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Abera MT, Abdela AF, Yaynishet YA, Tefera TG. Arborized pattern of MRI enhancement in spinal cord schistosomiasis: A report of 2 successful case outcomes. Radiol Case Rep 2024; 19:4190-4194. [PMID: 39101020 PMCID: PMC11295448 DOI: 10.1016/j.radcr.2024.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/18/2024] [Accepted: 06/27/2024] [Indexed: 08/06/2024] Open
Abstract
This case report describes 2 patients with spinal cord schistosomiasis diagnosed based on a magnetic resonance imaging finding of a unique arborized type of postcontrast enhancement. Both patients presented with back pain and lower limb weakness, and prompt treatment with an anti-schistomal agent and steroid resulted in significant neurological and radiological improvement. The report emphasizes the role of imaging in the early diagnosis of spinal cord schistosomiasis, as well as the importance of early treatment for the best clinical outcomes.
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Affiliation(s)
| | | | - Yodit A. Yaynishet
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Tesfaye G. Tefera
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
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2
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Yankey KP, Awoonor-William R, Owusu DN, Sackeyfio A, Nyarko V, Gross-Fenandez L, Addai F, Wulff I, Boachie-Adjei O. Neuroschistosomiasis: A Case Report and Review of Literature. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:450-454. [PMID: 39309391 PMCID: PMC11412587 DOI: 10.4103/jwas.jwas_174_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/19/2024] [Indexed: 09/25/2024]
Abstract
Spinal cord involvement is a rare complication of the schistosomiasis manifesting as myeloradiculopathy, medullary or conus-cauda equina syndrome which can lead to potentially serious long-term disability. Computed tomography and magnetic resonance imaging coupled with biochemical parameters have become the mainstay of diagnosis. Biopsy which is the gold standard of diagnosis demonstrating the organism is usually reserved for cases of diagnostic challenge. We report a rare case of upper thoracic spinal cord schistosomiasis diagnosed by biopsy in an 18-year-old male migrant presenting to a spine and orthopaedic centre in Ghana with complaints of upper back pain and associated myeloradiculopathy symptoms. Initial suspicion of intramedullary cord tumour was made based on magnetic resonance imaging findings warranting biopsy which revealed schistosoma spp. He was treated with anthelminthics and corticosteroids with a resolution of symptoms.
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Affiliation(s)
- Kwadwo Poku Yankey
- FOCOS Orthopaedic Hospital, Department of Neurosurgery Research Accra, Ghana
| | | | | | - Arthur Sackeyfio
- FOCOS Orthopaedic Hospital, Department of Neurosurgery Research Accra, Ghana
| | | | | | - Francis Addai
- FOCOS Orthopaedic Hospital, Department of Neurosurgery Research Accra, Ghana
| | - Irene Wulff
- FOCOS Orthopaedic Hospital, Department of Neurosurgery Research Accra, Ghana
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3
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Alves J, Bonifácio GV, Vieira R, Militão A, Guerreiro R. Long-Lasting Latent Neuroschistosomiasis in a Nonendemic Country: A Case Report. Cureus 2024; 16:e63007. [PMID: 39050315 PMCID: PMC11268978 DOI: 10.7759/cureus.63007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Neuroschistosomiasis is an uncommon yet serious cause of myelopathy. Schistosoma mansoni infection triggers a granulomatous immune response by the human host, resulting in many clinical presentations, depending on the size of the granuloma and its location. The parasitic infection can remain silent for a long period, and this diagnosis should be considered if there is a history of previous exposure in endemic regions. Prompt diagnosis and treatment are crucial for a favorable outcome, minimizing the risk of permanent neurological disability. A case of medullary neuroschistosomiasis is presented, many years after exposure, in a patient who presented with low back pain, rapidly progressing to paraparesis with significant gait impairment. Magnetic resonance imaging findings revealed extensive medullary involvement from the conus all the way to the cervical spine level. After ruling out other causes of myelopathy and considering previous history, total anti-Schistosoma antibodies were tested and detected, confirming the diagnosis. Steroids and schistosomicides were started, with remarkable clinical and imagiological improvement. The patient regained normal muscle strength, gait, and functional independence in the following six months.
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Affiliation(s)
- Janice Alves
- Department of Neurology, Unidade Local de Saúde Arrábida, Setúbal, PRT
| | | | - Rodrigo Vieira
- Department of Neurology, Unidade Local de Saúde do Algarve, Faro, PRT
| | - André Militão
- Department of Neurology, Unidade Local de Saúde Arrábida, Setúbal, PRT
| | - Rui Guerreiro
- Department of Neurology, Unidade Local de Saúde Arrábida, Setúbal, PRT
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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.
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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.
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5
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Qi YX, Huang MR, Sun HY, Wu XY, Liu ZT, Lu DB. Prevalence of depressive symptoms in patients with advanced schistosomiasis in China: A systematic review and meta-analysis. PLoS Negl Trop Dis 2024; 18:e0012003. [PMID: 38452104 PMCID: PMC10950241 DOI: 10.1371/journal.pntd.0012003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/19/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Advanced schistosomiasis is the most serious outcome of infection and has a negative impact on both physical fitness and mental health of patients, the latter of which has long been overlooked. Therefore, we performed this systematic review and meta-analysis to estimate the overall prevalence of depressive symptoms, one of the most common mental problems, in patients with advanced schistosomiasis in China. METHODS Six electronic databases were searched for studies reporting the prevalence of depressive symptoms in the targeted patients. Assessments were pooled using a fixed- or random-effects model based on heterogeneity test. Subgroup analyses were further performed and differences between/among groups were examined using the chi-squared test. The protocol had previously been registered in PROSPERO (CRD42023406708). RESULTS A total of 11 studies with 1,673 participants were included. The pooled prevalence of depressive symptoms in advanced schistosomiasis in China was 62.01% (95% CI: 51.30% - 72.72%), with a significant heterogeneity among studies. Depressive symptoms were more prevalent in patients with complications and more than half of the patients suffered a mild- or moderate-level of depression. No publication bias was found, and sensitivity analysis showed a stable result. CONCLUSIONS The overall prevalence of depressive symptoms in advanced schistosomiasis in China was high enough to warrant psychotherapeutic interventions, especially for patients with complications. This would greatly prevent or/and reduce depression and improve their quality of life.
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Affiliation(s)
- Yu-Xin Qi
- Department of Epidemiology and Statistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Meng-Rui Huang
- Department of Epidemiology and Statistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hui-Ying Sun
- Department of Epidemiology and Statistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Xiao-Yan Wu
- Department of Epidemiology and Statistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ze-Ting Liu
- Department of Epidemiology and Statistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Da-Bing Lu
- Department of Epidemiology and Statistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
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Kołodziej P, Szostakowska B, Lass A, Sulima M, Sikorska K, Kocki J, Krupski W, Starownik D, Bojar P, Szumiło J, Kasztelan-Szczerbińska B, Cichoż-Lach H, Bogucki J, Szymańska M, Fota-Markowska H, Bogucka-Kocka A. Chronic intestinal schistosomiasis caused by co-infection with Schistosoma intercalatum and Schistosoma mansoni. THE LANCET. INFECTIOUS DISEASES 2024; 24:e196-e205. [PMID: 37783223 DOI: 10.1016/s1473-3099(23)00486-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/23/2023] [Accepted: 07/19/2023] [Indexed: 10/04/2023]
Abstract
The Grand Round concerns a 24-year-old man from Zimbabwe who was studying and living in Poland. The patient had been complaining of abdominal pain, fatigue, alternating diarrhoea and constipation, and presence of blood in his stool for 3 years. The patient had the following diagnostic tests: colonoscopy, CT scan, histopathology, and parasitological and molecular tests. Results of the examinations showed that the cause of the patient's complaints was chronic intestinal schistosomiasis due to the co-infection with Schistosoma intercalatum and Schistosoma mansoni. The patient had two cycles of praziquantel therapy (Biltricide) and responded well to the treatment. In the Grand Round, we describe full diagnostics as well as clinical and therapeutic management in the patient with S intercalatum and S mansoni co-infection. This case allows us to draw attention to cases of forgotten chronic tropical diseases (including rare ones) in patients from regions with a high endemic index staying in non-endemic regions of the world for a long time. Co-infection with S intercalatum and S mansoni should be considered as a very rare clinical case.
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Affiliation(s)
- Przemysław Kołodziej
- Department of Biology and Genetics, Medical University of Lublin, Lublin, Poland.
| | - Beata Szostakowska
- Department of Tropical Parasitology, Medical University of Gdańsk, Gdańsk, Poland.
