Stula D, Liverani F, Gratzl O
Schweiz Arch Neurol Psychiatr (1985). 1986;137(4):15-23.
Eight cases of today rather rare infections of the brain and spinal cord with animal and plant parasites are described. Echinococcus was identified in one patient, cysticercus cellulosis in 4 and in 3 patients various fungi (actinomycosis Meyerii, aspergillus fumigatus, nokardiose asteroides) were found. Prior to the admission to the hospital none of these patients were correctly diagnosed. Animal parasites mimicked the symptomatology of a brain tumour or of a space occupying process. If localised intraspinally they produced signs similar to prolapsed lumbar disc. Plant parasites caused formation of particular suppurative granulation tissues in the form of abscesses which were often disseminated. By contrast, animal parasites produced only mechanical damage of the brain tissue. In addition to surgical intervention aiming at complete removal of parasite cysts or abscesses, drug therapy with the broadspectrum antibiotics or Praziquantel, an isochinoline derivate, is appropriate. Although due to the better diagnostic procedures and specific drug treatment the mortality rate in the countries with widespread parasite infections (Southern Europe and South America) has dropped from 50-80% to 5-6%, the experience shows that only about half of the patients survive the operation when a longer time-span is considered.
本文描述了8例如今较为罕见的由动植物寄生虫引起的脑和脊髓感染病例。1例患者确诊为棘球蚴病,4例为囊尾蚴病,3例发现了各种真菌(迈耶放线菌、烟曲霉、星状奴卡菌)。这些患者在入院前均未得到正确诊断。动物寄生虫的症状类似脑瘤或占位性病变。如果寄生在脊柱内,它们会产生类似腰椎间盘突出的症状。植物寄生虫会导致形成特殊的化脓性肉芽组织,表现为脓肿,且常常扩散。相比之下,动物寄生虫只会对脑组织造成机械性损伤。除了通过手术完全切除寄生虫囊肿或脓肿外,使用广谱抗生素或异喹啉衍生物吡喹酮进行药物治疗也是合适的。尽管由于诊断方法的改进和特异性药物治疗,寄生虫感染广泛的国家(南欧和南美)的死亡率已从50%-80%降至5%-6%,但经验表明,从较长时间段来看,只有约一半的患者能在手术后存活。