dc.contributor.advisor |
Sa, Carlos Alberto Morais de |
|
dc.contributor.author |
Pereira, Ivete Auto Espindola |
|
dc.date.accessioned |
2018-09-06T15:56:18Z |
|
dc.date.available |
2018-09-06T15:56:18Z |
|
dc.date.issued |
2006-10-20 |
|
dc.identifier.citation |
PEREIRA, Ivete Auto Espindola. Análise das apresentações clínicas da neurotoxoplasmose na era pós-HAART, correlacionadas com o grau de imunossupressão e ao uso ou não de profilaxia primária em pacientes HIV/AIDS ambulatoriais. 2006. 80 f. Dissertação (Mestrado em Neurologia) - Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, 2006. |
pt_BR |
dc.identifier.uri |
http://hdl.handle.net/unirio/12435 |
|
dc.description.sponsorship |
n/a |
pt_BR |
dc.language.iso |
Portuguese |
pt_BR |
dc.rights |
openAccess |
pt_BR |
dc.title |
Análise das apresentações clínicas da neurotoxoplasmose na era pós-HAART, correlacionadas com o grau de imunossupressão e ao uso ou não de profilaxia primária em pacientes HIV/AIDS ambulatoriais. |
pt_BR |
dc.title.alternative |
Analysis of the clinical presentations of neurotoxoplasmosis in the post-antiretroviral therapy era, correlated with the degree of immunosuppression and the use or not of prophylaxis in HIV/AIDS outpatients. |
pt_BR |
dc.type |
masterThesis |
pt_BR |
dc.contributor.referee |
Sa, Carlos Alberto Morais de |
|
dc.contributor.referee |
Lopes, Carlos Wilson Gomes |
|
dc.contributor.referee |
Alvarenga, Regina Maria Papais |
|
dc.degree.department |
CCBS |
pt_BR |
dc.degree.grantor |
Universidade Federal do Estado do Rio de Janeiro - UNIRIO |
pt_BR |
dc.degree.level |
Mestrado Acadêmico |
pt_BR |
dc.degree.local |
Rio de Janeiro, RJ |
pt_BR |
dc.degree.program |
Programa de Pós-Graduação em Neurologia |
pt_BR |
dc.subject.cnpq |
CIÊNCIAS DA SAÚDE |
pt_BR |
dc.subject.cnpq |
MEDICINA |
pt_BR |
dc.subject.cnpq |
NEUROLOGIA |
pt_BR |
dc.subject.en |
AIDS (Disease) |
pt_BR |
dc.subject.en |
Neurotoxoplasmosis |
pt_BR |
dc.subject.en |
Literature review |
pt_BR |
dc.description.abstracten |
Toxoplasmic encephalitis (TE) is the most frequent complication and principal cause
of cerebral mass lesions observed in later stages of HIV infection. It is caused by
Toxoplasma gondii, an obligate intracellular protozoan and TE is due to a reactivation
of a chronic infection. Since the beginning the AIDS era TE rised exclusively in HIVinfected
patients with CD4+ T-cell count < 100cells/mm3 and other opportunistic
diseases. Zidovudine (AZT) the first drug approved in 1987 for the treatment of HIV-1
infection did not promote enough immunological recovery in order to avoid
opportunistics infections. Since then new antiretroviral drugs has been approved such
didanosine (ddI), zalcitabine (ddC) and stavudine (d4T). They belong to the class of
nucleoside reverse transcriptase inhibitor like AZT, but the agreement concerning the
treatment was still the monotherapy, wich did not changed the situation. The clinical
benefits provided by monotherapy was modest and did not change the clinical
presentation of TE and did not reduced the opportunistics infections significantly. In
1996 the new treatment concept of AIDS with combination antiretroviral drugs and the
introduction of the HIV-1 protease inhibitors started the Highly Active Antiretroviral
Therapy era (HAART). The primary prophilaxis used associated with HAART was
stablished effective to prevent TE and those measures seemed at the time to be the
solution to modify the clinical picture. In fact, a significative decline of the number of
the cases occurred, but the TE was still the most prevalent central nervous system
disorder in advanced AIDS patients as observed in recents papers. Toxoplasma gondii
strains trials has been performed to attempt understain the relationship between the
cronic infection and the reactivation in AIDS pacients, because not all infected by the
parasite develop TE during the AIDS advanced stages and there are cases of TE with
atypical and severe course. Toxoplasma gondii seroprevalence rates vary with the age
and geographic region but it is high in the most of then and it keeps this infection as a
permanent clinical problem. Thus, it is very important to know the serological patient
status for T. gondii infection as soon as the HIV-1 Infection is confirmed. Behavioral
recommendations to prevent T. gondii contamination must be adopted for Toxoplasmaseronegative
patients can contribute to decline of the TE cases. In the pos-HAART era,
the usually TE clinical presentation are still being observed, specially in advanced
stages of the HIV-1 infection. However, TE have been observed as a immune
reconstitution syndrome (IRIS). This is related to improvements in the patients immune
systems with low CD4+ T-cell count associated with strong immune recovery obtained
with HAART.Toxoplasmic encephalitis (TE) is the most frequent complication and principal cause
of cerebral mass lesions observed in later stages of HIV infection. It is caused by
Toxoplasma gondii, an obligate intracellular protozoan and TE is due to a reactivation
of a chronic infection. Since the beginning the AIDS era TE rised exclusively in HIVinfected
patients with CD4+ T-cell count < 100cells/mm3 and other opportunistic
