Spinal neuroschistosomiasis caused by Schistoma mansoni: cases reported in two brothers

Intramedullary spinal schistosomiasis: A case report and review of the literature

INTRODUCTION

Spinal cord schistosomiasis is an extremely rare entity presenting with a wide range of neurological symptoms. The early diagnosis and treatment can improve neurological outcome. Histopathological examination is the gold standard for establishing the diagnosis of spinal schistosomiasis, revealing schistosoma eggs.

CASE REPORT

We report a case of a 13-year-old male, from Mauritania, with a history of drinking unsafe water, presenting with an acute urinary retention and gait disturbances evolving for 1 month. His clinical examination found an incomplete conus medullary syndrome made up of urinary retention, lively patellar reflexes on the right, ataxia when walking on the same side and indifferent cutaneous planter reflex. The magnetic resonance imaging (MRI) on dorsal spine revealed an enhancing mass involving the conus medullaris in the L1-L2 region suggestive of an arteriovenous malformation or a cavernoma. The resection tissue specimens for diagnosis were fixed with 10 % buffered formalin. The slides were stained with haematoxylin-eosin staining for light microscopy. The diagnosis of schistosomiasis spinal cord was retained. The child has been treated with oral praziquantel 25 mg/kg.

DISCUSSION

Diagnosis of schistosomiasis is based on a combination of clinical evaluation, imaging studies, and laboratory tests. However, definitive diagnosis typically requires histopathological examination of spinal cord lesions obtained through biopsy. Differential diagnosis is broad, including an acute vascular event and/or tumor, especially in children from endemic areas for schistosomiasis.

CONCLUSION

Schistosomiasis infection should be suspected when encountering medullary lesion associated to peripheral hypereosinophilia. Surgical excision combined with praziquantel may help improve neurological deficits.

Long-Lasting Latent Neuroschistosomiasis in a Nonendemic Country: A Case Report

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.

Malacological, socio-environmental evaluation, and evidence of local transmission and maintenance of schistosomiasis in an urban area of Northeast Brazil

To present the current epidemiological scenario of schistosomiasis related to urban transmission through an epidemiological risk assessment in Porto de Galinhas, a coastal area of Pernambuco, Brazil. Malacological and parasitological surveys were performed between the years 2018 and 2020. Snails were identified taxonomically and examined to confirm infection by Schistosoma mansoni, and so to identify Schistosomiasis Transmission Foci (STF) by the artificial light exposure technique. Stool samples were examined using the Kato-Katz method to identify schistosomiasis cases. Socioeconomic, environmental, behavioural and health data were collected by a questionnaire applied to participates in the survey and used to predict the schistosomiasis risk occurrence by multivariate logistic regression. In all, a total of 6466 snails of Biomphalaria glabrata were collected and 36 breeding sites were identified, of which 25 % were STF. A total of 2236 individuals took part of the survey which identified 187 cases of schistosomiasis, registering a positivity percentage of 8.36 %. The surveys identified the neighbourhoods with the highest risk for transmission while the socioenvironmental analysis identifies other risk factors for disease occurrence, such as gender, age range, level of education and absence of water drainage. We found that areas with poor sanitation, flooding during winter periods and dwellings located near mangroves should be treated by health authorities as priority areas for health interventions to minimize disease transmission. In addition, efforts to improve the population's educational level could certainly contribute to the adoption of measures to prevent and control this neglected tropical disease.

Pediatric Spinal Neuroschistosomiasis in Yemen: An Overlooked Dilemma in an Endemic Region

BACKGROUND

Neurological involvement in schistosomiasis presents a significant and serious complication. While the disease is generally considered treatable during the early stages, the rarity of this condition often leads to delays in diagnosis and treatment. This study aims to report the clinical characteristics of pediatric patients with spinal neuroschistosomiasis (NS) in an endemic area to the disease.

METHODS

A retrospective cross-sectional review was conducted at Althora General Hospital in Ibb, Yemen, from January 2016 to January 2021. The study examined confirmed pediatric cases of spinal NS, analyzing their clinical characteristics, laboratory and radiological data, treatment approaches, and complications.

RESULTS

The study identified 10 cases of spinal NS with a mean age of 10.1± 3.2 years. The majority (90%) were male and from rural areas, all with a history of freshwater exposure, a known risk factor for schistosomiasis. The average time from presentation to treatment was 33.4± 45.6 days (7-150 days). Common symptoms observed in all patients were bladder dysfunction and paresthesia (100%). Intestinal dysfunction was prevalent in 90% of cases, while 80% exhibited limb weakness or inability to walk. The diagnosis was confirmed through cerebrospinal fluid (CSF) serology in 80% of cases, and stool and urine exams yielded positive results in 90% and 30% of cases, respectively. Magnetic Resonance Imaging findings revealed medullary lesions in 50% of cases, cauda equina lesions in 20%, and multiple lesions in 30%. All patients received oral praziquantel and high-dose steroids for at least three days as part of their initial treatment. During the average follow-up period of 5.6±1.7 months, one patient experienced lower extremity paraplegia, while two cases (20%) showed partial improvement with residual deficits including urinary and fecal incontinence. Complete resolution of symptoms was achieved in seven cases (70%).

CONCLUSION

Schistosomiasis should be considered in pediatric patients with myeloradicular manifestations, especially in endemic areas. Early identification can be achieved through history, prompt imaging, and CSF serology. In the absence of immediate test results, expert-guided presumptive therapy should be considered to minimize neurological complications.

Alternate-day fasting, a high-sucrose/caloric diet and praziquantel treatment influence biochemical and behavioral parameters during Schistosoma mansoni infection in male BALB/c mice

Schistosoma mansoni-induced granulomas result in severe damage to the host's liver, as well as neurological and metabolic disorders. We evaluated the biochemical and behavioral changes during schistosomiasis under three diet protocols: ad libitum (AL), alternate-day fasting (ADF) and a high-sucrose/caloric diet (HSD). Healthy male BALB/c mice were divided into noninfected, matched infected and infected/treated [praziquantel (PZQ)] groups. Caloric intake and energy efficiency coefficients associated with diets were measured. Behavioral (exploratory and locomotor) and biochemical (glucose, triglycerides, total cholesterol, AST, ALT, ALP, and γ-GT) tests and histological analysis were performed. Fifteen weeks postinfection, HSD and PZQ promoted weight gain, with higher caloric consumption than ADF (p < 0.05), reflecting serum glucose levels and lipid profiles. HSD and PZQ prevented liver dysfunction (AST and ALT) and significantly prevented increases in granuloma area (p < 0.05). HSD and PZQ also significantly improved mouse physical performance in exploratory and locomotor behavior (p < 0.05), reversing the impaired motivation caused by infection. These findings showed that ADF worsened the course of S. mansoni infection, while HSD and PZQ, even with synergistic effects, prevented and/or attenuated biochemical and behavioral impairment from infection.

Medullary neuroschistosomiasis in adolescence: case report and literature review

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.