scenario – Dissemination of endemic diseases – Away from their common locations World Health Organization. The world health report 2007 Paracoccidioidomycosis Paracoccidioides brasiliensis • 1st systemic fungal infection in Brazil • 15♂ : 1♀ • Chronic pneumopathy ± – Mucosal and skin lesions – Disseminated lesions • CNS involvement: 8-10% Martinez R. Rev Soc Bras Med Tropical. 2010; 43:480 Paracoccidioidomycosis Paracoccidioides brasiliensis • Presentation – Granulomatous (pseudotumoral) • 90% cases – Meningeal disease (leptomeningeal) Tobón A. Rev Inst Med Tropical S Paulo. 2004;42:231-234 Paracoccidioidomycosis Male, 69 y, LOC Noncontrast Axial T1-Gd CT Axial T2 Paracoccidioidomycosis Male, 69 y, LOC Stereotactic Bx – Grocott H&E Paracoccidioidomycosis Male, 66 y, right hemiparesis Axial AxialFLAIR T1-Gd Coronal T2 Paracoccidioidomycosis Male, 66 y, right hemiparesis Multivoxel MRS Lip map – MRS Paracoccidioidomycosis Male, 66 y, right hemiparesis Axial DWI rCBV map Hotez PJ et al. PLoS Negl Trop Dis. 2008;2:e300 Cysticercosis - Taenia solium (pork tapeworm) http://www.dpd.cdc.gov/dpdx Cysticercosis Taenia solium (pork tapeworm) • Clinical manifestations nonspecific • Serologic tests: variable sensitivity/specificity • MR / CT – Parenchymal (60%) / Subarachnoid / Ventricular – 4 stages (parenchymal) • • • • Vesicular → cyst w/ scolex, no inflammatory response Colloid vesicular → cyst + inflammatory response Granular nodular → inflammatory resp + calcification Nodular calcified → calcification – Scolex → absolute dx criterion Del Brutto OH et al. Neurology. 2001;57:177-183 Cysticercosis Scolex characterization Axial T1 Axial T2 Axial FLAIR Axial T1+Gd Lucato LT et al. AJNR 2007;28:1501-1504 Cysticercosis Scolex characterization Axial FLAIR DWI Axial T1+Gd Lucato LT et al. 34th ESNR meeting. Athens, Greece. Sept 17-20,2009 Cysticercosis Granular nodular stage – viscous content Axial FLAIR Axial T2* Lucato LT et al. 34th ESNR meeting. Athens, Greece. Sept 17-20,2009 Cysticercosis Granular nodular stage – viscous content Axial T1+Gd Axial DWI Lucato LT et al. 34th ESNR meeting. Athens, Greece. Sept 17-20,2009 Chagas disease / American trypanosomiasis Trypanosoma cruzi http://www.dpd.cdc.gov/dpdx Chagas disease Trypanosoma cruzi • Reactivation of chronic disease – Immunosuppressed patients – AIDS-defining disease • Presentation – Pseudotumoral – Acute diffuse meningoencephalitis • Poor prognosis • MR/CT: no distinctive findings • CSF → diagnostic Lury KM, Castillo M. AJR. 2005; 185:550-552 Chagas disease T. cruzi trypomastigote forms – CSF Chagas disease Male, 46 y, heart tx, left hemiparesis Axial FLAIR Contrast CT Coronal T1-Gd Chagas disease Female, 33 y, HIV +, LOC Axial DWI FLAIR T1-Gd – 2– weeks 2initial weeks Contrast CT Axial FLAIR – 2 weeks Schistosomiasis Schistosoma mansoni http://www.dpd.cdc.gov/dpdx Schistosomiasis Schistosoma mansoni • Brain or spinal involvement • Theories – Ova transportation (retrograde venous flow) – Anomalous migration of adult worms • MR / CT – Variable – Linear and nodular enhancement pattern • “Arborized” appearance Sanelli PC et al. AJR 2001;177:1471–1474 Schistosomiasis Male, 26 y, headache, late-onset seizures Axial T2 Sagittal Axial T1-Gd T1-Gd Schistosomiasis Male, 35 y, headache, generalized seizures Axial T2 Sagittal Axial T1-Gd T1-Gd Schistosomiasis Male, 35 y, headache, generalized seizures Brain bx – H&E Thank you! [email protected]
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