1
|
Ibrahim M, Gad K, Khan T, Yousef W, Shabbir Z, Najibullah M, Abodief WT, Jarkhi HH, Azab WA. Pseudotumoral Encephalic Schistosomiasis: A Literature Review. World Neurosurg 2024; 184:5-13. [PMID: 38159601 DOI: 10.1016/j.wneu.2023.12.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/24/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
Pseudotumoral encephalic schistosomiasis (PES) is the chronic form of cerebral neuroschistosomiasis, and is rarely encountered in clinical practice. Clinically, PES closely resembles other intracranial space-occupying lesions including brain tumors. Laboratory investigations are usually inconclusive, and neuroradiologic findings are frequently reported as non-specific. Such diagnostic difficulties may result in delayed diagnosis and treatment. Across the literature, there is a paucity of information about and controversy over many aspects of the disease. Particularly, inconsistent magnetic resonance imaging (MRI) findings, a wide variation of medical treatment protocols, lacking consensus regarding the indications of surgery, and undetermined information regarding the impact of the extent of resection on prognosis. We herein review the pertinent literature with the aim of providing focused information regarding the pathogenesis of PES, its currently identified more distinctive neuroimaging features, and the indications and extent of surgery in light of the state-of-the-art operative neurosurgical practice. A distinctive multinodular arborizing pattern of PES lesions can often be observed on MRI in patients with PES. Praziquantel is considered by many authors to be the drug of choice in all cases, and seems to be effective at variable dose regimens. Although lesion excision utilizing current technology is generally safe, the indications and extent of surgery are still undetermined and should be decided on a case-by-case basis. Multicenter collaborative research is further needed to fill the existing gaps in the current knowledge on PES.
Collapse
Affiliation(s)
- Marwa Ibrahim
- Tropical Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt; Infection Control Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Khaled Gad
- Medical Imaging Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Tufail Khan
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Waleed Yousef
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Zafdam Shabbir
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Mustafa Najibullah
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Wael T Abodief
- Histopathology Department, Al-Sabah Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Hussain H Jarkhi
- Histopathology Department, Al-Sabah Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Waleed A Azab
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait.
| |
Collapse
|
2
|
Wu K, Zhao HY, Shu K, Lei T, Zeng L. Encephalic Schistosoma japonicum resembles brainstem neoplasm: Case report and literature review. Front Neurol 2022; 13:990998. [PMID: 36188392 PMCID: PMC9519849 DOI: 10.3389/fneur.2022.990998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Encephalic schistosomiasis is a rare and severe parasitic disease which manifests as granuloma formation around ectopic eggs that migrate to the brain. We present a rare case of a pseudotumoral form of Schistosoma japonicum in the brainstem that was initially misidentified as a malignant tumor. The patient presented with intermittent headaches, diplopia, and left limb weakness. Neurological examination revealed hypoesthesia of the left lower limb, limitation of right eye abduction, and decreased muscle strength of the left upper limb. The cerebrospinal fluid tested positive for antibodies against S. japonicum. After standard treatment for schistosomiasis, the patient achieved complete remission. This case highlights that encephalic schistosomiasis can occur in the brainstem and resemble a neoplasm on magnetic resonance imaging. Once diagnosed, however, complete remission is achievable by non-invasive medical treatment.
Collapse
|
3
|
Abstract
BACKGROUND Neuroschistosomiasis is not commonly encountered and is probably underrecognized. We hope these findings can help clinicians and radiologists to raise awareness of this disabling disorder. PURPOSE To demonstrate the magnetic resonance imaging (MRI) findings of cerebral schistosomiasis and correlate it with pathological findings. MATERIAL AND METHODS We identified seven patients with cerebral schistosomiasis from radiology and pathology archives of our hospital. Of the seven patients, six were pathologically confirmed. The remaining patient had pathologically confirmed spinal schistosomiasis with MRI findings of cerebral involvement. MRI and pathological findings of these patients were analyzed and correlated. RESULTS Multiple enhancing nodules at varying size were found in all patients. Prominent leptomeningeal or choroidal veins were found in six patients, four at the center of the foci and two at the periphery. Hemorrhage was identified in two patients. Histology revealed granulomas around ova in six patients. A prominent vein with ova in the lumen and wall of a vein was found in one patient and perivascular ova deposition was found in one patient. CONCLUSION Multiple enhancing nodules with central or peripheral veins in a circumscribed brain area are important signs to the diagnosis of cerebral schistosomiasis. The inflamed veins involved may be the route taken by the ova to spread to the brain tissue.