| | - Anna Lass
- Department of Tropical Parasitology, Medical University of Gdańsk, Gdańsk, Poland
| | - Małgorzata Sulima
- Division of Tropical and Parasitic Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Katarzyna Sikorska
- Division of Tropical and Parasitic Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Janusz Kocki
- Department of Clinical Genetics, Medical University of Lublin, Lublin, Poland
| | - Witold Krupski
- Department of Medical Radiology, Medical University of Lublin, Lublin, Poland
| | - Dorota Starownik
- Independent Public Clinical Hospital No. 4 in Lublin, Medical University of Lublin, Lublin, Poland
| | - Paweł Bojar
- Department of Pathomorphology, Beskid Oncology Centre-John Paul II Memorial City Hospital in Bielsko-Biala, Bielsko-Biała, Poland
| | - Justyna Szumiło
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | | | - Halina Cichoż-Lach
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, Lublin, Poland
| | - Jacek Bogucki
- Department of Organic Chemistry, Medical University of Lublin, Lublin, Poland
| | - Magdalena Szymańska
- Department of Biology and Genetics, Medical University of Lublin, Lublin, Poland
| | | | - Anna Bogucka-Kocka
- Department of Biology and Genetics, Medical University of Lublin, Lublin, Poland
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7
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Izquierdo-Condoy JS, Vásconez-Gonzáles J, Morales-Lapo E, Tello-De-la-Torre A, Naranjo-Lara P, Fernández R, Hidalgo MR, Escobar A, Yépez VH, Díaz AM, Oliva C, Ortiz-Prado E. Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases. Front Cell Infect Microbiol 2024; 14:1293782. [PMID: 38357446 PMCID: PMC10864624 DOI: 10.3389/fcimb.2024.1293782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Infectious diseases have consistently served as pivotal influences on numerous civilizations, inducing morbidity, mortality, and consequently redirecting the course of history. Their impact extends far beyond the acute phase, characterized by the majority of symptom presentations, to a multitude of adverse events and sequelae that follow viral, parasitic, fungal, or bacterial infections. In this context, myriad sequelae related to various infectious diseases have been identified, spanning short to long-term durations. Although these sequelae are known to affect thousands of individuals individually, a comprehensive evaluation of all potential long-term effects of infectious diseases has yet to be undertaken. We present a comprehensive literature review delineating the primary sequelae attributable to major infectious diseases, categorized by systems, symptoms, and duration. This compilation serves as a crucial resource, illuminating the long-term ramifications of infectious diseases for healthcare professionals worldwide. Moreover, this review highlights the substantial burden that these sequelae impose on global health and economies, a facet often overshadowed by the predominant focus on the acute phase. Patients are frequently discharged following the resolution of the acute phase, with minimal long-term follow-up to comprehend and address potential sequelae. This emphasizes the pressing need for sustained vigilance, thorough patient monitoring, strategic health management, and rigorous research to understand and mitigate the lasting economic and health impacts of infectious diseases more fully.
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8
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Alanazi RF, Al Karawi M, Almalki A, Sufiani F, Al Karawi S. Schistosomiasis Involving the Central Nervous System: Case Report of a Rare Complication. Case Rep Surg 2023; 2023:9968155. [PMID: 38115954 PMCID: PMC10730249 DOI: 10.1155/2023/9968155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/06/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Schistosomiasis is a parasitic infection caused by schistosome invasion of blood circulation. Neuroschistosomiasis is a severe cerebral complication that accounts for less than 2.3% of reported cases. Patients present with progressive encephalitis, seizures, or both. Management includes antiparasitic medications, steroids, and surgical intervention. Case Presentation. We report a case of a 44-year-old female who presented to the ER with a history of transient loss of consciousness (LOC) and seizure. Radiological investigations revealed a right frontal brain lesion. Histopathological results confirmed the diagnosis of schistosomiasis. Conclusion Schistosomiasis is a parasitic infection commonly diagnosed in patients who live in tropical areas. Early diagnosis with radiological and histopathological evaluation is required to identify patients at risk of developing severe neurological complications.
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Affiliation(s)
- Rahaf F. Alanazi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maryam Al Karawi
- College of Medicine, James Cook University, Townsville, Australia
| | - Abdulrahman Almalki
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Fahd Sufiani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pathology, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Sarmad Al Karawi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
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9
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Zhu HX, Li YC, Yang XP, Chu YH, Guo W, Chen RX, Guo DD, Cheng LJ, Li Y. Demographics and Clinical Characteristics of Patients with Neurocysticercosis: A Retrospective Study from Dali, China. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:283-291. [PMID: 37970452 PMCID: PMC10634465 DOI: 10.4103/sjmms.sjmms_298_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/19/2023] [Accepted: 08/28/2023] [Indexed: 11/17/2023]
Abstract
Background Neurocysticercosis (NCC), a predominant parasitic disease that affects the central nervous system and presents with diverse clinical manifestations, is a major contributor to acquired epilepsy worldwide, particularly in low-, middle-, and upper middle-income nations, such as China. In China, the Yunnan Province bears a significant burden of this disease. Objective To describe the demographic, clinical, and radiological features as well as serum and cerebrospinal fluid antibodies to cysticercus in patients with NCC from Dali, Yunnan Province, China. Materials and Methods This retrospective study included patients who were diagnosed with NCC at The First Affiliated Hospital of Dali University between January 2018 and May 2023 and were residing in Dali, Yunnan Province, China. Results A total of 552 patients with NCC were included, of which 33.3% belonged to Bai ethnicity. The clinical presentation of NCC exhibited variability that was influenced by factors such as the number, location, and stage of the parasites. Epilepsy/seizure (49.9%) was the most prevalent symptom, with higher occurrence in the degenerative stage of cysts (P < 0.001). Compared with other locations, cysticerci located in the brain parenchyma are more likely to lead to seizures/epilepsy (OR = 17.45, 95% CI: 7.96-38.25) and headaches (OR = 3.02, 95% CI: 1.23-7.41). Seizures/epilepsy are more likely in patients with cysts in the vesicular (OR = 2.71, 95% CI: 1.12-6.61) and degenerative (OR = 102.38, 95% CI: 28.36-369.60) stages than those in the calcified stage. Seizures was not dependent on the number of lesions. All NCC patients underwent anthelminthic therapy, with the majority receiving albendazole (79.7%). Conclusion This study provides valuable clinical insights into NCC patients in Dali and underscores the significance of NCC as a leading preventable cause of epilepsy.
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Affiliation(s)
- Han-Xiao Zhu
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
| | - Yang-Chao Li
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
| | - Xue-Ping Yang
- Clinical Medical College, Dali University, Dali, Yunnan, China
| | - Yu-Hao Chu
- Clinical Medical College, Dali University, Dali, Yunnan, China
| | - Wang Guo
- Clinical Medical College, Dali University, Dali, Yunnan, China
| | - Ruo-Xia Chen
- Clinical Medical College, Dali University, Dali, Yunnan, China
| | - Dan-Dan Guo
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
| | - Li-Jing Cheng
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
| | - Yun Li
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
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10
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Boyd MJ, Mendelson M, Dlamini SK, Wasserman S, Fakier G, Roberts R, Papavarnavas NS. A case of pericardial schistosomiasis and non-Hodgkin high grade B-cell lymphoma. S Afr J Infect Dis 2023; 38:524. [PMID: 37795202 PMCID: PMC10546256 DOI: 10.4102/sajid.v38i1.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/12/2023] [Indexed: 10/06/2023] Open
Abstract
Chronic schistosomiasis affects either the genitourinary or gastrointestinal tract. Rarely, schistosomes cause ectopic disease, such as in the case of a South African woman from a non-endemic province, who presented with suspected pericardial tamponade because of tuberculosis. However, histology and polymerase chain reaction from pericardial biopsy confirmed Schistosoma haematobium. A finding of mediastinal non-Hodgkin lymphoma came to light when our patient's clinical condition unexpectedly deteriorated. Contribution This case highlights an unusual manifestation of schistosomiasis.
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Affiliation(s)
- Michael J Boyd
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sipho K Dlamini
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sean Wasserman
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ghaalied Fakier
- Division of Anatomical Pathology, Department of Pathology and National Health Laboratory Services, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Riyaadh Roberts
- Division of Anatomical Pathology, Department of Pathology and National Health Laboratory Services, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nectarios S Papavarnavas
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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11
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Mustafa S, Matarneh AS, Mohamed A, Fadul A, Musa M, Mohamed RI, Abdallah E, Mohamed TG. Cerebral Neuroschistosomiasis Presenting as a Brain Mass. Cureus 2023; 15:e45418. [PMID: 37854757 PMCID: PMC10581503 DOI: 10.7759/cureus.45418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
Neuroschistosomiasis is a rare manifestation of schistosomal infections presenting with cerebral and spinal cord involvement. We reported a case of a 31-year-old woman who presented with a history of headache, dizziness, and nausea. Brain MRI with contrast showed features suggestive of brain lesion with edema, and a serology test for Schistosoma was positive. She was diagnosed with neuroschistosomiasis and treated with intravenous steroids followed by praziquantel resulting in a significant regression of the brain mass. Cerebral neuroschistosomiasis is a rare complication of Schistosoma infection, and clinicians should consider it among the differential diagnosis of unexplained brain lesions.
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Affiliation(s)
- Salma Mustafa
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | - Abdalla Fadul
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Muzamil Musa
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
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12
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Torres-Vitolas CA, Trienekens SCM, Zaadnoordijk W, Gouvras AN. Behaviour change interventions for the control and elimination of schistosomiasis: A systematic review of evidence from low- and middle-income countries. PLoS Negl Trop Dis 2023; 17:e0011315. [PMID: 37163556 PMCID: PMC10202306 DOI: 10.1371/journal.pntd.0011315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 05/22/2023] [Accepted: 04/16/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND For the last two decades, schistosomiasis control efforts have focussed on preventive treatment. The disease, however, still affects over 200 million people worldwide. Behaviour change (BC) interventions can strengthen control by interrupting transmission through modifying exposure behaviour (water contact) or transmission practices (open urination/defaecation); or through fostering treatment seeking or acceptance. This review examines these interventions to assess their effectiveness in modifying risk practices and affecting epidemiological trends. METHODOLOGY/PRINCIPAL FINDINGS A systematic multi-database literature search (PROSPERO CRD42021252368) was conducted for peer-reviewed publications released at any time before June 2021 assessing BC interventions for schistosomiasis control in low- and middle-income countries. 2,593 unique abstracts were identified, 66 were assigned to full text review, and 32 met all inclusion criteria. A typology of intervention models was outlined according to their use of behaviour change techniques and overarching rationale: health education (HEIs), social-environmental (SEIs), physical-environmental (PEIs), and incentives-centred interventions (ICIs). Available evidence does not allow to identify which BC approach is most effective in controlling risk behaviour to prevent schistosomiasis transmission. HEIs' impacts were observed to be limited by structural considerations, like infrastructure underdevelopment, economic obligations, socio-cultural traditions, and the natural environment. SEIs may address those challenges through participatory planning and implementation activities, which enable social structures, like governance and norms, to support BC. Their effects, however, appear context-sensitive. The importance of infrastructure investments was highlighted by intervention models. To adequately support BC, however, they require users' inputs and complementary services. Whilst ICIs reported positive impacts on treatment uptake, there are cost-effectiveness and sustainability concerns. Evaluation studies yielded limited evidence of independent epidemiological impacts from BC, due to limited use of suitable indicators and comparators. There was indicative evidence, however, that BC projects could sustain gains through treatment campaigns. CONCLUSIONS/SIGNIFICANCE There is a need for integrated interventions combining information provision, community-based planning, and infrastructure investments to support BC for schistosomiasis control. Programmes should carefully assess local conditions before implementation and consider that long-term support is likely needed. Available evidence indicates that BC interventions may contribute towards schistosomiasis control when accompanied by treatment activities. Further methodologically robust evidence is needed to ascertain the direct epidemiological benefits of BC.
