Cerebrospinal fluid analysis in infectiousCerebrospinal fluid (CSF) analysis is a classic tool for diagnosing infectious diseases of the nervous system (NS).The main diseases that can be diagnosed among NS infectious diseases are acute meningitis, acute meningoencephalitis and chronic meningitis. Acute bacterial meningitisYou may be aware that a lumbar puncture may save the life of a patent if correctly indicated. There is no other diagnostic tool that can be used in these patients ABStrACtCerebrospinal fluid (CSF) analysis very frequently makes the difference to the diagnosis, not only in relation to infections but also in other diseases of the nervous system such as inflammatory, demyelinating, neoplastic and degenerative diseases. The authors review some practical and important features of CSF analysis in infectious diseases of the nervous system, with regard to acute bacterial meningitis, herpetic meningoencephalitis, neurotuberculosis, neurocryptococcosis, neurocysticercosis and neurosyphilis.Keywords: cerebrospinal fluid, central nervous system, bacterial meningitis, herpes simplex virus, meningoencephalitis, meningeal tuberculosis, cryptococcal meningitis, neurocysticercosis, neurosyphilis.rESUMO O exame de líquido cefalorraquidiano (LCR) é frequentemente o elemento determinante para o diagnóstico não somente de infecções mas também de outras doenças do sistema nervoso, tais como doenças inflamatórias, desmielinizantes, neoplásicas e degenerativas. Os autores reveem alguns aspectos práticos e importantes quanto ao papel do exame de LCR em meningites bacterianas agudas, meningoencefalite herpética, neurotuberculose, neurocriptococose, neurocisticercose e neurossífilis.Palavras-Chave: líquido celalorraquidiano, sistema nervoso, meningites bacterianas, encefalites por herpes vírus, tuberculose meníngea, meningite criptococócica, neurocisticercose, neurossífilis.

SUMMARY -HTLV-l antibodies were investigated in serum and in CSF of 150 patients with neurologic disorders mainly myelopathies. The patients were considered into three groups according to the possible relationship of their disease to the presence of HTLV-l antibodies: no relationship risk (control group), occasional risk group, and possible risk group. In this latter are 56 patients with crural spastic paraparesis or paraplegia of unknown etiology (SP). HTLV-l antibodies were tested by the passive particle-agglutination method for anti-ATLA antibody detection. The search was negative in all patients of the control group, and positive (serum and/or CSF) in 16.5% of the patients from the second group and in 55.4% of the SP patients group. Clinical patterns in SP cases with HTLV-l antibodies were those of tropical spastic paraparesis (TSP). CSF patterns considered (cytology, protein content and gamma-globulins rate) were different between TSP group with HTLV-l antibodies in CSF and SP group with no HTLV-l antibodies detection either in serum or in CSF. The difference was significant. Results of this investigation confirm the high incidence of TSP in Brazil, and bring additional indication for searching HTLV-l antibodies in the CSF.HTLV-l anticorpos no soro e no liquido cefalorraqueano na paraparesis espástica tropical no Brasil.RESUMO -Foi pesquisada a presença de HTLV-l anticorpos no soro e no LCR de 150 pacientes com afeccões do sistema nervoso, particularmente mielopatias. Os pacientes foram considerados segundo três grupos, de acordo com a possível relação entre a doença e a presença de HTLV-l anticorpos: sem risco de relação (grupo controle); grupo de risco ocasional; grupo de risco possível. Este último abrange 56 pacientes com paraparesia ou paraplegia crural espástica de etiologia não esclarecida (PE). Foi utilizada para a pesquisa a técnica de aglutinação passiva de partículas para anti-ATLA anticorpo, sendo obtidos os seguintes resultados: não foram detectados HTLV-l anticorpos no grupo controle e foram detectados (soro e/ou LCR) em 16,5% dos pacientes do segundo grupo e em 55,4% daqueles do terceiro grupo. O quadro clínico dos pacientes com PE e HTLV-l anticorpos era compatível a paraparesia espática tropical (PET). Foi verificada diferença significativa quanto a dados do exame de LCR (citologia, concentração proteica e teor de globulinas gama) ao se compararem os pacientes com PET com HTLV-l anticorpos no LCR àqueles com PE em que tais anticorpos não foram detectados nem no soro e nem no LCR. Os resultados deste estudo confirmam a elevada incidência da PET no Brasil o ilustram a necessidade da pesquisa desses anticorpos também no LCR.In the last five years it has been emphasized the retrovirus HTLV-l serumposivity in several groups of patients with crural spastic paraparesis or paraplegia (SP). The HTLV-l antibodies were searched once in each case in CSF (150) and in serum samples (97). Passive particle-agglutination technic for anti-ATLA antibody detection (Fujirebio, Japan) was used. As preconized, se...