Collapse
Affiliation(s)
- Chun-yan Lu
- Department of Radiology, Sichuan University West China Hospital, Chengdu, Sichuan, PR China
| | - Sha Zhao
- Department of Pathology, Sichuan University West China Hospital, Chengdu, Sichuan, PR China
| | - Yi Wei
- Department of Radiology, Sichuan University West China Hospital, Chengdu, Sichuan, PR China
| |
Collapse
|
4
|
Xia T, Giri BR, Liu J, Du P, Li X, Li X, Li S, Cheng G. RNA sequencing analysis of altered expression of long noncoding RNAs associated with Schistosoma japonicum infection in the murine liver and spleen. Parasit Vectors 2020; 13:601. [PMID: 33261628 PMCID: PMC7705434 DOI: 10.1186/s13071-020-04457-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Schistosomiasis is a chronic, debilitating infectious disease caused by members of the genus Schistosoma. Previous findings have suggested a relationship between infection with Schistosoma spp. and alterations in the liver and spleen of infected animals. Recent reports have shown the regulatory role of noncoding RNAs, such as long noncoding RNAs (lncRNAs), in different biological processes. However, little is known about the role of lncRNAs in the mouse liver and spleen during Schistosoma japonicum infection. METHODS In this study, we identified and investigated lncRNAs using standard RNA sequencing (RNA-Seq). The biological functions of the altered expression of lncRNAs and their target genes were predicted using bioinformatics. Ten dysregulated lncRNAs were selected randomly and validated in reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR) experiments. RESULTS Our study identified 29,845 and 33,788 lncRNAs from the liver and spleen, respectively, of which 212 were novel lncRNAs. We observed that 759 and 789 of the lncRNAs were differentially expressed in the respective organs. The RT-qPCR results correlated well with the sequencing data. In the liver, 657 differentially expressed lncRNAs were predicted to target 2548 protein-coding genes, whereas in the spleen 660 differentially expressed lncRNAs were predicted to target 2673 protein-coding genes. Moreover, functional annotation showed that the target genes of the differentially expressed lncRNAs were associated with cellular processes, metabolic processes, and binding, and were significantly enriched in metabolic pathways, the cell cycle, ubiquitin-mediated proteolysis, and pathways in cancer. CONCLUSIONS Our study showed that numerous lncRNAs were differentially expressed in S. japonicum-infected liver and spleen compared to control liver and spleen; this suggested that lncRNAs may be involved in pathogenesis in the liver and spleen during S. japonicum infection.
Collapse
Affiliation(s)
- Tianqi Xia
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Key Laboratory of Animal Parasitology, Ministry of Agriculture and Rural Affairs, Shanghai, 200241, People's Republic of China
| | - Bikash Ranjan Giri
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Key Laboratory of Animal Parasitology, Ministry of Agriculture and Rural Affairs, Shanghai, 200241, People's Republic of China
| | - Jingyi Liu
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Key Laboratory of Animal Parasitology, Ministry of Agriculture and Rural Affairs, Shanghai, 200241, People's Republic of China
| | - Pengfei Du
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Key Laboratory of Animal Parasitology, Ministry of Agriculture and Rural Affairs, Shanghai, 200241, People's Republic of China
| | - Xue Li
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Key Laboratory of Animal Parasitology, Ministry of Agriculture and Rural Affairs, Shanghai, 200241, People's Republic of China
| | - Xuxin Li
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Key Laboratory of Animal Parasitology, Ministry of Agriculture and Rural Affairs, Shanghai, 200241, People's Republic of China
| | - Shun Li
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Key Laboratory of Animal Parasitology, Ministry of Agriculture and Rural Affairs, Shanghai, 200241, People's Republic of China
| | - Guofeng Cheng
- Shanghai Tenth People's Hospital, Institute for Infectious Diseases and Vaccine Development, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China. .,Tongji University School of Medicine, 1239 Si-ping Road, Shanghai, 200092, People's Republic of China.
