Schistosomal myeloradiculopathy due to Schistosoma mansoni: Report on 17 cases from an endemic area

Abstract

Background:After malaria, schistosomiasis is the second most prevalent tropical disease. The prevalence of oviposition in CNS of infected persons varies from 0.3 to 30%. The conus medullaris is a primary site of schistosomiasis, either granulomatous or acute necrotizing myelitis.Objective:To report the clinical, radiological, and laboratory results of spinal cord schistosomiasis (SCS) and to design proper therapeutic regimens.Materials and Methods:Seventeen patients (13 males and four females) with SCS were enrolled between 1994 and 2009 at Mansoura University Hospitals. Their median age at diagnosis was 19 years (13-30 years). Independent neurological, radiological, and laboratory assessments were performed for both groups, excluding pathological confirmation that was done earlier in eight patients (Group 1). In the group 2 (nine patients), indirect hemagglutination (IHA) test for bilharziasis in blood and cerebrospinal fluid (CSF) was performed. Higher positive titer in CSF than serum indicated SCS plus induction of antibilharzial and corticosteroid protocols for 12 months with a three-year follow-up.Results:Rate of neurological symptoms of granulomatous intramedullary cord lesion was assessed independently in 16 cases and acute paraparesis in one case. All patients in group 2 had positive IHA against Schistosoma mansoni with median CSF and serum ranges 1/640 and 1/320, respectively. Seven patients (41.18%) had complete recovery, eight patients (47.06%) showed partial recovery, and no response was reported in two patients (11.76%) (P = 0.005). There was no recorded mortality in the current registry.Conclusions:Rapid diagnosis of SCS with early medical therapies for 12 months is a crucial tool to complete recovery.

Parasites in central nervous system

“…Epilepsy can be caused by schistosomiasis [58]. In Egypt, schistosomiasis due to Schistosoma mansoni of the spinal cord is considered the primary cause of the parasitic invasion of the spinal cord [59]. Neurological involvement usually occurs within weeks or months after infection when eggs migrate via the vascular system to the spinal cord or the brain.…”

Prevention and control of schistosomiasis: a current perspective

“…45 Corticosteroids reduce the immune response, hence prevent excessive granulomatous inflammation and tissue damage. 44,46,47 Clinical trials are required to test the effect of corticosteroids in the treatment of schistosomiasis. However, case reports indicate a beneficial effect of their use in combination with praziquantel and other antischistosomal drugs.…”

Schistosomal Myeloradiculopathy in a Non-Endemic Area

“…3 There is no consensus regarding the length of steroid treatment in the literature, however there is evidence that it should be done for more than two months and, if discontinued before six months increases the risk of symptom relapse. 3, 10 Badr, in a report of 17 patients with SMR in Egypt, reported that among patients who discontinued the corticosteroids early on (less than 60 days of use), 75% had recurrent symptoms of myelopathy. 10 Andrade, analyzing 16 SMR patients treated with praziquantel 60 mg/kg/day for three days in combination with prednisone 100 mg/day, showed that improvement in the symptoms was observed starting from the first two weeks of treatment.…”

“…3, 10 Badr, in a report of 17 patients with SMR in Egypt, reported that among patients who discontinued the corticosteroids early on (less than 60 days of use), 75% had recurrent symptoms of myelopathy. 10 Andrade, analyzing 16 SMR patients treated with praziquantel 60 mg/kg/day for three days in combination with prednisone 100 mg/day, showed that improvement in the symptoms was observed starting from the first two weeks of treatment. The regression speed varied according to each patient.…”

“…Early treatment of parasitic infections involving the CNS improves the prognosis and decreases morbidity and mortality. 10 Importantly, the occurrence of SMR, unlike other severe forms of schistosomiasis, does not depend on high parasitic loads. Generally, patients with SMR have few eggs per gram of feces and often come from low prevalence areas.…”