how to print barcode in c# Diseases Caused by Trematodes in Microsoft Office

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Diseases Caused by Trematodes
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(Table 32-6 and page 1062) Schistosomiasis The ova of trematodes seldom involve the nervous system, but when they do, the infecting organism is usually Schistosoma japonicum and, less often, Schistosoma haematobium or Schistosoma mansoni It is said that Schistosoma japonicum has a tendency to localize in the cerebral hemispheres and S mansoni in the spinal cord, but there have been many exceptions The cerebral lesions form in relation to direct parasitic invasion of blood vessels and take the form of mixed necrotizing and ischemic parenchymal foci that are in ltrated by eosinophils and giant cells (Scrimgeour and Gajdusek) The lesions do not calcify Schistosomiasis is widespread in tropical regions, especially in the Nile Valley of Egypt; North American neurologists have little contact with it except in travelers who have bathed in lakes or rivers where the snail hosts of the parasite are plentiful The initial manifestation is often a local skin irritation at the site of entry of the parasite (swimmer s itch), but the patient frequently does not offer this information unless sought An estimated 3 to 5 percent of patients develop neurologic symptoms several months after exposure Headaches, convulsions (either focal or generalized), and other cerebral signs appear; with lesions of larger size, papilledema may develop, simulating a brain tumor Some types of Schistosoma infection (also called Bilharzia), mainly mansoni, tend to localize in the spinal cord, causing an acute or subacute myelitis that is concentrated in the conus medullaris The clinical picture is of a subacutely developing transverse cord lesion There is often preceding leg or radicular pain and bladder control is affected prominently This is one of the most frequent forms of myelitis in Brazil and other parts of South America We have observed a few cases in students returning from Africa; their lesions were in the conus Unless treated immediately, there may be permanent paralysis of the legs and bladder from in ammatory and microvascular destruction of the lower cord Examination of the CSF in the myelitic form discloses a pleocytosis, sometimes with an increase in eosinophils (more than half of patients), increased protein content, and sometimes increased pressure Biopsy of liver and rectal mucosa, skin tests, and complement xation tests con rm the diagnosis The role of serologic tests has not been clearly established The other major trematode, Paragonimus, has been known rarely to invade the brain, where it creates a solitary granulomatous nodule comparable to that seen in schistosomiasis Treatment This consists of praziquantel orally in a dosage of 20 mg/kg tid In one series, 8 of 9 patients with epilepsy due to cerebral schistosomiasis became seizure-free after treatment with praziquantel Surgical excision of spinal granulomatous tumors is sometimes indicated, but the results are unpredictable
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Figure 32-8 Cysticercosis on MRI Multiple small enhancing cysts and a large cerebellar cyst in a man whose presenting illness was the result of obstructive hydrocephalus The cysts are in the early stage of degeneration and have not yet calci ed
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intense in ammatory reaction leading to hydrocephalus, vasculitis, and stroke as well as cranial nerve palsies This so-called racemose form of the illness is little altered by the use of praziquantel or any other form of therapy (Estanol et al) Treatment The therapy of this disorder has been greatly improved in recent years by the use of CT and MRI and the administration of praziquantel, an antihelminthic agent that is also active against all species of schistosomes The usual dose of praziquantel is 50 mg/kg of body weight, given orally daily for 15 to 30 days, depending upon the size and activity of the lesions Albendazole (5 mg/kg tid for 15 to 30 days), an alternative treatment, is believed by some to be more effective Initially, treatment may seem to exacerbate neurologic symptoms, with an increase in cells and protein in the CSF, but then the patient improves and may become asymptomatic, with a striking decrease in the size and number of cysts on CT scanning Corticosteroids may be useful if a large single lesion is causing symptoms by its mass effect Other Cestode Infections Infection with Echinococcus occasionally affects the brain The usual sources of infection are water and vegetables contaminated by canine feces After they are ingested, the ova hatch and the freed embryos migrate, primarily to lung and liver, but sometimes to brain (approximately 2 percent of cases), where a large solitary (hydatid) cyst may be formed The typical lesion is a large uid- lled cyst with the parasite visible by imaging procedures, but a solid nodular brain lesion, a chitinoma, is also known to occur We have also observed a compressive spinal cord lesion Treatment with the drug mebendazole is recommended when surgery is not feasible Cerebral coenuriasis (Coenurus cerebralis) is an uncommon infestation by larvae of the tapeworm Taenia multiceps It occurs mainly in sheep-raising areas where there are many dogs, the latter being the de nitive hosts The larvae form grape-like cysts, most often in the posterior fossa, which obstruct the spinal uid pathways and cause signs of increased intracranial pressure Surgical removal is possible Another cestode, Spirometra mansoni, may migrate within the
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