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Affiliation(s)
- Carlos A. Torres-Vitolas
- Unlimit Health, London, United Kingdom
- School of Public Health, Imperial College London, London, United Kingdom
| | - Suzan C. M. Trienekens
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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13
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Mansonic neuroschistosomiasis in the childhood: an undiagnosed pathology? Childs Nerv Syst 2023; 39:481-489. [PMID: 36258049 DOI: 10.1007/s00381-022-05696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022]
Abstract
Schistosomiasis is an endemic parasitic disease in several tropical countries. In Brazil, the only prevalent species of parasite responsible for schistosomiasis is Schistosoma mansoni. Neuroschistosomiasis is the second most frequent form of infection and the primary ectopic manifestation, with predominant involvement of the lower thoracic spinal cord and lumbar and lumbosacral regions. The frequent contact of children with contaminated ponds and the immaturity of their immune systems make this age group especially susceptible to infection by this parasite. Therefore, neuroschistosomiasis mansoni should always be considered in cases of transverse myelitis in children from endemic regions. The treatment for this condition is quite simple and effective, resulting in total recovery of neurological deficits if the diagnosis is made early.
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14
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Lo NC, Bezerra FSM, Colley DG, Fleming FM, Homeida M, Kabatereine N, Kabole FM, King CH, Mafe MA, Midzi N, Mutapi F, Mwanga JR, Ramzy RMR, Satrija F, Stothard JR, Traoré MS, Webster JP, Utzinger J, Zhou XN, Danso-Appiah A, Eusebi P, Loker ES, Obonyo CO, Quansah R, Liang S, Vaillant M, Murad MH, Hagan P, Garba A. Review of 2022 WHO guidelines on the control and elimination of schistosomiasis. THE LANCET. INFECTIOUS DISEASES 2022; 22:e327-e335. [PMID: 35594896 DOI: 10.1016/s1473-3099(22)00221-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 01/13/2023]
Abstract
Schistosomiasis is a helminthiasis infecting approximately 250 million people worldwide. In 2001, the World Health Assembly (WHA) 54.19 resolution defined a new global strategy for control of schistosomiasis through preventive chemotherapy programmes. This resolution culminated in the 2006 WHO guidelines that recommended empirical treatment by mass drug administration with praziquantel, predominately to school-aged children in endemic settings at regular intervals. Since then, school-based and community-based preventive chemotherapy programmes have been scaled-up, reducing schistosomiasis-associated morbidity. Over the past 15 years, new scientific evidence-combined with a more ambitious goal of eliminating schistosomiasis and an increase in the global donated supply of praziquantel-has highlighted the need to update public health guidance worldwide. In February, 2022, WHO published new guidelines with six recommendations to update the global public health strategy against schistosomiasis, including expansion of preventive chemotherapy eligibility from the predominant group of school-aged children to all age groups (2 years and older), lowering the prevalence threshold for annual preventive chemotherapy, and increasing the frequency of treatment. This Review, written by the 2018-2022 Schistosomiasis Guidelines Development Group and its international partners, presents a summary of the new WHO guideline recommendations for schistosomiasis along with their historical context, supporting evidence, implications for public health implementation, and future research needs.
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Affiliation(s)
- Nathan C Lo
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA, USA.
| | | | - Daniel G Colley
- Department of Microbiology, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA
| | | | - Mamoun Homeida
- Academy of Medical Sciences and Technology, Khartoum, Sudan
| | - Narcis Kabatereine
- Accelerating Resilient, Innovative, and Sustainable Elimination of NTDs, Vector Control Division, Kampala, Uganda
| | | | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Nicholas Midzi
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Francisca Mutapi
- Institute of Immunology and Infection Research, Tackling Infections to Benefit Africa Partnership, University of Edinburgh, Edinburgh, UK
| | - Joseph R Mwanga
- Department of Epidemiology, Biostatistics and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Reda M R Ramzy
- National Nutrition Institute, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt
| | - Fadjar Satrija
- School of Veterinary Medicine and Biomedicine, IPB University, Bogor, Indonesia
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Joanne P Webster
- Department of Pathobiology and Population Science, Royal Veterinary College, University of London, London, UK
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Paolo Eusebi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Eric S Loker
- Department of Biology, University of New Mexico, Albuquerque, NM, USA
| | - Charles O Obonyo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Song Liang
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Michel Vaillant
- Competence Centre for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, NY, USA
| | - Paul Hagan
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Amadou Garba
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
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15
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Mohamed AA, Mengistu MG, Haftu H, Mustefa M, Yusuf AA. Spinal cord Schistosomiasis: A child's case with an unsatisfactory outcome that mimicked an intramedullary neoplasm. A rare case report. Ann Med Surg (Lond) 2022; 82:104708. [PMID: 36268327 PMCID: PMC9577854 DOI: 10.1016/j.amsu.2022.104708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/26/2022] Open
Abstract
Neuroshcistosomiasis is a life-threatening complication of schistosomiasis. Its prevalence in endemic populations is believed to be underreported at 1–4%. We report a four-year-old child who came to our hospital relatively late since the presentation of weakness and incontinence. MRI revealed long segment (T12-L1) ill-defined intramedullary lesions with cord extension having patchy enhancements. Despite the administration of both praziquantel and pulse prednisolone treatment, there was no convincing result. We thus question the role of steroids and praziquantel in individuals with late-diagnosed spinal schistosomiasis. Neuroshcistosomiasis is a life-threatening complication of schistosomiasis. Its prevalence in endemic populations is believed to be underreported at 1–4%. We report a four-year-old child who came to our hospital relatively late since the presentation of weakness and incontinence. MRI revealed long segment ill-defined intramedullary lesions with cord extension having patchy enhancements. High power view microscope displayed four schistosome parasites having a ventral horn. Despite the administration of both praziquantel and pulse prednisolone treatment, there was no convincing result.
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16
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A 9-Year-old Boy With Fever, Eosinophilia, and Neurologic Symptoms. Pediatr Infect Dis J 2022; 41:862-865. [PMID: 36734968 DOI: 10.1097/inf.0000000000003479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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17
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Yu D, Wang A, Zhang J, Li X, Jiang C, Zhou H. Genomic analysis of schistosomiasis-associated colorectal cancer reveals a unique mutational landscape and therapeutic implications. Genes Dis 2022. [DOI: 10.1016/j.gendis.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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18
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Idro R, Ogwang R, Barragan A, Raimondo JV, Masocha W. Neuroimmunology of Common Parasitic Infections in Africa. Front Immunol 2022; 13:791488. [PMID: 35222377 PMCID: PMC8866860 DOI: 10.3389/fimmu.2022.791488] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
Parasitic infections of the central nervous system are an important cause of morbidity and mortality in Africa. The neurological, cognitive, and psychiatric sequelae of these infections result from a complex interplay between the parasites and the host inflammatory response. Here we review some of the diseases caused by selected parasitic organisms known to infect the nervous system including Plasmodium falciparum, Toxoplasma gondii, Trypanosoma brucei spp., and Taenia solium species. For each parasite, we describe the geographical distribution, prevalence, life cycle, and typical clinical symptoms of infection and pathogenesis. We pay particular attention to how the parasites infect the brain and the interaction between each organism and the host immune system. We describe how an understanding of these processes may guide optimal diagnostic and therapeutic strategies to treat these disorders. Finally, we highlight current gaps in our understanding of disease pathophysiology and call for increased interrogation of these often-neglected disorders of the nervous system.
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Affiliation(s)
- Richard Idro
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Rodney Ogwang
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Antonio Barragan
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Joseph Valentino Raimondo
- Division of Cell Biology, Department of Human Biology, Neuroscience Institute and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Willias Masocha
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
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19
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Belizario VY,J, de Cadiz AE, Navarro RC, Flores MJC, Molina VB, Dalisay SNM, Medina JRC, Lumangaya CR. The status of schistosomiasis japonica control in the Philippines: The need for an integrated approach to address a multidimensional problem. INTERNATIONAL JOURNAL OF ONE HEALTH 2022. [DOI: 10.14202/ijoh.2022.8-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Schistosomiasis japonica remains a public health concern in many areas of the Philippines. Adequate and updated information is essential to enhance policy and service delivery toward control and elimination. Despite the efforts on schistosomiasis control in the Philippines, some challenges remain in these dimensions. An integrated surveillance system is recommended to determine the prevalence of infection in humans, animal reservoirs, and snail intermediate hosts, allowing the identification of high-priority areas for targeted interventions. This will entail the enhancement of laboratory diagnosis capacity through the use of more sensitive techniques, complemented by capacity building of concerned human and animal health professionals. Given the zoonotic nature of schistosomiasis japonica, adopting the One Health approach is essential to influence policies and interventions that may accelerate control and elimination. This can be achieved through the attainment of mass drug administration coverage targets and intensified case finding and management, robust implementation and integration of veterinary public health activities, the conduct of snail control measures, provision of safe water, sanitation, and hygiene services, and health promotion and education into the national schistosomiasis control and elimination program. This review aimed to describe the status of schistosomiasis japonica control in the Philippines in the context of human health, animal health, vector ecology and management, environmental health, and sociocultural dimensions.