| |
Collapse
|
5
|
Shen J, Yuan L, Sun Y, Jiang X, Shao X. Case Report: Multiple Schistosomiasis Japonica Cerebral Granulomas without Gastrointestinal System Involvement: Report of Two Cases and Review of Literature. Am J Trop Med Hyg 2020; 102:1376-1381. [PMID: 32274982 DOI: 10.4269/ajtmh.19-0797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Most schistosomiasis japonica cerebral granulomas reported in the literature have been single and located in the cerebellum, and multiple lesions located in the cerebral hemisphere are uncommon and often misdiagnosed as metastases or gliomas. We describe two rare cases of multiple schistosomiasis japonica cerebral granulomas. Laboratory examinations and cerebrospinal fluid were normal. Parasite eggs were not detected in the stool. No positive findings were detected in the abdominal ultrasonography or chest radiography. Magnetic resonance revealed two intensive patchy lesions in the cerebral hemisphere and surrounded by a large area of edema in both of our patients. Both were misdiagnosed as glioma or metastatic carcinoma before operation. Pathological examination confirmed that the diagnosis was schistosomiasis japonica cerebral granuloma. Praziquantel and dexamethasone were administered. Both patients are alive, symptom-free, and without evidence of recurrence. Combining our date with other literature reports, we summarize the possible mechanism, reasons for misdiagnosis, radiological characteristics, surgical treatment, and postoperative management of schistosomiasis japonica cerebral granuloma, which can be used for clinical reference and to improve our knowledge of schistosomiasis japonica cerebral granuloma.
Collapse
Affiliation(s)
- Jun Shen
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Lili Yuan
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Yongkang Sun
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Xiaochun Jiang
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Xuefei Shao
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| |
Collapse
|
6
|
Wang X, Fu Q, Song R, Duan B, Bergquist R, Xu J, Li S, Zhou D, Qin Z. Antinuclear antibodies and interleukin responses in patients with Schistosoma japonicum infection. Parasite Immunol 2018; 40:e12577. [PMID: 30074250 DOI: 10.1111/pim.12577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 07/10/2018] [Accepted: 07/30/2018] [Indexed: 01/12/2023]
Abstract
Schistosomiasis poses a serious threat to public health, and the infection will develop into chronic and advanced late-stage disease if not treated. Apart from the clinical signs due to immune reactions to schistosome eggs trapped in host tissues, it also increases the risk for the development of autoimmunity reflected by dysfunctional, auto-reactive antibodies. Antinuclear antibodies (ANA) have been reported in schistosomiasis due to S. mansoni and S. haematobium. We demonstrate ANA in schistosomiasis japonica and explore the relationship between this infection and autoimmune disease by measuring ANA and interleukin (IL)-10, IL-12 and IL-17 responses in the sera of 125 Chinese patients with different stages of schistosomiasis japonica. The incidence rates of ANA in the patients with acute, chronic and late stages of schistosomiasis infection were 6.7%, 23.3% and 70.0%, respectively, with statistically significant differences between each stage (P = 0.000). IL-17 concentrations were high at the acute stage of schistosomiasis compared to the other stages of the disease (P = 0.000). This pattern was also seen for IL-10 and IL-12 concentrations (P = 0.01). IL concentrations in patients in the chronic and late stages of the disease were low and showed no difference compared to the healthy adults.
