Treatment of Schistosomal Myeloradiculopathy with Praziquantel and Corticosteroids and Evaluation by Magnetic Resonance Imaging: A Longitudinal Study

Silva, Luciana C.S.; Maciel, Pedro E.; Ribas, João Gabriel Ramos; Souza-Pereira, Silvio Roberto; Antunes, Carlos; Lambertucci, José Roberto

doi:10.1086/425611

Cited by 59 publications

(70 citation statements)

References 29 publications

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“…The other point is that treatment should be kept up for at least two months. We were able to document improvements, particularly regarding urinary symptoms and sexual dysfunction, for up to six months after starting on steroids 32 . In the case of our patient, we believe that treatment with steroids was halted too early within the course of the spinal cord involvement.…”

Section: Discussionmentioning

confidence: 88%

Simultaneous occurrence of brain tumor and myeloradiculopathy in schistosomiasis mansoni: case report

Lambertucci

Souza-Pereira

Carvalho

2009

Rev. Soc. Bras. Med. Trop.

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Simultaneous occurrence of brain tumor and myeloradiculopathy in cases of Manson's schistosomiasis have only rarely been described. We report the case of a 38-year-old man who developed seizures during a trip to Puerto Rico and in whom a brain tumor was diagnosed by magnetic resonance imaging: brain biopsy revealed the diagnosis of schistosomiasis. He was transferred to a hospital in the United States and, during hospitalization, he developed sudden paraplegia. The diagnosis of myeloradiculopathy was confirmed at that time. He was administered praziquantel and steroids. The brain tumor disappeared, but the patient was left with paraplegia and fecal and urinary dysfunction. He has now been followed up in Brazil for one year, and his clinical state, imaging examinations and laboratory tests are presented here. Key-words:Brain tumor. Neuroschistosomiasis. Myeloradiculopathy. RESUMOTem sido descrita, raramente, na esquistossomose mansônica, a ocorrência simultânea de tumor cerebral e mielorradiculopatia. Relatamos aqui o caso de um homem de 38 anos que desenvolveu convulsões, durante viagem a Porto Rico, e um tumor cerebral foi diagnosticado à ressonância magnética: a biópsia do cérebro revelou o diagnóstico de esquistossomose. Ele foi transferido para hospital na América do Norte e durante a hospitalização desenvolveu súbita paraplegia. O diagnóstico de mielorradiculopatia foi confirmado na ocasião. Ele recebeu praziquantel e esteróides. O tumor cerebral desapareceu, mas o paciente permaneceu com paraplegia, disfunção urinária e fecal. Ele tem sido acompanhado no Brasil no último ano e o seu estado clínico, os métodos de imagem e os exames de laboratório são apresentados aqui. Palavras-chaves:Tumor cerebral. Neuroesquistossomose. Mielorradiculopatia. Neurological involvement is associated with infection by the three main species of Schistosoma (Schistosoma mansoni, Schistosoma japonicum and Schistosoma haematobium) 1 2 9 11 13 21 . Although myeloradiculopathy is the most common neurological complication of Schistosoma mansoni infection, the prevalence of cerebral and spinal cord schistosomiasis is unknown. Neuroschistosomiasis is probably underdiagnosed, underestimated and underreported 8 12 14 .Severe neurological involvement has been described during the early post-infective stage in non-immune patients 10 15 . Acute encephalitis and cerebral vasculitis have been reported during primary infection with Schistosoma mansoni 9 28 . Asymptomatic neuroschistosomiasis appears to be more frequent in association with the more severe chronic forms of Schistosoma mansoni. A Brazilian autopsy case series revealed scattered ova of Schistosoma mansoni in 25% of the brains of patients (without neurological deficit) who died due to hepatosplenic schistosomiasis 24 .Schistosoma mansoni can also cause a brain tumor-like syndrome due to slowly expanding cerebral and cerebellar lesions 4 6 15 18 23 24 26 27 .Schistosomal myeloradiculopathy is the most severe and disabling ectopic form of Schistosoma mansoni infection 11 13 1...

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Section: Discussionmentioning

confidence: 88%

Simultaneous occurrence of brain tumor and myeloradiculopathy in schistosomiasis mansoni: case report

Lambertucci

Souza-Pereira

Carvalho

2009

Rev. Soc. Bras. Med. Trop.

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“…Muller and Stender reported for the first time in 1930 a case of complete thoracolumbar transverse myelitis in a young man who had travelled to Brazil [19]. The most common site of clinically significant NS is the spinal cord [20][21][22][23]. In Brazil (1948), the first review of ectopic schistosomiasis was published by Faust [24] who reported that 8 of the 82 cases that had been described at that time presented signs of spinal cord lesions, and that 3 of these patients were infected with Schistosoma mansoni.…”