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Affiliation(s)
- Vicente Y. , Jr. Belizario
- Department of Parasitology, College of Public Health, University of the Philippines, Manila, Philippines; Neglected Tropical Diseases Study Group, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Aleyla E. de Cadiz
- Department of Biological Sciences and Environmental Studies, College of Science and Mathematics, University of the Philippines, Mindanao, Philippines
| | - Rohani C. Navarro
- National Institute of Molecular Biology and Biotechnology, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Mary Jane C. Flores
- Department of Biology, College of Science, De La Salle University, Manila, Philippines
| | - Victorio B. Molina
- Department of Environmental and Occupational Health, College of Public Health, University of the Philippines, Manila, Philippines
| | - Soledad Natalia M. Dalisay
- Department of Anthropology, College of Social Sciences and Philosophy, University of the Philippines, Diliman, Philippines
| | - John Robert C. Medina
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines, Manila, Philippines
| | - Carlo R. Lumangaya
- Neglected Tropical Diseases Study Group, National Institutes of Health, University of the Philippines, Manila, Philippines
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20
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Reis PA, Castro-Faria-Neto HC. Systemic Response to Infection Induces Long-Term Cognitive Decline: Neuroinflammation and Oxidative Stress as Therapeutical Targets. Front Neurosci 2022; 15:742158. [PMID: 35250433 PMCID: PMC8895724 DOI: 10.3389/fnins.2021.742158] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/31/2021] [Indexed: 12/29/2022] Open
Abstract
In response to pathogens or damage signs, the immune system is activated in order to eliminate the noxious stimuli. The inflammatory response to infectious diseases induces systemic events, including cytokine storm phenomenon, vascular dysfunction, and coagulopathy, that can lead to multiple-organ dysfunction. The central nervous system (CNS) is one of the major organs affected, and symptoms such as sickness behavior (depression and fever, among others), or even delirium, can be observed due to activation of endothelial and glial cells, leading to neuroinflammation. Several reports have been shown that, due to CNS alterations caused by neuroinflammation, some sequels can be developed in special cognitive decline. There is still no any treatment to avoid cognitive impairment, especially those developed due to systemic infectious diseases, but preclinical and clinical trials have pointed out controlling neuroinflammatory events to avoid the development of this sequel. In this minireview, we point to the possible mechanisms that triggers long-term cognitive decline, proposing the acute neuroinflammatory events as a potential therapeutical target to treat this sequel that has been associated to several infectious diseases, such as malaria, sepsis, and, more recently, the new SARS-Cov2 infection.
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Affiliation(s)
- Patricia Alves Reis
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
- Biochemistry Department, Roberto Alcântara Gomes Biology Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
- *Correspondence: Patricia Alves Reis,
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21
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Ferreira LF, Di Pace FT, Silva GD. A Woman With Eosinophilic Brainstem Meningoencephalitis. JAMA Neurol 2022; 79:198-199. [PMID: 35006258 DOI: 10.1001/jamaneurol.2021.4861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lucas Fernandes Ferreira
- Department of Neurology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Filipe Tupinamba Di Pace
- Department of Neurology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Guilherme Diogo Silva
- Department of Neurology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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22
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OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:704-709. [DOI: 10.1093/trstmh/trac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/07/2021] [Accepted: 02/03/2022] [Indexed: 11/12/2022] Open
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Clinical Spectrum of Schistosomiasis: An Update. J Clin Med 2021; 10:jcm10235521. [PMID: 34884223 PMCID: PMC8672275 DOI: 10.3390/jcm10235521] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/17/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022] Open
Abstract
Schistosomiasis is a helminthic infection and one of the neglected tropical diseases (NTDs). It is caused by blood flukes of the genus Schistosoma. It is an important public health problem, particularly in poverty-stricken areas, especially those within the tropics and subtropics. It is estimated that at least 236 million people worldwide are infected, 90% of them in sub-Saharan Africa, and that this disease causes approximately 300,000 deaths annually. The clinical manifestations are varied and affect practically all organs. There are substantial differences in the clinical presentation, depending on the phase and clinical form of schistosomiasis in which it occurs. Schistosomiasis can remain undiagnosed for a long period of time, with secondary clinical lesion. Here, we review the clinical profile of schistosomiasis. This information may aid in the development of more efficacious treatments and improved disease prognosis.
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Ibrahim AM, Saleh HA, Zayed KM, Ghazy M. Colchicum Ritchii flower: a new molluscicidal plant for Biomphalaria alexandrina snails and the infective stages of Schistosoma mansoni. MOLLUSCAN RESEARCH 2021. [DOI: 10.1080/13235818.2021.2003982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amina Mohamed Ibrahim
- Environmental Research and Medical Malacology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Hassnaa Ahmed Saleh
- Environmental Research and Medical Malacology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Khaled M. Zayed
- Environmental Research and Medical Malacology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Mahassen Ghazy
- Water Pollution Research Department, National Research Centre, Giza, Egypt
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25
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Ferrari TCA, Albricker ACL, Gonçalves IM, Freire CMV. Schistosome-Associated Pulmonary Arterial Hypertension: A Review Emphasizing Pathogenesis. Front Cardiovasc Med 2021; 8:724254. [PMID: 34676250 PMCID: PMC8523797 DOI: 10.3389/fcvm.2021.724254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/13/2021] [Indexed: 12/21/2022] Open
Abstract
Schistosomiasis, especially due to Schistosoma mansoni, is a well-recognized cause of pulmonary arterial hypertension (PAH). The high prevalence of this helminthiasis makes schistosome-related PAH (Sch-PAH) one of the most common causes of this disorder worldwide. The pathogenic mechanisms underlying Sch-PAH remain largely unknown. Available evidence suggests that schistosome eggs reach the lung via portocaval shunts formed as a consequence of portal hypertension due to hepatosplenic schistosomiasis. Once deposited into the lungs, the eggs elicit an immune response resulting in periovular granuloma formation. Immune mediators drive transforming growth factor-β (TGF-β) release, which gives rise to pulmonary vascular inflammation with subsequent remodeling and development of angiomatoid and plexiform lesions. These mechanisms elicited by the eggs seem to become autonomous and the vascular lesions progress independently of the antigen. Portopulmonary hypertension, which pathogenesis is still uncertain, may also play a role in the genesis of Sch-PAH. Recently, there have been substantial advances in the diagnosis and treatment of PAH, but it remains a difficult condition to recognize and manage, and patients still die prematurely from right-heart failure. Echocardiography is used for screening, and the formal diagnosis requires right-heart catheterization. The experience in treating Sch-PAH is largely limited to the phosphodiesterase type 5 inhibitors, with evidence suggesting that these vasodilators improve symptoms and may also improve survival. Considering the great deal of uncertainty about Sch-PAH pathogenesis, course, and treatment, the aim of this review is to summarize current knowledge on this condition emphasizing its pathogenesis.
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Affiliation(s)
- Teresa Cristina Abreu Ferrari
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana Cristina Lopes Albricker
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ina Morais Gonçalves
- Graduação em Medicina, Centro Universitário de Belo Horizonte, Belo Horizonte, Brazil
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Profiro de Oliveira JH, Arruda IES, Izak Ribeiro de Araújo J, Chaves LL, de La Rocca Soares MF, Soares-Sobrinho JL. Why do few drug delivery systems to combat neglected tropical diseases reach the market? An analysis from the technology's stages. Expert Opin Ther Pat 2021; 32:89-114. [PMID: 34424127 DOI: 10.1080/13543776.2021.1970746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Many drugs used to combat schistosomiasis, Chagas disease, and leishmaniasis (SCL) have clinical limitations such as: high toxicity to the liver, kidneys and spleen; reproductive, gastrointestinal, and heart disorders; teratogenicity. In this sense, drug delivery systems (DDSs) have been described in the literature as a viable option for overcoming the limitations of these drugs. An analysis of the level of development (TRL) of patents can help in determine the steps that must be taken for promising technologies to reach the market. AREAS COVERED This study aimed to analyze the stage of development of DDSs for the treatment of SCL described in patents. In addition, we try to understand the main reasons why many DDSs do not reach the market. In this study, we examined DDSs for drugs indicated by WHO and treatment of SCL, by performing a search for patents. EXPERT OPINION In this present work we provide arguments that support the hypothesis that there is a lack of integration between academia and industry to finance and continue research, especially the development of clinical studies. We cite the translational research consortia as the potential alternative for developing DDSs to combat NTDs.
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Affiliation(s)
| | | | | | - Luise Lopes Chaves
- Department of Pharmacy, Federal University of Pernambuco, Recife, Recife-Pernambuco
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Medullary neuroschistosomiasis in adolescence: case report and literature review. Childs Nerv Syst 2021; 37:2735-2741. [PMID: 34169385 DOI: 10.1007/s00381-021-05267-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Medullary neuroschistosomiasis is a severe complication of gastrointestinal infection by Schistosoma. There are several endemic areas, wherein the only causative species present is Schistosoma mansoni, which is responsible for the clinical manifestations of all cases in those areas. METHODS We report the case of a 13-year-old female with lumbar pain and progressive lower limb weakness, with a delayed diagnosis of medullary involvement by the parasite. We also reviewed the literature on the disease. CONCLUSIONS Although it is related to the less severe forms of schistosomiasis, one should pay attention to the diagnosis of neuroschistosomiasis in cases of transverse myelitis in patients who traveled to endemic areas. The delay in diagnosis and, consequently, the introduction of treatment may result in irreversible neurological sequelae.