Collapse
Affiliation(s)
- Xiang Wang
- Institute of Biology and Medical Sciences, Soochow University, Suzhou, China.,Key Laboratory of Molecular Virology & Immunology, Vaccine Research Center, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Qiong Fu
- RenjiHospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Song
- RenjiHospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bowen Duan
- Key Laboratory of Molecular Virology & Immunology, Vaccine Research Center, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | | | - Jing Xu
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
| | - Shizhu Li
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
| | - Dongming Zhou
- Key Laboratory of Molecular Virology & Immunology, Vaccine Research Center, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Zhiqiang Qin
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
| |
Collapse
|
7
|
Härter G, Frickmann H, Zenk S, Wichmann D, Ammann B, Kern P, Fleischer B, Tannich E, Poppert S. Diagnosis of neuroschistosomiasis by antibody specificity index and semi-quantitative real-time PCR from cerebrospinal fluid and serum. J Med Microbiol 2014; 63:309-312. [DOI: 10.1099/jmm.0.066142-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We describe the case of a 16-year-old German male expatriate from Ghana who presented with obstipation, dysuria, dysaesthesia of the gluteal region and the lower limbs, bilateral plantar hypaesthesia and paraesthesia without pareses. A serum–cerebrospinal fluid (CSF) Schistosoma spp. specific antibody specificity index of 3.1 was considered highly suggestive of intrathecal synthesis of anti-Schistosoma spp. specific antibodies, although standardization of this procedure has not previously been described. Diagnosis was confirmed by detection of Schistosoma DNA in CSF by semi-quantitative real-time PCR at 100-fold concentration compared with serum. Accordingly the two diagnostic procedures, which have not previously been applied for routine diagnosis, appear to be useful for the diagnosis of neuroschistosomiasis. Clinical symptoms resolved following anthelmintic and anti-inflammatory therapy.
Collapse
Affiliation(s)
- Georg Härter
- Department of Infectious Diseases and Clinical Immunology, Comprehensive Infectious Diseases Centre Ulm and Clinic of Internal Medicine III, University Hospital Ulm, Germany
| | - Hagen Frickmann
- Institute for Microbiology, Virology and Hygiene, University Hospital Rostock, Germany
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Germany
| | - Sebastian Zenk
- Institute for Medical Microbiology and Hygiene, University Hospital Ulm, Germany
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Bettina Ammann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Peter Kern
- Department of Infectious Diseases and Clinical Immunology, Comprehensive Infectious Diseases Centre Ulm and Clinic of Internal Medicine III, University Hospital Ulm, Germany
| | | | - Egbert Tannich
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Sven Poppert
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| |
Collapse
|
8
|
|
9
|
Abstract
Schistosomiasis is a parasitic disease caused by blood flukes of the genus Schistosoma. Currently 200 million people worldwide are infected. Neurological manifestations are a result of the inflammatory response of the host to egg deposition in the brain and spinal cord and is usually seen in patients with recent infection with no evidence of systemic illness. Cerebral and cerebellar disease can result in headache, seizure, and increased intracranial pressure. Cerebral schistosomiasis is more common in Schistosoma japonicum, but increasing cases due to Schistosoma mansoni are being reported in the literature. Other complications of cerebral schistosomiasis include delirium, loss of consciousness, visual field impairment, focal motor deficits, and ataxia. Myelopathy is the most common neurological manifestation of Schistosoma mansoni and the conus medullaris and cauda equine are the most common sites of involvement. Severe disease can result in flaccid paraplegia with areflexia, sphincter dysfunction, and sensory disturbance. Early recognition and prompt treatment are essential when physicians are faced with schistosomiasis involving the central nervous system. Schistosomicidal drugs, such as praziquantel, steroids and surgery, are the mainstay of therapy for this severe form of schistosomiasis.