In an eight years time period (July 1984-June 1992) CSF samples of 40718 patients were studied, and 610 were from patients with AIDS clinically diagnosed and immunologically confirmed through HIV antibodies detection. Among opportunistic infections detected in them 85 were CNS cryptococcosis. For the purpose of this study the CSF of these 85 patients are the AIDS group of CNS cryptococcosis. For comparison, CSF data from 50 patients with CNS cryptococcosis but without AIDS were taken (non-AIDS group); in this group, 22 patients were immunosuppressed after renal transplant. In AIDS group, the more frequent CSF findings were: yeast presence at direct exam (Fuchs-Rosenthal cell counting chamber), growing of the yeast in cultures, and gamma globulins increase. In non-AIDS group were more frequent: hypercytosis, neutrophil cells presence, and total protein increase. Differences between the two groups are discussed taking into account CNS/CSF immune changes induced by HIV infection. It is concluded that in CNS cryptococcosis of patients with AIDS the CSF evidenced more extensive signs of the fungal opportunistic infection than signs of inflammatory response to the infection. The latter were more prominent among patients of the non-AIDS group of CNS cryptococcosis.

R E S U M O -Foram estudados oito pacientes com histoplasmose do sistema nervoso central, nenhum deles com sinais clínicos ou laboratoriais de imunodepressão. O tempo de doença por ocasião do diagnóstico variava entre 6 e 108 meses (mediana 36 meses). Principais sinais e sintomas encontrados: síndrome de hipertensão intracraniana, em 6 pacientes; déficit de memória, em 4; confusão mental, em 4; convulsões, em 2; paraparesia ou paraplegia crural, em 2; incontinência urinária, em 2; impotência sexual, em 1. A forma meningoencefalítica foi encontrada em 6 pacientes e a granulomatosa, em 2. O diagnóstico foi feito: por biópsia em 1 caso; por necropsia, em 2; através de cultura do sedimento do L C R em meio de Sabounaud, em 1; através da detecção de anticorpos a, Histoplasma capsulatum no L C R , em 5. Main signs and symptoms were: intracranial hypertension in 6 patients; impairment of memory in 4; confusion in 4; seizures in 2; urinary incontinence in 2; sexual impotency in 1. Meningoencephalitic form was present in 6 patients, while the granulomatous form w a s found in 2. Diagnostic confirmation was based on: biopsy, in 1 case; necropsy, in 2 cases; cerebrospinal fluid ( C S F ) sediment culture, in 1; detection of antibodies against Histoplasma capsulatum in the CSF, in 5 ciases. There was, in all patients, an expresive difference between CSF alterations (intense, merging acute and chronic phase elements) and clinical symptomatology (patients in general oligosymptomatic). Foi observada profunda discrepância entre as alterações detectadas ao exame de L C R (intensas, com elementos de fase aguda mesclados a elementos de fase crônica) e o quadro clí-nico por ocasião do diagnóstico (pacientes em geral oligossintomáticos). P A L A V R A S -C H K E Y W O R D S : histoplasmosis, central nervous system; clinical features; diagnosis.A histoplasmose é infecção provocada pelo Histoplasma capsulatum (H. capsulatum), fungo que vive no solo e encontra ambiente propício para seu desenvolvimento no tubo digestivo de alguns animais. É clássica a sua presença em fezes de morcegos e, menos frequentemente, de pombos e outras aves, selvagens ou não. O H. capsulatum foi isolado do solo em mais de 50 países, sobretudo nas regiões temperadas. Nos vales dos rios Ohio e Mississipi, nos EUA, são registrados anualmente cerca de 500000 casos novos de infecção pulmonar por histoplasmose. Estima-se que, nessas regiões, aproximadamente 40 milhões

In a seven year time period (July 1984 to June 1991) were studied CSF samples of 36,216 new patients, 470 of them infected by HIV. Number of AIDS patients represents 1.30% of total cases examined in the laboratory during this time period. Normal CSF was observed in only 16 cases (3.4%). Associated pathologies occurred in 66% of cases. Opportunistic infections predominated among them (227 cases). Data support indication for CSF examination in HIV infected patients. This exam must be as complete as possible.