Section: Epidemiologymentioning

confidence: 99%

Schistosomiasis complications in tropical neurology: A review

Boubacar¹,

Diallo²,

Cissé³

et al. 2017

Clin Case Rep Rev

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Nerve locations of schistosomiasis are exceptional. However, Schistosomiasis is a public health probem in more countries. We're doing here a literature review of epidemiology and the diagnostic difficulty of complications due to schistosomiasis in particular those of the nervous system and this in the context of sub Saharan Africa and some endemic areas. Schistosomiasis is endemic to sub-Saharan Africa, South America, Asia, the Middle East, and the Caribbean Islands. The majority of infections with Schistosoma haematobium, Schistosoma mansoni and Schistosoma intercalatum are found in sub-Saharan Africa. The typical clinical diagnosis, acute schistosomiasis (Katayama fever) typically includes fever, urticarial swellings, myalgias, eosinophilia, and bloody diarrhea. Symptoms may last for weeks but are uncommon in populations with endemic infection. However, diagnostic techniques are not developed in this area of Africa. Also the low level of life of patients does not always allow the already available techniques in Africa. It is necessary that the scientific societies of tropical countries may develop diagnostic criteria for these parasitic myelopathies to harmonize clinical research results and ensure continuous training of clinicians in the diagnosis and management of this disease entity.

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“…Spinal cord swelling in T1; hyper intensity in T2; heterogeneous captation of the contrast showing small focal areas more intensely contrasted in T1 forming a granular pattern can be observed. The so-called 'characteristic' (but not 100% specific) MRI image of SCMN comprises linear central lesion surrounded by multiple small nodules giving an arboreal appearance though less specific images may also occur [7][8][9][10] .…”

Section: Otávio Augusto Moreno De Carvalhomentioning

confidence: 99%

Mansonic neuroschistosomiasis

Carvalho

2013

Arq. Neuro-Psiquiatr.

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Mansonic neuroschistosomiasis (MN) is not only the most common but also the most serious ectopic presentation of the infection by Schistosoma mansoni 1 which is a digenetic trematode and the only natural inhabitant of the mesenteric veins of human beings. Both, brain and spinal cord can be independently affected by the infection. The involvement of the central nervous system (CNS) can occur at any time from the beginning of the egg spawn and can be symptomatic or asymptomatic. The involvement of the spinal cord is more frequent.In patients with mild forms of the infection by S. man soni, it means the intestinal and the hepatointestinal forms, the anomalous migration of worms in copula to sites next to the CNS promoting the deposition of many eggs into an restrict area of the CNS, or followed by egg spawn in situ 2 (when the worms themselves reach the CNS), or the occurrence of massive embolization of eggs from the mesenteric portal venous system to the CNS are the most important mechanisms for the establishment of symptomatic MN. In both cases the worms or the eggs reach the CNS through the retrograde venous flux in the Batson's venous plexus, which has no valves and links the portal venous system and the inferior caval vein to the veins of the spinal cord as well as of the brain. Concomitantly or right after the acute or toxemic form of schistosomiasis (Katayama Syndrome), although rarely, encephalitis 3 or encephalomyelitis can occur as part of the acute manifestation of the infection. At this phase, vasculitis of the CNS can also occur.Brain MN by itself is due to the presence of eggs and/or adult worms in situ. As aforementioned it can be symptomatic or asymptomatic. The presence of clinical symptoms depend upon the amount of eggs in an delimited region of the brain, the intensity of the inflammatory reaction surrounding the eggs and/or worms, the location of the lesion and whether there is mass effect or not. Seizures (partial or generalized), signs and symptoms of intracranial hypertension, focal signs (in the pseudotumoral form), acute headache, visual disturbances, as well as brain and meningeal hemorrhage can also occur. Headache, ataxia, nystagmus, nausea and vomiting are present in the pseudotumoral forms of the cerebellum. The asymptomatic form of brain MN is more frequently MD, Infectologist, Neurologist and CSF Specialist, Fundação José Silveira, Salvador BA, Brazil.Correspondence: Otávio Augusto Moreno-Carvalho; Rua Professor Aristides Novis 105 / 1201B; 40210-630 Salvador BA -Brasil; E-mail: nascimentocarvalho@hotmail.com ABStrACt Mansonic neuroschistosomiasis (MN) is not only the most common but also the most serious ectopic presentation of the infection by Schistosoma mansoni. Both, brain and spinal cord can be independently affected by the infection, but the later is more frequently affected. Brain MN by itself is due to the presence of eggs and/or adult worms in situ and can be symptomatic or asymptomatic. Unlike the brain MN, spinal cord mansonic neuroschistosomiasis is more frequently sympt...

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Treatment of Schistosomal Myeloradiculopathy with Praziquantel and Corticosteroids and Evaluation by Magnetic Resonance Imaging: A Longitudinal Study

Abstract: Treatment with praziquantel associated with corticosteroids was successful in all cases. MRI proved to be a good method for the diagnosis of SMR and helpful in the evaluation of response to treatment.

Cited by 59 publications

References 29 publications

Simultaneous occurrence of brain tumor and myeloradiculopathy in schistosomiasis mansoni: case report

Simultaneous occurrence of brain tumor and myeloradiculopathy in schistosomiasis mansoni: case report

Schistosomiasis complications in tropical neurology: A review

Mansonic neuroschistosomiasis

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