Collapse
Affiliation(s)
- Christina Marie Coyle
- Albert Einstein College of Medicine and the Jacobi Medical Center, Bronx, New York, NY, USA.
| |
Collapse
|
10
|
Abstract
Parasitic infections of the central nervous system (CNS) include two broad categories of infectious organisms: single-celled protozoa and multicellular metazoa. The protozoal infections include malaria, American trypanosomiasis, human African trypanosomiasis, toxoplasmosis, amebiasis, microsporidiasis, and leishmaniasis. The metazoal infections are grouped into flatworms, which include trematoda and cestoda, and roundworms or nematoda. Trematoda infections include schistosomiasis and paragonimiasis. Cestoda infections include cysticercosis, coenurosis, hydatidosis, and sparganosis. Nematoda infections include gnathostomiasis, angiostrongyliasis, toxocariasis, strongyloidiasis, filariasis, baylisascariasis, dracunculiasis, micronemiasis, and lagochilascariasis. The most common route of CNS invasion is through the blood. In some cases, the parasite invades the olfactory neuroepithelium in the nasal mucosa and penetrates the brain via the subarachnoid space or reaches the CNS through neural foramina of the skull base around the cranial nerves or vessels. The neuropathological changes vary greatly, depending on the type and size of the parasite, geographical strain variations in parasitic virulence, immune evasion by the parasite, and differences in host immune response. Congestion of the leptomeninges, cerebral edema, hemorrhage, thrombosis, vasculitis, necrosis, calcification, abscesses, meningeal and perivascular polymorphonuclear and mononuclear inflammatory infiltrate, microglial nodules, gliosis, granulomas, and fibrosis can be found affecting isolated or multiple regions of the CNS, or even diffusely spread. Some infections may be present as an expanding mass lesion. The parasites can be identified by conventional histology, immunohistochemistry, in situ hybridization, and PCR.
Collapse
Affiliation(s)
- José Eymard Homem Pittella
- Pathology Service, Hospital das Clínicas, Medical Faculty of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| |
Collapse
|
11
|
|
12
|
Cerebral schistosomiasis due to Schistosoma haematobium confirmed by PCR analysis of brain specimen. J Clin Microbiol 2011; 49:3703-6. [PMID: 21849689 DOI: 10.1128/jcm.01073-11] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The case of a 25-year-old Japanese male who had cerebral schistosomiasis caused by Schistosoma haematobium is reported here. Although serum antibody tests showed a cross-reaction with other helminths and no ova were excreted in urine or feces, the existence of Schistosoma haematobium in the brain was confirmed by PCR analysis.
Collapse
|
13
|
Lv S, Zhang Y, Steinmann P, Zhou XN, Utzinger J. Helminth infections of the central nervous system occurring in Southeast Asia and the Far East. ADVANCES IN PARASITOLOGY 2010; 72:351-408. [PMID: 20624537 DOI: 10.1016/s0065-308x(10)72012-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although helminth infections of the central nervous system (CNS) are rare, their public health implications must not be neglected. Indeed, several helminth species can cause cerebrospinal infections, especially if humans serve as intermediate or non-permissive host. The diagnosis of cerebrospinal helminthiases is difficult, and the detection of parasites in cerebrospinal fluid is rarely successful. Cerebrospinal helminth infections therefore often remain undetected, and hence prognosis is poor. Increases in tourism and population movements are risk factors for cerebrospinal helminthiases and infections pose particular challenges to clinicians in non-endemic areas. In this review, we focus primarily on food-borne helminthiases that are endemic and often emerging in Southeast Asia and the Far East, namely angiostrongyliasis, gnathostomiasis, sparganosis, paragonimiasis and cysticercosis. Additionally, we discuss neuroschistosomiasis, a disease that is transmitted through human-water contact. For each disease, we describe the pathogen, its transmission route and possible mechanisms for entering the CNS. We also summarise common signs and symptoms, challenges and opportunities for diagnosis, treatment, clinical management, geographical distribution and epidemiology. The adoption of a comprehensive set of diagnostic criteria for different cerebrospinal helminthiases is proposed, including epidemiological history, typical signs and symptoms, neuroimaging and laboratory findings. Finally, risk factors, and research needs for enhanced patient management and population-based control measures are discussed.
Collapse
Affiliation(s)
- Shan Lv
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | | | | | | | | |
Collapse
|