Journal of tropical pediatrics · 2011
Correlation between the clinico radiological heterogeneity and the immune-inflammatory profiles in pediatric patients with neurocysticercosis from a tertiary referral centre.
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Kashyap Bineeta, Das Shukla, Jain Sarika, Agarwal Anju, Kaushik Jaya Shankar, Kaur Iqbal R
Аннотация
INTRODUCTION: Neurocysticercosis (NCC) is the leading cause of epilepsy in developing world. Cysticercal lesions develop in brain depending upon a combination of host immune-inflammatory response, mainly mediated by cytokines produced by cysticercal antigens.
AIM AND OBJECTIVES: To correlate between MRI findings and levels of Th1/Th2 cytokines present in sera of children clinically suspected of NCC with generalized or partial seizure.
MATERIAL AND METHODS: Fifty children presenting with history of seizures and/or mass effects and/or hydrocephalous, with a diagnosis of NCC based on the clinical and radiological profile were included. Antibody (IgM) for NCC and Th1/Th2 cytokine response (TNF-α, IL-2/and IL-6) detection was done on sera from all the patients following manufacturer's instructions.
RESULTS: Out of 50 cases, 10 presented with acute symptoms of NCC with an immunological response of a predominance of pro-inflammatory cytokines (IL-2: 8, TNF-α: 2). High IL-6 was found in 40 children indicating an active lesion with chronic granulomas suggestive of parasitic destruction and persisting presentation with seizures. However, the levels of IL-6 differed with values lower in patients with inactive (calcified lesions) forms of NCC. A significant proportion (43 of 50 cases) had negative serology, probably because of the waning of antibody response months or years after the parasites die.
CONCLUSION: Parasite maintains equilibrium with host immune response in early infection, a mild Th1 response is provoked; but later this equilibrium is disturbed toward Th2 response that leads to parasite destruction. Number or stage of the parasites along with immunegenetic aspects may explain the pleomorphic and unpredictable course of NCC.
AIM AND OBJECTIVES: To correlate between MRI findings and levels of Th1/Th2 cytokines present in sera of children clinically suspected of NCC with generalized or partial seizure.
MATERIAL AND METHODS: Fifty children presenting with history of seizures and/or mass effects and/or hydrocephalous, with a diagnosis of NCC based on the clinical and radiological profile were included. Antibody (IgM) for NCC and Th1/Th2 cytokine response (TNF-α, IL-2/and IL-6) detection was done on sera from all the patients following manufacturer's instructions.
RESULTS: Out of 50 cases, 10 presented with acute symptoms of NCC with an immunological response of a predominance of pro-inflammatory cytokines (IL-2: 8, TNF-α: 2). High IL-6 was found in 40 children indicating an active lesion with chronic granulomas suggestive of parasitic destruction and persisting presentation with seizures. However, the levels of IL-6 differed with values lower in patients with inactive (calcified lesions) forms of NCC. A significant proportion (43 of 50 cases) had negative serology, probably because of the waning of antibody response months or years after the parasites die.
CONCLUSION: Parasite maintains equilibrium with host immune response in early infection, a mild Th1 response is provoked; but later this equilibrium is disturbed toward Th2 response that leads to parasite destruction. Number or stage of the parasites along with immunegenetic aspects may explain the pleomorphic and unpredictable course of NCC.