diseases. Zidovudine (AZT) the first drug approved in 1987 for the treatment of HIV-1
infection did not promote enough immunological recovery in order to avoid
opportunistics infections. Since then new antiretroviral drugs has been approved such
didanosine (ddI), zalcitabine (ddC) and stavudine (d4T). They belong to the class of
nucleoside reverse transcriptase inhibitor like AZT, but the agreement concerning the
treatment was still the monotherapy, wich did not changed the situation. The clinical
benefits provided by monotherapy was modest and did not change the clinical
presentation of TE and did not reduced the opportunistics infections significantly. In
1996 the new treatment concept of AIDS with combination antiretroviral drugs and the
introduction of the HIV-1 protease inhibitors started the Highly Active Antiretroviral
Therapy era (HAART). The primary prophilaxis used associated with HAART was
stablished effective to prevent TE and those measures seemed at the time to be the
solution to modify the clinical picture. In fact, a significative decline of the number of
the cases occurred, but the TE was still the most prevalent central nervous system
disorder in advanced AIDS patients as observed in recents papers. Toxoplasma gondii
strains trials has been performed to attempt understain the relationship between the
cronic infection and the reactivation in AIDS pacients, because not all infected by the
parasite develop TE during the AIDS advanced stages and there are cases of TE with
atypical and severe course. Toxoplasma gondii seroprevalence rates vary with the age
and geographic region but it is high in the most of then and it keeps this infection as a
permanent clinical problem. Thus, it is very important to know the serological patient
status for T. gondii infection as soon as the HIV-1 Infection is confirmed. Behavioral
recommendations to prevent T. gondii contamination must be adopted for Toxoplasmaseronegative
patients can contribute to decline of the TE cases. In the pos-HAART era,
the usually TE clinical presentation are still being observed, specially in advanced
stages of the HIV-1 infection. However, TE have been observed as a immune
reconstitution syndrome (IRIS). This is related to improvements in the patients immune
systems with low CD4+ T-cell count associated with strong immune recovery obtained
with HAART. |
pt_BR |
dc.degree.country |
Brasil |
pt_BR |
dc.description.sponsordocumentnumber |
n/a |
pt_BR |
dc.description.abstractpt |
Neurotoxoplasmose (NT) é a afecção neurológica mais freqüente e a principal causa de
lesões com efeito de massa em pacientes com AIDS e contagem de células T CD4+ < 100
mm3. Desenvolve-se caracteristicamente como reativação de infecção prévia e seu agente
etiológico é o protozoário intracelular obrigatório Toxoplasma gondii (T. gondii). No
início da epidemia de AIDS, em 1983, a NT surgia exclusivamente no contexto da
imunodepressão grave, em pacientes com outros sinais de imunodeficiência. O AZT, a
primeira droga empregada para combate ao vírus, em 1987, não promovia recuperação
imunológica suficiente para evitar a instalação de doenças oportunistas. A partir de então
novas drogas anti-retrovirais foram sendo aprovadas, mas o consenso de tratamento era o
da monoterapia, situação que em nada modificou as apresentações clínicas da NT e nem
reduziu o número de casos. Em 1996, o conceito de tratamento da AIDS com antiretrovirais
combinados e o surgimento de uma nova classe de medicamentos, os
inibidores da protease, deu início à era do tratamento anti-retroviral de alta atividade
(HAART). O uso de profilaxia primária associado à HAART foi sedimentado e essas
medidas pareceram, à época, ter sido a solução para modificar esse quadro. De fato,
ocorreu significativa redução no número de casos, mas a NT permanece como a mais
prevalente desordem do SNC em pacientes com AIDS avançada, como recentes
publicações. Estudo de cepas de T. gondii vem sendo desenvolvidos na tentativa de
compreender a relação entre infecção crônica e reativação de cistos, em indivíduos com
AIDS, pois nem todos cronicamente infectados pelo parasita desenvolvem NT durante o
período de doença avançada e há casos de evolução excepcionalmente grave. A taxa de
soropositividade ao parasita, diferente nas diversas partes do mundo, mas
significativamente alta na maioria deles, mantém essa infecção como uma preocupação
permanente. Portanto, é de fundamentamental importância estabelecer se o paciente é
IgG+ para T. gondii tão logo o diagnóstico de infecção pelo HIV-1 seja confirmado.
Adoção de medidas preventivas relacionadas à infecção pelo parasita pode contribuir
para redução do número de casos de NT. Na era pós-HAART, as apresentações clínicas
da neurotoxoplasmose continuam sendo observadas em sua grande maioria em ambiente
de grave prejuízo às defesas imunológicas. No entanto, tem sido registrada como
síndrome de reconstituição imune (SRI) e seu desenvolvimento está relacionado a baixas
contagens de células T CD4+ associado à rapida recuperação da resposta imunológica
obtida com os diversos esquemas HAART. |
pt_BR |
dc.subject.pt |
AIDS (Doença) |
pt_BR |
dc.subject.pt |
Neurotoxoplasmose |
pt_BR |
dc.subject.pt |
Revisão de literatura |
pt_BR |