Intrathecal synthesis of immunoglobulins in eosinophilic meningoencephalitis due to Angiostrongylus cantonensis
Intrathecal synthesis of immunoglobulins in eosinophilic meningoencephalitis due to Angiostrongylus cantonensis
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DOI：
10.1128/cdli.5.4.452-455.1998
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发表时间：
1998-07-01
期刊：
影响因子：
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通讯作者：
Reiber, H
中科院分区：
文献类型：
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作者：
Dorta-Contreras, A;Reiber, H
广州管圆线虫所致嗜酸粒细胞性脑膜脑炎在古巴为地方病，发生于儿童，由意外接触土壤中的蜗牛引起。其病程致命性不如东南亚成年患者常见。对24例儿科患者的脑脊液（CSF）和血清样本进行分析，并在CSF/血清商值图（赖贝尔图）中评估，以描述疾病过程中发生的神经免疫反应和血 - 脑脊液屏障功能障碍。在首次诊断性腰椎穿刺时，所有病例均伴有嗜酸粒细胞性细胞增多（1920 ± 400个细胞/微升）、中度血 - 脑脊液屏障功能障碍（即CSF/血清白蛋白商值升高），且无鞘内免疫球蛋白G（IgG）、IgA和IgM类反应。7天后，在临床早期恢复时，75%的患者血 - 脑脊液屏障功能障碍恢复正常，但与此同时，所有病例均出现鞘内免疫球蛋白合成，表现为两类反应（85%的患者为IgG和IgA）或三类反应（IgG、IgA和IgM；30%）。尽管总细胞数下降，但嗜酸粒细胞的比例（40%）仍然较高。结合由细菌或病毒引起的其他感染性疾病的脑脊液模式，对这种针对寄生虫及其毒素的炎症反应的神经免疫模式进行了讨论。
Eosinophilic meningoencephalitis due to the nematode Angiostrongylus cantonensis, which is endemic to Cuba, occurs in children and is due to accidental contact with soil snails. The course is less often fatal than in adult patients in southeastern Asia. Cerebrospinal fluid (CSF) and serum samples from 24 pediatric patients were analyzed and evaluated in CSF/serum quotient diagrams (Reiber graphs) to characterize the neuroimmunological response and the blood-CSF barrier dysfunction that occur in the course of the disease. At the time of the first diagnostic lumbar puncture, together with eosinophilic pleocytosis (1,920 +/- 400 cells/mu l), intermediate blood-CSF barrier dysfunction (i.e., an increased CSF/serum albumin quotient) with no intrathecal immunoglobulin G (IgG), IgA, and IgM class response was observed in all cases, Seven days later, at the time of early clinical recovery, the blood-CSF barrier dysfunction was normalized in 75% of the patients, but meanwhile, intrathecal immunoglobulin synthesis emerged in all cases, as either a two-class response (IgG and IgA in 85% of the patients) or a three-class response (IgG, IgA, and IgM; 30%). The fraction of eosinophilic cells (40%) remained large despite a decreasing total cell count. The neuroimmunological pattern of this inflammatory response to the parasite and its toxins is discussed with regard to the CSF patterns of other infectious diseases caused by bacteria or viruses.