Encefalomielite disseminada aguda e vacinação antimeningocócica A e C: relato de caso

Py, Marco O.; André, Charles

doi:10.1590/S0004-282X1997000400020

Resumos

Os autores descrevem o caso clínico de paciente do sexo feminino, de 25 anos, que desenvolveu encefalomielite aguda disseminada (EDA) iniciando-se cinco dias após vacinação para meningococcus A e C (Pasteur-Meríeux) na campanha de vacinação realizada em dezembro de 1995 na cidade do Rio de Janeiro. Houve excelente resposta clínica e neurorradiológica após tratamento com corticosteróides em altas doses (pulsoterapia). Não foram encontrados relatos sobre a associação entre a vacina antimeningocócica e a EDA. A associação entre EDA e leptospirose ou infecções por Mycoplasma sugerem porém que a síndrome pode ser precipitada não só por viroses ou vacinação antiviral como também pela exposição do organismo a proteínas e polissacarídeos de bactérias.

encefalomielite aguda disseminada; vacina bacteriana efeitos adversos; Neisseria meningitidis

A 25-year-old woman developed acute disseminated post-vaccinal encephalomyelitis (ADEM) following vaccination with A plus C meningococcal vaccine (Pasteur-Merieux). Fast disappearance of symptoms and gradual resolution of MR1 demyelinating lesions occurred after steroid treatment with high doses of intravenous methylprednisolone. To our knowledge, ADEM has not been previously described in association with meningococcal vaccine. Although most cases of ADEM occur following viral infections and vaccination, the syndrome has previously been related to leptospirosis and Mycoplasma pneumoniae infections. This suggests that it may also be related to exposure to polysaccharide-protein vaccines such as the Group A plus Group C meningococcal vaccine.

encephalomyelitis acute disseminated; bacterial vaccine adverse effects; Neisseria meningitidis

Encefalomielite disseminada aguda e vacinação antimeningocócica A e C. Relato de caso

Acute disseminated encephalomyelitis: association with meningococcal A and C vaccine. Case report

Marco O. Py^I; Charles André^II

^IMestrando do Serviço de Neurologia, HUCFF/ UFRJ

^IIProfessor Assistente de Neurologia da Faculdade de Medicina da UFRJ

RESUMO

Os autores descrevem o caso clínico de paciente do sexo feminino, de 25 anos, que desenvolveu encefalomielite aguda disseminada (EDA) iniciando-se cinco dias após vacinação para meningococcus A e C (Pasteur-Meríeux) na campanha de vacinação realizada em dezembro de 1995 na cidade do Rio de Janeiro. Houve excelente resposta clínica e neurorradiológica após tratamento com corticosteróides em altas doses (pulsoterapia). Não foram encontrados relatos sobre a associação entre a vacina antimeningocócica e a EDA. A associação entre EDA e leptospirose ou infecções por Mycoplasma sugerem porém que a síndrome pode ser precipitada não só por viroses ou vacinação antiviral como também pela exposição do organismo a proteínas e polissacarídeos de bactérias.

Palavras-chave: encefalomielite aguda disseminada; vacina bacteriana efeitos adversos; Neisseria meningitidis.

ABSTRACT

A 25-year-old woman developed acute disseminated post-vaccinal encephalomyelitis (ADEM) following vaccination with A plus C meningococcal vaccine (Pasteur-Merieux). Fast disappearance of symptoms and gradual resolution of MR1 demyelinating lesions occurred after steroid treatment with high doses of intravenous methylprednisolone. To our knowledge, ADEM has not been previously described in association with meningococcal vaccine. Although most cases of ADEM occur following viral infections and vaccination, the syndrome has previously been related to leptospirosis and Mycoplasma pneumoniae infections. This suggests that it may also be related to exposure to polysaccharide-protein vaccines such as the Group A plus Group C meningococcal vaccine.

Key-words: encephalomyelitis acute disseminated, bacterial vaccine adverse effects, Neisseria meningitidis.

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Aceite: 20-abril-1997.

Dr. Charles André - Serviço de Neurologia, Hospital Universitário Clementino Fraga Filho - Av. Brigadeiro Trompowsky s/nº, 10º andar - 21941-590 Rio de Janeiro RJ - Brasil.