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The returned traveler with neurologic manifestations: could my patient have a parasite? Curr Opin Infect Dis 2021; 34:245-254. [PMID: 33769967 DOI: 10.1097/qco.0000000000000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The present review focuses on parasitic infections of the central nervous system (CNS) that can affect the international traveler. RECENT FINDINGS The epidemiology of imported parasitic infections is changing and clinicians are treating increasing numbers of returned travelers with parasitic infections in the CNS with which they are not familiar. SUMMARY The epidemiology, life cycle, clinical manifestations, diagnosis, and treatment of parasites that affect the CNS will be discussed.
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Bhattacharyya S, Bradshaw MJ. Infections of the Spine and Spinal Cord. Continuum (Minneap Minn) 2021; 27:887-920. [PMID: 34623097 DOI: 10.1212/con.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Infections of the spine and spinal cord are associated with a high risk of morbidity and mortality and, therefore, require prompt clinical recognition, efficient diagnostic evaluation, and interdisciplinary treatment. This article reviews the pathophysiology, epidemiology, clinical manifestations, diagnosis, and treatment of infections of the spine and spinal cord to help practicing clinicians recognize, evaluate, and manage patients with such infections. RECENT FINDINGS Aging of the population, increasing use of immunosuppressive medications, and other factors have contributed to increasing rates of spinal infections. Although the most common agents responsible for spinal infections remain bacteria and viruses, fungal infections occur in individuals who are immunocompromised, and parasitic infections are common in endemic regions, but patterns are in evolution with migration and climate change. Recent outbreaks of acute flaccid myelitis in children have been associated with enteroviruses A71 and D68. SUMMARY Infections of the spine and spinal cord can be challenging to diagnose, requiring a thorough history and neurologic examination, laboratory studies of serum and CSF, neuroimaging (particularly MRI), and, in some instances, biopsy, to establish a diagnosis and treatment regimen. Interdisciplinary management including collaboration with experts in internal medicine, infectious disease, and neurosurgery is important to improve clinical outcomes.
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Abstract
PURPOSE OF REVIEW This article reviews how parasites affect the human nervous system, with a focus on four parasitic infections of major public health importance worldwide, two caused by protozoa (malaria and toxoplasmosis) and two by helminths (neurocysticercosis and schistosomiasis). RECENT FINDINGS Parasitic infections in humans are common, and many can affect the central nervous system where they may survive unnoticed or may cause significant pathology that can even lead to the death of the host. Neuroparasitoses should be considered in the differential diagnosis of neurologic lesions, particularly in individuals from endemic regions or those with a history of travel to endemic regions. SUMMARY Cerebral malaria is a significant cause of mortality, particularly in African children, in whom infected red blood cells affect the cerebral vessels, causing severe encephalopathy. Neurocysticercosis is the most common cause of acquired epilepsy worldwide and has varied clinical presentations, depending on the number, size, and location of the parasites in the nervous system as well as on the host's inflammatory response. Toxoplasmosis is distributed worldwide, affecting a significant proportion of the population, and may reactivate in patients who are immunosuppressed, causing encephalitis and focal abscesses. Schistosomiasis causes granulomatous lesions in the brain or the spinal cord.
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Gasparotto J, Senger MR, Telles de Sá Moreira E, Brum PO, Carazza Kessler FG, Peixoto DO, Panzenhagen AC, Ong LK, Campos Soares M, Reis PA, Schirato GV, Góes Valente WC, Araújo Montoya BO, Silva FP, Fonseca Moreira JC, Dal-Pizzol F, Castro-Faria-Neto HC, Gelain DP. Neurological impairment caused by Schistosoma mansoni systemic infection exhibits early features of idiopathic neurodegenerative disease. J Biol Chem 2021; 297:100979. [PMID: 34303703 PMCID: PMC8361297 DOI: 10.1016/j.jbc.2021.100979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022] Open
Abstract
Schistosomiasis, a neglected tropical disease caused by trematodes of the Schistosoma genus, affects over 250 million people around the world. This disease has been associated with learning and memory deficits in children, whereas reduced attention levels, impaired work capacity, and cognitive deficits have been observed in adults. Strongly correlated with poverty and lack of basic sanitary conditions, this chronic endemic infection is common in Africa, South America, and parts of Asia and contributes to inhibition of social development and low quality of life in affected areas. Nonetheless, studies on the mechanisms involved in the neurological impairment caused by schistosomiasis are scarce. Here, we used a murine model of infection with Schistosoma mansoni in which parasites do not invade the central nervous system to evaluate the consequences of systemic infection on neurologic function. We observed that systemic infection with S. mansoni led to astrocyte and microglia activation, expression of oxidative stress-induced transcription factor Nrf2, oxidative damage, Tau phosphorylation, and amyloid-β peptide accumulation in the prefrontal cortex of infected animals. We also found impairment in spatial learning and memory as evaluated by the Morris water maze task. Administration of anthelmintic (praziquantel) and antioxidant (N-acetylcysteine plus deferoxamine) treatments was effective in inhibiting most of these phenotypes, and the combination of both treatments had a synergistic effect to prevent such changes. These data demonstrate new perspectives toward the understanding of the pathology and possible therapeutic approaches to counteract long-term effects of systemic schistosomiasis on brain function.
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Affiliation(s)
- Juciano Gasparotto
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mario Roberto Senger
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Laboratório de Bioquímica Experimental e Computacional de Fármacos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Emilio Telles de Sá Moreira
- Laboratório de Bioquímica Experimental e Computacional de Fármacos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Pedro Ozorio Brum
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Flávio Gabriel Carazza Kessler
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniel Oppermann Peixoto
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Alana Castro Panzenhagen
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lin Kooi Ong
- Monash University Malaysia, School of Pharmacy, Bandar Sunway, Selangor, Malaysia; School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Australia, Callaghan, NSW, Australia
| | - Marlene Campos Soares
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Patricia Alves Reis
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Giuliana Viegas Schirato
- Laboratório de Bioquímica Experimental e Computacional de Fármacos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Walter César Góes Valente
- Laboratório de Bioquímica Experimental e Computacional de Fármacos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Bogar Omar Araújo Montoya
- Laboratório de Bioquímica Experimental e Computacional de Fármacos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Floriano P Silva
- Laboratório de Bioquímica Experimental e Computacional de Fármacos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - José Claudio Fonseca Moreira
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Felipe Dal-Pizzol
- Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Hugo C Castro-Faria-Neto
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Daniel Pens Gelain
- Departamento de Bioquímica, Centro de Estudos em Estresse Oxidativo, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Stothard JR, Webster BL. Acute Schistosomiasis: Which Molecular Diagnostic Test Is Best and Why. Clin Infect Dis 2021; 72:1699-1700. [PMID: 32215645 DOI: 10.1093/cid/ciaa319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/24/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bonnie L Webster
- Department of Life Sciences, Natural History Museum, London, United Kingdom
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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.
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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
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Gui QF, Jin HL, Zhu F, Lu HF, Zhang Q, Xu J, Yang YM, Xiao C. Gut microbiota signatures in Schistosoma japonicum infection-induced liver cirrhosis patients: a case-control study. Infect Dis Poverty 2021; 10:43. [PMID: 33771232 PMCID: PMC8004463 DOI: 10.1186/s40249-021-00821-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/08/2021] [Indexed: 12/15/2022] Open
Abstract
Background Several studies have assessed the role of gut microbiota in various cirrhosis etiologies, however, none has done so in the context of Schistosoma japonicum infection in humans. We, therefore, sought to determine whether gut microbiota is associated with S. japonicum infection-induced liver cirrhosis. Methods From December 2017 to November 2019, 24 patients with S. japonicum infection-induced liver cirrhosis, as well as 25 age- and sex-matched controls from the Zhejiang Province, China, were enrolled. Fecal samples were collected and used for 16S rRNA gene sequencing (particularly, the hypervariable V4 region) using the Illumina MiSeq system. Wilcoxon Rank-Sum and PERMANOVA tests were used for analysis. Results Eight hundred and seven operational taxonomic units (OTUs) were detected, of which, 491 were common between the two groups, whereas 123 and 193 were unique to the control and cirrhosis groups, respectively. Observed species, Chao, ACE, Shannon, Simpson, and Good’s coverage indexes, used for alpha diversity analysis, showed values of 173.4 ± 63.8, 197.7 ± 73.0, 196.3 ± 68.9, 2.96 ± 0.57, 0.13 ± 0.09, and 1.00 ± 0.00, respectively, in the control group and 154.0 ± 68.1, 178.6 ± 75.1, 179.9 ± 72.4, 2.68 ± 0.76, 0.19 ± 0.18, and 1.00 ± 0.00, respectively, in the cirrhosis group, with no significant differences observed between the groups. Beta diversity was evaluated by weighted UniFrac distances, with values of 0.40 ± 0.13 and 0.40 ± 0.11 in the control and cirrhosis groups, respectively (P > 0.05). PCA data also confirmed this similarity (P > 0.05). Meanwhile, the relative abundance of species belonging to the Bacilli class was higher in cirrhosis patients [median: 2.74%, interquartile range (IQR): 0.18–7.81%] than healthy individuals (median: 0.15%, IQR: 0.47–0.73%; P < 0.01), and that of Lactobacillales order was also higher in cirrhosis patients (median: 2.73%, IQR: 0.16–7.80%) than in healthy individuals (median: 0.12%, IQR: 0.03–0.70%; P < 0.05). Conclusions Cumulatively, our results suggest that the gut microbiota of S. japonicum infection-induced liver cirrhosis patients is similar to that of healthy individuals, indicating that bacterial taxa cannot be used as non-invasive biomarkers for S. japonicum infection-induced liver cirrhosis. ![]()
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Affiliation(s)
- Qi-Feng Gui
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-Chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Hui-Lin Jin
- Department of Geriatrics, Wangdian People's Hospital, Jiaxing, Zhejiang, People's Republic of China
| | - Feng Zhu
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-Chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Hai-Feng Lu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Qin Zhang
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-Chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Jia Xu
- Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-Chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.,Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yun-Mei Yang
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China. .,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-Chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
| | - Chi Xiao
- School of Basic Medical Sciences & Forensic Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China.
