Nadir görülen bir beyin apsesi etkeni: Nörotoksokariazis
Küçük Resim Yok
Tarih
2014
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
İnsanlarda toksokariazise bağlı; viseral larva migrans, oküler larva migrans ve gizli toksokariazis olmak üzere üç sendrom tanımlanmıştır. Nörotoksokariazis dördüncü bir sendrom olarak tanımlanabilirse de, çoğunlukla viseral larva migrans tablosunun içinde nörolojik hastalık olarak kabul edilmektedir. Bu raporda toksokariazise bağlı bir beyin apsesi olgusu sunulmaktadır. Elli altı yaşında kadın hasta baş ağrısı, sağ yüze ve dişlere vuran ağrı, sağ el dördüncü ve beşinci parmaklarda uyuşma şikayetleriyle hastanemize başvurmuştur. Çekilen kraniyal, difüzyon, dinamik manyetik rezonans görüntüleme (MRG)’de; supratentorial kesitlerde derin beyaz cevherde özgül olmayan natürde birkaç adet hiper intensite, solda frontal korteks derin beyaz cevherde, çevresinde belirgin ödem bulguları bulunan dinamik kontrastlı görüntülerde kontrast tutulumu göstermeyen yaklaşık 13 x 12 mm boyutunda bir lezyon görülmüştür. Stereotaktik biyopsinin histolojik incelemesinde beyin dokusunda yaygın histiosit infiltrasyonu saptanmıştır. Histokimyasal incelemede özgül bir etken bulunamamıştır. Serum ve beyin omurilik sıvısı örneklerine toksokariazis için uygulanan serolojik testlerde, western blot yöntemiyle pozitif sonuç alınmıştır. Enfeksiyon hastalıkları kliniğine yatırılan hastaya nörotoksokariazis tanısıyla albendazol (200 mg tablet 2 x 2) tedavisi başlanmıştır. Tedavinin 14. gününde çekilen kontrol kraniyal MRG’de lezyonda regresyon saptanan hastanın, albendazol tedavisinin bir aya tamamlanması planlanmıştır. Üç ay sonra kraniyal MRG için kontrole geldiğinde, hastanın 3 ay boyunca albendazol tedavisine devam ettiği öğrenilmiştir. Kontrol kraniyal MRG’de bir önceki tetkikle karşılaştırmalı muayenede sol frontal centrum semiovale düzeyinde takipte minimal regresyon gösteren ve sol serebral hemisferde 2 adet takipte stabil özelliklerde beyaz maddede T2A hiperintens lezyonlar izlenmiştir. Hasta albendazol ile başarılı bir şekilde tedavi edilmiş olup, progresyon açısından kontrollere çağırılarak halen takip edilmektedir. Sunulan bu olgu, ülkemizde ensefalit/beyin apsesi etiyolojisinde nadir de olsa nörotoksokariazisin de yer alabileceğini düşündürmektedir.
Toxocariasis in man is associated with three syndromes which are visceral larva migrans, ocular larva migrans and covert toxocariasis. Although neurotoxocariasis is defined as the fourth syndrome of toxocariasis, it is usually considered as a neurological disease which is usually concomitant with visceral larva migrans. In this report, a case of brain abscess caused by toxocariasis was presented. A 56 years- old female patient was admitted to our hospital with headache, pain referring to right side of her face and teeth, numbness of forth and fifth finger of her right hand. Cranial diffusion weighted, dynamic magnetic resonance imaging (MRI) revealed a few non-specific intensities at supratentorial white mat- ter, an approximately 13 x 12 mm lesion without contrast enhancement and a significant edema around the white matter in the left frontal cortex. Histologic examination after stereotactic biopsy of the lesion revealed diffuse histiocyte infiltration. A specific agent could not be detected in the histochemical examination. Western-blot test for toxocariasis in serum and cerebrospinal fluid samples were found positive. She was transferred to the infectious diseases clinic, and albendazole therapy (400 mg, q12h) was started. Albendazole treatment was completed for a total of one month following the regression of the cranial MRI findings on the 14th day of therapy. The patient is recalled for cranial MRI control three months later. However, it was noted that she continued albendazole for three months. Compared to the previous MRI, there were two stabilized T2A hyperintense lesions in left cranial hemisphere and minimally regressed lesions at the level of left frontal centrum semiovale. The patient was successfully treated with albendazole. There was no relapse after six month follow-up. This case was presented to withdraw attention to neurotoxocariasis which may be encountered although rarely in the etiology of encephalitis/ brain abscess.
Toxocariasis in man is associated with three syndromes which are visceral larva migrans, ocular larva migrans and covert toxocariasis. Although neurotoxocariasis is defined as the fourth syndrome of toxocariasis, it is usually considered as a neurological disease which is usually concomitant with visceral larva migrans. In this report, a case of brain abscess caused by toxocariasis was presented. A 56 years- old female patient was admitted to our hospital with headache, pain referring to right side of her face and teeth, numbness of forth and fifth finger of her right hand. Cranial diffusion weighted, dynamic magnetic resonance imaging (MRI) revealed a few non-specific intensities at supratentorial white mat- ter, an approximately 13 x 12 mm lesion without contrast enhancement and a significant edema around the white matter in the left frontal cortex. Histologic examination after stereotactic biopsy of the lesion revealed diffuse histiocyte infiltration. A specific agent could not be detected in the histochemical examination. Western-blot test for toxocariasis in serum and cerebrospinal fluid samples were found positive. She was transferred to the infectious diseases clinic, and albendazole therapy (400 mg, q12h) was started. Albendazole treatment was completed for a total of one month following the regression of the cranial MRI findings on the 14th day of therapy. The patient is recalled for cranial MRI control three months later. However, it was noted that she continued albendazole for three months. Compared to the previous MRI, there were two stabilized T2A hyperintense lesions in left cranial hemisphere and minimally regressed lesions at the level of left frontal centrum semiovale. The patient was successfully treated with albendazole. There was no relapse after six month follow-up. This case was presented to withdraw attention to neurotoxocariasis which may be encountered although rarely in the etiology of encephalitis/ brain abscess.
Açıklama
Anahtar Kelimeler
Mikrobiyoloji
Kaynak
Mikrobiyoloji Bülteni
WoS Q Değeri
Scopus Q Değeri
Cilt
48
Sayı
3