1. Adams RD, Victor M. In: Principles of neurology, Ed5. New York: McGraw-Hill, 1993:776-798.
2. Anderson EL, Bowers T, Mink CM, Kennedy DJ, Belske RB, Harabek H, Pais L, Holder P, Carlone GM. Safety and immunogenicity of meningococcal A and C polysaccharide conjugate vaccine in adults. Infect Immun 1994;62:3391-3395.
3. Decarex G, Szyper M, Ectors M, Cornil A, Fronhon L. Central nervous system complications of Mycoplasma pneumoniae. J Neurol Neurosurg Psychiatry 1980;43:883-887.
4. Donovan MK, Lenn NJ. Postinfectious encephalomyelitis with localized basal ganglia involvement. Pediatr Neurol 1989;5:311-313.
5. Feery BJ. Adverse reactions after smallpox vaccination. Med J Aust 1977;2:180-183.
6. Gale JL, Thapa PB, Wassilak SG, Bobo JK, Mendelman PM, Foy HM. Risk of serious acute neurological illness after immunization with diphtheria-tetanus-pertussis vaccine. JAMA 1994;271:37-41.
7. Gurvich EB. The age-dependent risk of postvaccination complications in vaccinees with smallpox vaccine. Vaccine 1992;10:96-97.
8. Johnson RT, Griffin DE, Hirsch RL, Wobinsky JS, Noedenbeck S, Soriano IL, Vaisberg A. Measles encephalomyelitis: clinical and immunologic studies. N Engl J Med 1984;310:137-141.
9. Jubelt B, Miller JR. Viral infections. In Rowland LP (ed). Merritt's textbook of neurology, Ed9. New York: Williams & Wilkins,1995:142-179.
10. Kanzaki A, Yabuki S. Acute disseminated encephalomyelitis associated with cytomegalovirus infection: a case report. Rinsko-Shinkeigaku 1994;34:511-513.
11. Kepes JJ. Large focal tumor-like demyelinating lesions of the brain: intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? A study of 31 patients. Ann Neurol 1993;33:18-27.
12. Koplan JP, Schoenbaum SC, Weinstein MC, Fraser DW. Pertussis vaccine: an analysis of benefits, risks and costs. N Engl J Med 1979;301:906-911.
13. Menkes JH, Kinsbourne M. Workshop on neurologic complications of pertussis and pertussis vaccination. Neuropediatrics 1990;21:171-176.
14. Merlo C, Steffen R, Candis T, Tsai T, Karabatsos N. Possible association of encephalitis and 17D yellow fever vaccination in a 29-year-old traveler (letter). Vaccine 1993;11:691.
15. Ohtaki E, Matsuiski T, Hirano Y, Maekawa K. Acute disseminated encephalomyelitis after treatment with Japanese B encephalitis vaccine (Nakayama-Yoken and Beijing strains). J Neurol Neurosurg Psychiatry 1995;59:316-317.
16. Pasternak JF, DeVivo DC, Prensky AL. Steroid-responsive encephalomyelitis in childhood. Neurology 1980;30:481-486.
17. Poser CM. Neurological complications of swine influenza vaccination. Acta Neurol Scand 1982;66:413-431.
18. Rosenberg GA. Meningoencephalitis following an influenza vaccination. N Engl J Med 1970;283:1209.
19. Swaddiwudhipong W, Prayoonwiwat N, Kunasol P, Choomkasien P. A high incidence of neurological complications following Semple anti-rabies vaccine. Southeast Asian J Trap Med Public Health 1987;18:526-531.
20. Twumasi PAJr, Kumak S, Leach A, O'Dempsey TJ, Ceesay SJ, Todd J, Broome CV, Carlone GM, Pais LB, Holder PK. A trial of a group A plus group C meningococcal polysaccharide-protein conjugate vaccine in Africa infants. J Infect Dis 1995;171:632-638.

Datas de Publicação

Publicação nesta coleção
21 Out 2010
Data do Fascículo
Set 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Adams RD, Victor M. In: Principles of neurology, Ed5. New York: McGraw-Hill, 1993:776-798.