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de Wilton A, Aggarwal D, Jäger HR, Manji H, Chiodini PL. Delayed diagnosis of spinal cord schistosomiasis in a non-endemic country: A tertiary referral centre experience. PLoS Negl Trop Dis 2021; 15:e0009161. [PMID: 33571228 PMCID: PMC7904161 DOI: 10.1371/journal.pntd.0009161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/24/2021] [Accepted: 01/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Neuroschistosomiasis is a severe complication of schistosomiasis, triggered by the local immune reaction to egg deposition, with spinal cord involvement the most well recognised form. Early treatment with praziquantel and high dose steroids leads to a reduction of neurological sequelae. The rarity of this condition in returning travellers to high income countries can result in delayed diagnosis and treatment. We aimed to evaluate the diagnosis and management of neuroschistosomiasis in a UK national referral centre. Materials/Methods A retrospective review of confirmed clinical cases of spinal schistosomiasis referred to the Hospital for Tropical Diseases, UK, between January 2016 and January 2020 was undertaken. Electronic referral records were interrogated and patient demographic, clinical, laboratory, and radiological data collected. Results Four cases of neuroschistosomiasis were identified. The median age at diagnosis was 28 (range 21 to 50) with three male patients. All patients had epidemiological risk factors for schistosomiasis based on travel history and freshwater exposure; two in Uganda (River Nile), one in Malawi and one in Nigeria. All patients presented with features of transverse myelitis including back pain, leg weakness, paraesthesia and urinary dysfunction. The mean time from presentation to health services to definitive treatment was 42.5 days (range 16–74 days). Diagnosis was confirmed with CSF serology for schistosomiasis in all cases. Radiological features on MRI spine included enhancement focused predominantly in the lower thoracic spinal cord in three cases and the conus in one patient. All patients received a minimum of three days of oral praziquantel and high dose steroids. At three-month follow-up, one patient had complete resolution of symptoms and three had residual deficit; one patient was left with urinary and faecal incontinence, another had urinary retention, and the final patient has persistent leg pains and constipation. Conclusion We observed a marked delay in diagnosis of neuroschistosomiasis in a non-endemic country. We advocate undertaking a thorough travel history, early use of imaging and CSF schistosomal serology to ensure early diagnosis of neuroschistosomiasis in patients presenting with consistent symptoms. If schistosomal diagnostics are not immediately available, presumptive treatment under the guidance of a tropical medicine specialist should be considered to minimize the risk of residual disability. We advocate for consensus guidelines to be produced and reporting to be performed in a uniform way for patients with spinal schistosomiasis. Schistosomiasis is a parasitic neglected tropical disease causing morbidity and mortality in several tropical regions. The most commonly described complications of schistosomiasis include urinary tract and gastrointestinal pathology. However, ectopic migration of parasitic worms and their eggs into the central nervous system can lead to profound and life altering disability. This phenomenon, referred to as ‘Neuroschistosomiasis’ is a rarely reported in non-endemic countries. However, occurrence is increasingly recognised in non-endemic regions due to the increase in global travel. We report the clinical and radiological characteristics of four patients who developed neuroschistosomiasis following tropical freshwater exposure. The report informs diagnosis of schistosomiasis, diagnostic features including subtle radiological findings typical of schistosomiasis, and management of neuroschistosomiasis. The report further highlights the delays in diagnosis of these patients, and the importance of travel history and seeking specialist parasitological advice when patients present with spinal cord syndromes following relevant exposures.
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Affiliation(s)
- Angus de Wilton
- The Hospital for Tropical Diseases, University College London Hospitals, United Kingdom
- * E-mail:
| | - Dinesh Aggarwal
- The Hospital for Tropical Diseases, University College London Hospitals, United Kingdom
| | - Hans Rolf Jäger
- UCL Queen Square Institute of Neurology, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Hadi Manji
- Department of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Peter L. Chiodini
- The Hospital for Tropical Diseases, University College London Hospitals, United Kingdom
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
PURPOSE OF REVIEW This article reviews infectious etiologies of spinal cord dysfunction, emphasizing the importance of recognizing common clinicoradiographic syndromes and interpreting them in the context of exposure risk and individual host susceptibilities. RECENT FINDINGS This article discusses the shifting spectrum of neurologic infectious diseases, the growing population of patients who are immunocompromised, and the emergence of effective antiretroviral therapies. In addition, it discusses new molecular and serologic tests that have the potential to enhance our ability to rapidly and accurately diagnose infectious diseases of the spine. SUMMARY When evaluating patients with suspected infectious myelopathies, it is imperative to narrow the range of pathogens under consideration. The geography, seasonality, and clinicoradiographic presentation and immunocompetence status of the patient define the range of potential pathogens and should guide testing and initial management.
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Longitudinally Extensive Transverse Myelitis: A Sub-Saharan Conundrum. Case Rep Neurol Med 2020; 2020:8879121. [PMID: 33376612 PMCID: PMC7744221 DOI: 10.1155/2020/8879121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 11/25/2022] Open
Abstract
Spinal cord schistosomiasis is a rare, underdiagnosed manifestation of schistosomiasis. We present the case of a 36-year-old male who presented to our institution with a one-week history of low back pain with rapidly progressive lower limb weakness, loss of sensation, and flaccid paraparesis. An MRI of the spine showed a longitudinally extensive transverse myelitis from T6 to L1, with enhancement at the cauda equina region. Further review of the images and serological tests eventually led to diagnosis of spinal schistosomiasis. He was treated with praziquantel and high-dose steroids, with minimal improvement in his symptoms.
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Matarneh AS, Abdullah W, Khan AA, Sadiq A, Farooqui K. A Case of Neuroschistosomiasis Presenting as Transverse Myelitis: The Importance of History Taking. Cureus 2020; 12:e11445. [PMID: 33324527 PMCID: PMC7732780 DOI: 10.7759/cureus.11445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/19/2022] Open
Abstract
Neuroschistosomiasis is a rare manifestation of Schistosoma infection and can either manifest as cerebritis or with spinal cord involvement. We present a case of low back pain and lower limb weakness, which was initially managed as idiopathic transverse myelitis and later on found to have neuroschistosomiasis. A 23-year-old Sudanese gentleman presented with a one-week history of low back pain, lower limb weakness, and urinary retention. An urgent MRI of the spine with contrast showed features suggestive of transverse myelitis. The patient was treated with intravenous methylprednisolone for five days, which showed significant improvement in his symptoms. One week later, the patient developed the same symptoms again. An urgent MRI spine showed an interval progression of MRI findings. Repeat history taking revealed a history of swimming many times in the river Nile. Serology was sent for Schistosoma and came positive with titer 1:1280. He was treated as neuroschistosomiasis with intravenous steroids for three days, followed by praziquantel for five days along with the steroids, after which he showed significant improvement in his lower limb weakness. Spinal neuroschistosomiasis is one of the very rare complications of Schistosoma infection that should be kept in mind when dealing with unexplained myelopathy with a history of travel or origin from an endemic area. If not treated promptly, it can result in severe irreversible complications.
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Affiliation(s)
| | - Wafa Abdullah
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Adeel A Khan
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Amna Sadiq
- Radiology, Hamad Medical Corporation, Doha, QAT
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Abstract
The innate immune system in the central nervous system (CNS) is mainly represented by specialized tissue-resident macrophages, called microglia. In the past years, various species-, host- and tissue-specific as well as environmental factors were recognized that essentially affect microglial properties and functions in the healthy and diseased brain. Host microbiota are mostly residing in the gut and contribute to microglial activation states, for example, via short-chain fatty acids (SCFAs) or aryl hydrocarbon receptor (AhR) ligands. Thereby, the gut microorganisms are deemed to influence numerous CNS diseases mediated by microglia. In this review, we summarize recent findings of the interaction between the host microbiota and the CNS in health and disease, where we specifically highlight the resident gut microbiota as a crucial environmental factor for microglial function as what we coin "the microbiota-microglia axis."
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Affiliation(s)
- Omar Mossad
- Institute of NeuropathologyFaculty of MedicineUniversity of FreiburgFreiburgGermany
- Faculty of BiologyUniversity of FreiburgFreiburgGermany
| | - Daniel Erny
- Institute of NeuropathologyFaculty of MedicineUniversity of FreiburgFreiburgGermany
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Domingues ALC, Barbosa CS, Agt TFA, Mota AB, Franco CMR, Lopes EP, Loyo R, Gomes ECS. Spinal neuroschistosomiasis caused by Schistoma mansoni: cases reported in two brothers. BMC Infect Dis 2020; 20:724. [PMID: 33008310 PMCID: PMC7530957 DOI: 10.1186/s12879-020-05428-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background Spinal neuroschistosomiasis (SN) is one of the most severe clinical presentations of schistosomiasis infection and an ectopic form of the disease caused by any species of Schistosoma. In Brazil, all cases of this clinical manifestation are related to Schistosoma mansoni, the only species present in the country. Although many cases have been reported in various endemic areas in Brazil, this is the first time in the literature that SN is described in two brothers. Case presentation Two cases of SN were accidentally diagnosed during an epidemiological survey in an urban area endemic for schistosomiasis transmission. Both patients complained of low back pain and muscle weakness in the lower limbs. Sphincter dysfunction and various degrees of paresthesia were also reported. The patients’ disease was classified as hepato-intestinal stage schistosomiasis mansoni at the onset of the chronic form. A positive parasitological stool test for S. mansoni, clinical evidence of myeloradicular damage and exclusion of other causes of damage were the basic criteria for diagnosis. After treatment with praziquantel and corticosteroid, the patients presented an improvement in symptoms, although some complaints persisted. Conclusions It is important to consider SN when patients come from areas endemic for transmission of schistosomiasis mansoni. Clinical physicians and neurologists should consider this diagnostic hypothesis, because recovery from neurological injuries is directly related to early treatment. As, described here in two brothers, a genetic predisposition may be related to neurological involvement. Primary care physicians should thus try to evaluate family members and close relatives in order to arrive at prompt schistosomiasis diagnosis in asymptomatic individuals and propose treatment in an attempt to avoid progression to SN.
