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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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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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Vasconcelos Miranda TA, Tsuchiya K, Lucato LT. Imaging of Central Nervous System Parasitic Infections. Neuroimaging Clin N Am 2023; 33:125-146. [DOI: 10.1016/j.nic.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cimini A, Ricci M, Gigliotti PE, Pugliese L, Chiaravalloti A, Danieli R, Schillaci O. Medical Imaging in the Diagnosis of Schistosomiasis: A Review. Pathogens 2021; 10:pathogens10081058. [PMID: 34451522 PMCID: PMC8401107 DOI: 10.3390/pathogens10081058] [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: 07/30/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 12/15/2022] Open
Abstract
Schistosomiasis is one of the most important parasitic diseases and it is endemic in tropical and subtropical areas. Clinical and laboratory data are fundamental for the diagnosis of schistosomiasis, but diagnostic imaging techniques such as x-rays, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) may be helpful in the evaluation of disease severity and complications. In this context, the aim of this review is to explore the actual role of diagnostic imaging in the diagnosis of schistosomiasis, underlining advantages and drawbacks providing information about the utilization of diagnostic imaging techniques in this context. Furthermore, we aim to provide a useful guide regarding imaging features of schistosomiasis for radiology and nuclear medicine physicians of non-endemic countries: in fact, in the last years non-endemic countries have experienced important flows of migrants from endemic areas, therefore it is not uncommon to face cases of this disease in daily practice.
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Affiliation(s)
- Andrea Cimini
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
- Correspondence: ; Tel.: +39-(06)-20902467
| | - Maria Ricci
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
| | - Paola Elda Gigliotti
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
| | - Luca Pugliese
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
- Department of Radiology, San Giovanni Calibita Fatebenefratelli Hospital, Via di Ponte di Quattro Capi 39, 00186 Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
- Nuclear Medicine Section, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Roberta Danieli
- Department of Human Sciences and Promotion of the Quality of Life, University San Raffaele, Via di Val Cannuta 247, 00166 Rome, Italy;
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
- Nuclear Medicine Section, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
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Bruscky IS, Bruscky DMV, de Melo FL, Medeiros ZM, Correia CDC. Cerebral mansoni schistosomiasis: a systematic review of 33 cases published from 1989 to 2019. Trans R Soc Trop Med Hyg 2021; 115:1410-1413. [PMID: 34037805 DOI: 10.1093/trstmh/trab067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/22/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We investigated the epidemiology, clinical presentation and outcomes of individuals affected by cerebral schistosomiasis. METHODS This systematic review was planned in accordance with current guidelines for performing comprehensive systematic reviews and meta-analysis, including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. RESULTS Most of patients presented with seizures (48.5%), which is a non-specific symptom despite its high prevalence. There was no specific clinical manifestation that could help the diagnosis, which was made in 69.7% by histopathological analysis of brain tissue. CONCLUSIONS Seizures are a non-specific symptom to diagnose patients with cerebral schistosomiasis and accurate clinical indicators need to be derived through further studies.
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Affiliation(s)
- Igor Silvestre Bruscky
- University of Pernambuco, 310 Arnobio Marques Street, Santo Amaro, Recife, Pernambuco, Brazil 50100-130
| | | | | | - Zulma Maria Medeiros
- University of Pernambuco, 310 Arnobio Marques Street, Santo Amaro, Recife, Pernambuco, Brazil 50100-130
| | - Carolina da Cunha Correia
- University of Pernambuco, 310 Arnobio Marques Street, Santo Amaro, Recife, Pernambuco, Brazil 50100-130
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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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Wen SCH, Anderson R, Ryan MM, Kumbla S, Wray A, Steer A. Pediatric Neuroschistosomiasis: A Case Report and Review of the Literature. J Pediatric Infect Dis Soc 2019; 8:489-491. [PMID: 30840073 DOI: 10.1093/jpids/piz009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/15/2019] [Accepted: 01/29/2019] [Indexed: 11/15/2022]
Abstract
Neuroschistosomiasis is a rare but severe manifestation of Schistosoma infection. Diagnosis is challenging and surgical biopsy is often required to confirm diagnosis and exclude malignancy. We present a pediatric case of presumed pseudotumoral cerebral schistosomiasis secondary to Schistosoma mansoni with an excellent therapeutic response to empirical praziquantel and corticosteroid treatment.
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Affiliation(s)
- Sophie C H Wen
- Infection Management Prevention Service, Queensland Children's Hospital, Brisbane, Australia
| | - Rebecca Anderson
- Infectious Diseases Unit, Department of General Medicine, Victoria, Australia
| | - Monique M Ryan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Departments of Neurology, University of Melbourne, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Surekha Kumbla
- Departments of Medical Imaging, Department of Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Alison Wray
- Departments of Neurosurgery, Department of Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew Steer
- Infectious Diseases Unit, Department of General Medicine, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Departments of Centre for International Child Health, Department of Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia
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Nepal P, Ojili V, Songmen S, Batchala P, Kumar D, Nagar AM. Multisystem imaging review of human schistosomiasis: characteristic imaging findings. Clin Imaging 2019; 54:163-171. [DOI: 10.1016/j.clinimag.2019.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/07/2019] [Accepted: 01/15/2019] [Indexed: 12/14/2022]
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