[2] 2. Anderson EL, Bowers T, Mink CM, Kennedy DJ, Belske RB, Harabek H, Pais L, Holder P, Carlone GM. Safety and immunogenicity of meningococcal A and C polysaccharide conjugate vaccine in adults. Infect Immun 1994;62:3391-3395.

[3] 3. Decarex G, Szyper M, Ectors M, Cornil A, Fronhon L. Central nervous system complications of Mycoplasma pneumoniae. J Neurol Neurosurg Psychiatry 1980;43:883-887.

[4] 4. Donovan MK, Lenn NJ. Postinfectious encephalomyelitis with localized basal ganglia involvement. Pediatr Neurol 1989;5:311-313.

[5] 5. Feery BJ. Adverse reactions after smallpox vaccination. Med J Aust 1977;2:180-183.

[6] 6. Gale JL, Thapa PB, Wassilak SG, Bobo JK, Mendelman PM, Foy HM. Risk of serious acute neurological illness after immunization with diphtheria-tetanus-pertussis vaccine. JAMA 1994;271:37-41.

[7] 7. Gurvich EB. The age-dependent risk of postvaccination complications in vaccinees with smallpox vaccine. Vaccine 1992;10:96-97.

[8] 8. Johnson RT, Griffin DE, Hirsch RL, Wobinsky JS, Noedenbeck S, Soriano IL, Vaisberg A. Measles encephalomyelitis: clinical and immunologic studies. N Engl J Med 1984;310:137-141.

[9] 9. Jubelt B, Miller JR. Viral infections. In Rowland LP (ed). Merritt's textbook of neurology, Ed9. New York: Williams & Wilkins,1995:142-179.

[10] 10. Kanzaki A, Yabuki S. Acute disseminated encephalomyelitis associated with cytomegalovirus infection: a case report. Rinsko-Shinkeigaku 1994;34:511-513.

[11] 11. Kepes JJ. Large focal tumor-like demyelinating lesions of the brain: intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? A study of 31 patients. Ann Neurol 1993;33:18-27.

[12] 12. Koplan JP, Schoenbaum SC, Weinstein MC, Fraser DW. Pertussis vaccine: an analysis of benefits, risks and costs. N Engl J Med 1979;301:906-911.

[13] 13. Menkes JH, Kinsbourne M. Workshop on neurologic complications of pertussis and pertussis vaccination. Neuropediatrics 1990;21:171-176.

[14] 14. Merlo C, Steffen R, Candis T, Tsai T, Karabatsos N. Possible association of encephalitis and 17D yellow fever vaccination in a 29-year-old traveler (letter). Vaccine 1993;11:691.

[15] 15. Ohtaki E, Matsuiski T, Hirano Y, Maekawa K. Acute disseminated encephalomyelitis after treatment with Japanese B encephalitis vaccine (Nakayama-Yoken and Beijing strains). J Neurol Neurosurg Psychiatry 1995;59:316-317.

[16] 16. Pasternak JF, DeVivo DC, Prensky AL. Steroid-responsive encephalomyelitis in childhood. Neurology 1980;30:481-486.

[17] 17. Poser CM. Neurological complications of swine influenza vaccination. Acta Neurol Scand 1982;66:413-431.

[18] 18. Rosenberg GA. Meningoencephalitis following an influenza vaccination. N Engl J Med 1970;283:1209.

[19] 19. Swaddiwudhipong W, Prayoonwiwat N, Kunasol P, Choomkasien P. A high incidence of neurological complications following Semple anti-rabies vaccine. Southeast Asian J Trap Med Public Health 1987;18:526-531.

[20] 20. Twumasi PAJr, Kumak S, Leach A, O'Dempsey TJ, Ceesay SJ, Todd J, Broome CV, Carlone GM, Pais LB, Holder PK. A trial of a group A plus group C meningococcal polysaccharide-protein conjugate vaccine in Africa infants. J Infect Dis 1995;171:632-638.

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Encefalomielite disseminada aguda e vacinação antimeningocócica A e C: relato de caso

Acute disseminated encephalomyelitis: association with meningococcal A and C vaccine: case report

Resumos

Datas de Publicação