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Affiliation(s)
- Ana Lúcia Coutinho Domingues
- Department of Gastroenterology, Clinical Hospital, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Constança Simões Barbosa
- Department of Parasitology, Schistosomiasis Reference Laboratory, Aggeu Magalhães Institute, Fiocruz - Ministry of Health, Recife, PE, 50740-465, Brazil
| | - Thiago Frederico Andrade Agt
- Department of Neurology, Clinical Hospital, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Andréia Braga Mota
- Department of Neurology, Clinical Hospital, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Clélia Maria Ribeiro Franco
- Department of Neurology, Clinical Hospital, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Edmundo Pessoa Lopes
- Department of Gastroenterology, Clinical Hospital, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Rodrigo Loyo
- Department of Parasitology, Schistosomiasis Reference Laboratory, Aggeu Magalhães Institute, Fiocruz - Ministry of Health, Recife, PE, 50740-465, Brazil
| | - Elainne Christine Souza Gomes
- Department of Parasitology, Schistosomiasis Reference Laboratory, Aggeu Magalhães Institute, Fiocruz - Ministry of Health, Recife, PE, 50740-465, Brazil.
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Lampros A, Caumes E, Psimaras D, Galanaud D, Clarençon F, Peyre M, Deltour S, Bielle F, Lhote R, Haroche J, Amoura Z, Cohen Aubart F. [Infection associated cerebral vasculitis]. Rev Med Interne 2020; 42:258-268. [PMID: 32868117 DOI: 10.1016/j.revmed.2020.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/26/2020] [Accepted: 05/07/2020] [Indexed: 12/11/2022]
Abstract
Infections are a frequent cause of cerebral vasculitis, important to diagnose because a specific treatment may be required. Infection-associated vasculitis can be caused by angiotropic pathogens (varicella zoster virus, syphilis, aspergillus). They can be associated with subarachnoidal meningitis (tuberculosis, pyogenic meningitis, cysticercosis). They can appear contiguously to sinuses or orbital infection (aspergillosis, mucormycosis). Finally, they also may be due to an immune mechanism in the context of chronic infections (hepatitis B virus, hepatitis C virus, human immunodeficiency virus). Cerebral vasculitis are severe conditions and their prognosis is directly linked to early recognition and diagnosis. Infectious causes must therefore be systematically considered ahead of cerebral vasculitis, and the appropriate investigations must be determined according to the patient's clinical context. We propose here an update on the infectious causes of cerebral vasculitis, their diagnosis modalities, and therapeutic options.
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Affiliation(s)
- A Lampros
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de Médecine Interne 2, Centre de Référence Maladies systémiques rares et Histiocytoses, 75013 Paris, France
| | - E Caumes
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service des maladies infectieuses et tropicales, 75013 Paris, France
| | - D Psimaras
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de Neurologie 2, 75013 Paris, France
| | - D Galanaud
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de Neuroradiologie, 75013 Paris, France
| | - F Clarençon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de Neuroradiologie, 75013 Paris, France
| | - M Peyre
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de Neurochirurgie, 75013 Paris, France
| | - S Deltour
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service des Urgences cérébro-vasculaires, 75013 Paris, France
| | - F Bielle
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de Neuropathologie, 75013 Paris, France
| | - R Lhote
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de Médecine Interne 2, Centre de Référence Maladies systémiques rares et Histiocytoses, 75013 Paris, France
| | - J Haroche
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de Médecine Interne 2, Centre de Référence Maladies systémiques rares et Histiocytoses, 75013 Paris, France
| | - Z Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de Médecine Interne 2, Centre de Référence Maladies systémiques rares et Histiocytoses, 75013 Paris, France
| | - F Cohen Aubart
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de Médecine Interne 2, Centre de Référence Maladies systémiques rares et Histiocytoses, 75013 Paris, France.
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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.
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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
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Gobbi F, Tamarozzi F, Buonfrate D, van Lieshout L, Bisoffi Z, Bottieau E. New Insights on Acute and Chronic Schistosomiasis: Do We Need a Redefinition? Trends Parasitol 2020; 36:660-667. [PMID: 32505540 DOI: 10.1016/j.pt.2020.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/29/2022]
Abstract
A precise timeframe to differentiate acute schistosomiasis (AS) and chronic schistosomiasis (CS) is not well defined. Based on recent published literature, lung nodular lesions in AS and CS seem to have the same pathophysiology, that is, eggs laid in situ by adult worms, during an ectopic migration. Moreover, the occurrence of lung nodules due to clusters of eggs and the systemic immunoallergic reaction of AS (Katayama syndrome) may be two separate clinical entities, which may overlap during the early phase of infection. Consequently, the classical distinction between AS and CS loses much of its conceptual validity. If adult worms play a more important role in the early phase of the disease the clinical management of AS should probably be revised.
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Affiliation(s)
- Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar (Verona), Italy.
| | - Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar (Verona), Italy
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar (Verona), Italy
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Zeno Bisoffi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar (Verona), Italy; Università degli Studi di Verona, Verona, Italy
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Majmundar N, Patel PD, Dodson V, Tran A, Goldstein I, Assina R. Parasitic infections of the spine: case series and review of the literature. Neurosurg Focus 2020; 46:E12. [PMID: 30611161 DOI: 10.3171/2018.10.focus18472] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/26/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVEAlthough parasitic infections are endemic to parts of the developing world and are more common in areas with developing economies and poor sanitary conditions, rare cases may occur in developed regions of the world.METHODSArticles eligible for the authors' literature review were initially searched using PubMed with the phrases "parasitic infections" and "spine." After the authors developed a list of parasites associated with spinal cord infections from the initial search, they expanded it to include individual diagnoses, using search terms including "neurocysticercosis," "schistosomiasis," "echinococcosis," and "toxoplasmosis."RESULTSTwo recent cases of parasitic spinal infections from the authors' institution are included.CONCLUSIONSKey findings on imaging modalities, laboratory studies suggestive of parasitic infection, and most importantly a thorough patient history are required to correctly diagnose parasitic spinal infections.
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Silva TR, Rocha Santos MA, Macedo de Resende L, Labanca L, Caporali JFDM, Scoralick Dias RT, Utsch Gonçalves D. Vestibular Evoked Myogenic Potential on Ocular, Cervical, and Soleus Muscles to Assess the Extent of Neurological Impairment in HTLV-1 Infection. Front Neurol 2020; 11:433. [PMID: 32508741 PMCID: PMC7253674 DOI: 10.3389/fneur.2020.00433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/23/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: Vestibular Evoked Myogenic Potential (VEMP) can be used to test central vestibular pathways from the midbrain to the lumbar spine, according to the muscle tested. Purpose: to compare the spinal cord alteration in individuals with HTLV-1-associated myelopathy (HAM) and with HTLV-1-asymptomatic infection using the VEMP recorded from different muscles. Methods: VEMP was recorded in 90 individuals of whom 30 had HAM, 30 were HTLV-1 asymptomatic carriers, and 30 negative controls. VEMP was recorded in the oculomotor muscle (oVEMP), testing the vestibulo-ocular reflex, and in the cervical muscle (cVEMP) and soleus muscle (sVEMP), testing the vestibulospinal reflex, respectively, in the cervical and in the lumbar spinal level. The type of stimulation was auditory for oVEMP and cVEMP, and galvanic for sVEMP. The compared variables were the latencies of the electrophysiological waves. Results: HTLV-1-asymptomatic group was similar to the controls regarding oVEMP (p = 0.461), but different regarding cVEMP (p < 0.001) and sVEMP (p < 0.001). HAM group has presented the worst latencies and was different from the HTLV-1-asymptomatic group in the VEMP of all the tested muscles (p < 0.001). The concomitant occurrence of VEMP alterations in the three recorded muscles of the same individual was found in 2 (6.7%) asymptomatic carriers and in 20 (66.7%) patients with HAM (p = 0.001). The analysis of VEMP alteration per group and per muscle has showed that, in HTLV-1-asymptomatic group, oVEMP was altered in 3 (10.0%) individuals, cVEMP in 10 (33.3%) and sVEMP in 13 (43.3%). In HAM group, oVEMP was altered in 23 (76.6%) individuals, cVEMP in 27 (90%), and sVEMP in 30 (100%). Conclusion: HTLV-1-neurological damage has followed an ascendant progression beginning at the lumbar spine in the stage of a clinically asymptomatic infection, whereas HAM has affected not only the spine, but also the midbrain.
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Affiliation(s)
- Tatiana Rocha Silva
- Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marco Aurélio Rocha Santos
- Graduate Program in Phonoaudiological Sciences, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luciana Macedo de Resende
- Graduate Program in Phonoaudiological Sciences, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ludimila Labanca
- Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Graduate Program in Phonoaudiological Sciences, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Júlia Fonseca de Morais Caporali
- Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rafael Teixeira Scoralick Dias
- Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Denise Utsch Gonçalves
- Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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46
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Zijlstra EE, van Hellemond JJ, Moes AD, de Boer C, Boeschoten SA, van Blijswijk CEM, van der Vuurst de Vries RM, Bailey PAB, Kampondeni S, van Lieshout L, Smits SL, Katchanov J, Mkandawire NM, Rothe C. Nontraumatic Myelopathy in Malawi: A Prospective Study in an Area with High HIV Prevalence. Am J Trop Med Hyg 2020; 102:451-457. [PMID: 31837130 DOI: 10.4269/ajtmh.19-0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Nontraumatic myelopathy causes severe morbidity and is not uncommon in Africa. Clinically, patients often present with paraplegia, and extrinsic cord compression and transverse myelitis are most common causes. Data on exact pathogenesis are scanty because of limitations in diagnostic methods. In Queen Elizabeth Central Hospital, Blantyre, Malawi, we recorded consecutive patients presenting with nontraumatic paraplegia for maximally 6 months between January and July 2010 and from March to December 2011. The diagnostic workup included imaging and examining blood, stool, urine, sputum, and cerebrospinal fluid (CSF) samples for infection. After discharge, additional diagnostic tests, including screening for virus infections, borreliosis, syphilis, and schistosomiasis, were carried out in the Netherlands. The clinical diagnosis was, thus, revised in retrospect with a more accurate final differential diagnosis. Of 58 patients included, the mean age was 41 years (range, 12-83 years) and the median time between onset and presentation was 18 days (range, 0-121 days), and of 55 patients tested, 23 (42%) were HIV positive. Spinal tuberculosis (n = 24, 41%), tumors (n = 16, 28%), and transverse myelitis (n = 6, 10%) were most common; in six cases (10%), no diagnosis could be made. The additional tests yielded evidence for CSF infection with Schistosoma, Treponema pallidum, Epstein-Barr virus (EBV), HHV-6, HIV, as well as a novel cyclovirus. The diagnosis of the cause of paraplegia is complex and requires access to an magnetic resonance imaging (MRI) scan and other diagnostic (molecular) tools to demonstrate infection. The major challenge is to confirm the role of detected pathogens in the pathophysiology and to design an effective and affordable diagnostic approach.
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Affiliation(s)
| | - Jaap J van Hellemond
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arthur D Moes
- Division of Nephrology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christa de Boer
- Infectious Disease Control, Municipal Health Service Zuid-Holland Zuid, Dordrecht, The Netherlands
| | - Shelley A Boeschoten
- Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | | | | | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Saskia L Smits
- Viroclinics Biosciences BV, Rotterdam Science Tower, Rotterdam, The Netherlands
| | - Juri Katchanov
- Department of Hematology and Oncology, LMU University of Munich, Munich, Germany.,Department of Medicine, College of Medicine, Blantyre, Malawi
| | | | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,Department of Medicine, College of Medicine, Blantyre, Malawi
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47
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Duarte Armindo R, Costa S, Almeida V, Barroso C. Cerebral schistosomiasis in a patient travelling from São Tomé and Príncipe. BJR Case Rep 2020; 6:20190055. [PMID: 32201606 PMCID: PMC7068093 DOI: 10.1259/bjrcr.20190055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/23/2019] [Accepted: 08/29/2019] [Indexed: 12/02/2022] Open
Abstract
Aiming to raise awareness for the possibility of schistosomal involvement of the central nervous system in travellers returning from endemic areas and/or immigrants to nonendemic areas, the authors report a case of neuroschistosomiasis in a Portuguese patient coming from the Republic of São Tomé and Príncipe with good clinical outcome following praziquantel therapy. This is the first case of neuroschistosomiasis associated with São Tomé and Príncipe reported in literature and further studies are needed to confirm which species of this parasite are endemic of that region. We conclude that early diagnosis is key to reduce clinical severity and therefore validation of new diagnostic techniques and establishment of consensual treatment guidelines would be important.
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Affiliation(s)
| | - Sónia Costa
- Neurology Unit, Hospital Vila Franca Xira, Vila Franca de Xira, Portugal
| | - Vânia Almeida
- Neurology Unit, Hospital Vila Franca Xira, Vila Franca de Xira, Portugal
| | - Cândida Barroso
- Neurology Unit, Hospital Vila Franca Xira, Vila Franca de Xira, Portugal
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Schistosomiasis-from immunopathology to vaccines. Semin Immunopathol 2020; 42:355-371. [PMID: 32076812 PMCID: PMC7223304 DOI: 10.1007/s00281-020-00789-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/05/2020] [Indexed: 12/18/2022]
Abstract
Schistosomiasis (bilharzia) is a neglected tropical disease caused by trematode worms of the genus Schistosoma. The transmission cycle involves human (or other mammalian) water contact with surface water contaminated by faeces or urine, as well as specific freshwater snails acting as intermediate hosts. The main disease-causing species are S. haematobium, S. mansoni and S. japonicum. According to the World Health Organisation, over 250 million people are infected worldwide, leading to considerable morbidity and the estimated loss of 1.9 million disability-adjusted life years (DALYs), a likely underestimated figure. Schistosomiasis is characterised by focal epidemiology and an over-dispersed population distribution, with higher infection rates in children. Complex immune mechanisms lead to the slow acquisition of immune resistance, but innate factors also play a part. Acute schistosomiasis, a feverish syndrome, is most evident in travellers following a primary infection. Chronic schistosomiasis affects mainly individuals with long-standing infections residing in poor rural areas. Immunopathological reactions against schistosome eggs trapped in host tissues lead to inflammatory and obstructive disease in the urinary system (S. haematobium) or intestinal disease, hepatosplenic inflammation and liver fibrosis (S. mansoni and S. japonicum). An effective drug—praziquantel—is available for treatment but, despite intensive efforts, no schistosomiasis vaccines have yet been accepted for public use. In this review, we briefly introduce the schistosome parasites and the immunopathogenic manifestations resulting from schistosomiasis. We then explore aspects of the immunology and host-parasite interplay in schistosome infections paying special attention to the current status of schistosomiasis vaccine development highlighting the advancement of a new controlled human challenge infection model for testing schistosomiasis vaccines.
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Belaz S, Chiforeanu D, Devaux JM, Tattevin P, Robert-Gangneux F, Gangneux JP. A 37-Year-Old Woman With Left Sensomotor Seizure. Brain Pathol 2020; 29:577-578. [PMID: 31290229 DOI: 10.1111/bpa.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sorya Belaz
- Department of Parasitology and Mycology, Infectious Diseases Centre Hospitalier Régional Universitaire, Rennes, France
| | - Dan Chiforeanu
- Department of Anatomopathology, Infectious Diseases Centre Hospitalier Régional Universitaire, Rennes, France
| | - Jean-Maxime Devaux
- Department of Parasitology and Mycology, Infectious Diseases Centre Hospitalier Régional Universitaire, Rennes, France
| | - Pierre Tattevin
- Infectious Diseases Centre Hospitalier Régional Universitaire, Rennes, France
| | - Florence Robert-Gangneux
- Department of Parasitology and Mycology, Infectious Diseases Centre Hospitalier Régional Universitaire, Rennes, France
| | - Jean-Pierre Gangneux
- Department of Parasitology and Mycology, Infectious Diseases Centre Hospitalier Régional Universitaire, Rennes, France
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50
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Tan Z, Lei Z, Zhang Z, Zhang H, Shu K, Hu F, Lei T. Identification and characterization of microglia/macrophages in the granuloma microenvironment of encephalic schistosomiasis japonicum. BMC Infect Dis 2019; 19:1088. [PMID: 31888505 PMCID: PMC6937796 DOI: 10.1186/s12879-019-4725-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background Egg-induced immune response and granuloma formation are thought to be the basis of central nervous system (CNS)-related clinical symptoms of Schistosoma japonicum. Microglia/macrophages are the major immune cells involved in detection and subsequent elimination of pathogens and injured tissue in the brain. However, little is known about their role in the pathogenesis of neuroschistosomiasis. The main purpose of the study is to clarify the pathological involvement of microglia/macrophages in the pathogenesis of neuroschistosomiasis (NS). Methods Staining techniques were applied to the granuloma tissues excised from 4 patients, as well as mice model which was established by microinjecting viable S. japonicum eggs into the brain. Clinical features of the patients and neurological symptoms in mice were also collected and analyzed in terms of their correlation with microglia/macrophages. Results Microglia/macrophages constituted the major portions of the granulomas surrounding the eggs in both all human cases and S. japonicum egg-injected mice. Granuloma persisted in all patients accompanied by unremitted neurological symptoms, while in mice granuloma formation initiated on day 3, peaked on day 7 and subsided on day 30 post injection with S. japonicum eggs. No neurological abnormalities were observed in egg-injected mice except for significant weight decrease on day 3 compared with saline-injected control. M1 polarization of microglia/macrophages was confirmed in egg-injected mice 3 days post injection and in all human cases. M2 polarization was absent in human patients despite the duration of complaints but dominated in the whole progression of egg-induced pathology in mice until the elimination of eggs and subsidence of neuroinflammation on day 30 post injection. Conclusions Microglia/macrophages participated actively in the granuloma microenvironment of encephalic schistosomiasis japonicum in both human and mice. The polarization pattern of microglia/macrophages coincided with the symptomatic features in human cases and S. japonicum egg-injected mice, indicating M2 instead of M1 activation as a probably more important mediator in the battle against egg-induced pathology and concomitant manifestations. These new findings will shed light on the pathogenesis of NS from a brand-new perspective, and may contribute to the immunotherapy development for such disease, favoring perhaps M2 polarization of microglia/macrophages as a feasible strategy.
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Affiliation(s)
- Zhoubin Tan
- Sino-German Neuro-Oncology Molecular Laboratory, Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuowei Lei
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuo Zhang
- Sino-German Neuro-Oncology Molecular Laboratory, Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Present Address: Department of Neurosurgery, Philipps University Marburg, Baldingerstr, Marburg, Germany
| | - Huaqiu Zhang
- Sino-German Neuro-Oncology Molecular Laboratory, Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Shu
- Sino-German Neuro-Oncology Molecular Laboratory, Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Hu
- Sino-German Neuro-Oncology Molecular Laboratory, Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ting Lei
- Sino-German Neuro-Oncology Molecular Laboratory, Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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