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Lakhani DA, Deng F, Lin DDM. Infectious Diseases of the Brain and Spine: Parasitic and Other Atypical Transmissible Diseases. Magn Reson Imaging Clin N Am 2024; 32:347-361. [PMID: 38555145 DOI: 10.1016/j.mric.2024.02.002] [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] [Indexed: 04/02/2024]
Abstract
Atypical infections of the brain and spine caused by parasites occur in immunocompetent and immunosuppressed hosts, related to exposure and more prevalently in endemic regions. In the United States, the most common parasitic infections that lead to central nervous system manifestations include cysticercosis, echinococcosis, and toxoplasmosis, with toxoplasmosis being the most common opportunistic infection affecting patients with advanced HIV/AIDS. Another rare but devastating transmittable disease is prion disease, which causes rapidly progressive spongiform encephalopathies. Familiarity and understanding of various infectious agents are a crucial aspect of diagnostic neuroradiology, and recognition of unique features can aid timely diagnosis and treatment.
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Affiliation(s)
- Dhairya A Lakhani
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francis Deng
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Doris D M Lin
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Uchôa LRA, Lucato LT. Newer Updates in Pediatric Intracranial Infection. Semin Roentgenol 2023; 58:88-109. [PMID: 36732014 DOI: 10.1053/j.ro.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Luiz Ricardo Araújo Uchôa
- Neuroradiology Section, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
| | - Leandro Tavares Lucato
- Neuroradiology Section, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil; Grupo Fleury, São Paulo, Brazil
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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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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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Gouveia LR, Santos JC, Silva RD, Batista AD, Domingues ALC, Lopes EPDA, Silva RO. Diagnosis of coinfection by schistosomiasis and viral hepatitis B or C using 1H NMR-based metabonomics. PLoS One 2017; 12:e0182196. [PMID: 28763497 PMCID: PMC5538707 DOI: 10.1371/journal.pone.0182196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/13/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diagnosis of liver involvement due to schistosomiasis in asymptomatic patients from endemic areas previously diagnosed with chronic hepatitis B (HBV) or C (HCV) and periportal fibrosis is challenging. H-1 Nuclear Magnetic Resonance (NMR)-based metabonomics strategy is a powerful tool for providing a profile of endogenous metabolites of low molecular weight in biofluids in a non-invasive way. The aim of this study was to diagnose periportal fibrosis due to schistosomiasis mansoni in patients with chronic HBV or HCV infection through NMR-based metabonomics models. METHODOLOGY/PRINCIPAL FINDINGS The study included 40 patients divided into two groups: (i) 18 coinfected patients with schistosomiasis mansoni and HBV or HCV; and (ii) 22 HBV or HCV monoinfected patients. The serum samples were analyzed through H-1 NMR spectroscopy and the models were based on Principal Component Analysis (PCA) and Partial Least Squares-Discriminant Analysis (PLS-DA). Ultrasonography examination was used to ascertain the diagnosis of periportal fibrosis. Exploratory analysis showed a clear separation between coinfected and monoinfected samples. The supervised model built from PLS-DA showed accuracy, R2 and Q2 values equal to 100%, 98.1% and 97.5%, respectively. According to the variable importance in the projection plot, lactate serum levels were higher in the coinfected group, while the signals attributed to HDL serum cholesterol were more intense in the monoinfected group. CONCLUSIONS/SIGNIFICANCE The metabonomics models constructed in this study are promising as an alternative tool for diagnosis of periportal fibrosis by schistosomiasis in patients with chronic HBV or HCV infection from endemic areas for Schistosoma mansoni.
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Affiliation(s)
- Liana Ribeiro Gouveia
- Postgraduate Program in Chemistry, Fundamental Chemistry Department, Center for Exact and Natural Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Joelma Carvalho Santos
- Postgraduate Program in Tropical Medicine, Center for Health Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Ronaldo Dionísio Silva
- Postgraduate Program in Chemistry, Fundamental Chemistry Department, Center for Exact and Natural Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Andrea Dória Batista
- Postgraduate Program in Tropical Medicine, Center for Health Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Department of Internal Medicine, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Ana Lúcia Coutinho Domingues
- Postgraduate Program in Tropical Medicine, Center for Health Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Edmundo Pessoa de Almeida Lopes
- Postgraduate Program in Tropical Medicine, Center for Health Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Department of Internal Medicine, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Ricardo Oliveira Silva
- Postgraduate Program in Chemistry, Fundamental Chemistry Department, Center for Exact and Natural Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Magnetic Resonance Spectroscopy for Evaluating Portal-Systemic Encephalopathy in Patients with Chronic Hepatic Schistosomiasis Japonicum. PLoS Negl Trop Dis 2016; 10:e0005232. [PMID: 27977668 PMCID: PMC5199111 DOI: 10.1371/journal.pntd.0005232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/29/2016] [Accepted: 12/05/2016] [Indexed: 12/02/2022] Open
Abstract
Portal-systemic encephalopathy (PSE) is classified as type B hepatic encephalopathy. Portal-systemic shunting rather than liver dysfunction is the main cause of PSE in chronic hepatic schistosomiasis japonicum (HSJ) patients. Owing to lack of detectable evidence of intrinsic liver disease, chronic HSJ patients with PSE are frequently clinically undetected or misdiagnosed, especially chronic HSJ patients with covert PSE (subclinical encephalopathy). In this study, we investigated whether magnetic resonance spectroscopy (MRS) could be a useful tool for diagnosing PSE in chronic HSJ patients. Magnetic resonance (MR) T1-weighted imaging, diffusion-weighted imaging, and MRS were performed in 41 chronic HSJ patients with suspected PSE and in 21 age-matched controls. The T1 signal intensity index (T1SI) and apparent diffusion coefficient (ADC) value were obtained in the Globus pallidus. Liver function was also investigated via serum ammonia and liver function tests. Higher T1SI and ADC values, increased lactate and glutamine levels, and decreased myo-inositol were found in the bilateral Globus pallidus in chronic HSJ patients with PSE. No significantly abnormal serum ammonia or liver function tests were observed in chronic HSJ patients with PSE. On the basis of these findings, we propose a diagnostic procedure for PSE in chronic HSJ patients. This study reveals that MRS can be useful for diagnosing PSE in chronic HSJ patients. Portal-systemic encephalopathy (PSE) is classified as type B hepatic encephalopathy. Portal-systemic shunting rather than liver dysfunction is the main cause of PSE in chronic hepatic schistosomiasis japonicum (HSJ) patients. Chronic HSJ patients with PSE are frequently misdiagnosed as suffering from dementia, depression, and other psychiatric disorders. However, there are few studies of this type of encephalopathy. In this study, magnetic resonance spectroscopy (MRS) was used as a noninvasive tool to detect abnormalities in brain metabolism in chronic HSJ patient with PSE. The results demonstrate that MRS would be useful for the diagnosis of PSE in chronic HSJ patients. Based on the results, a diagnostic procedure for PSE has also been proposed.
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Góes VC, Neves RH, Arnóbio A, Bernardo-Filho M, Machado-Silva JR. Streptozotocin (STZ) and schistosomiasis mansoni change the biodistribution of radiopharmaceutical sodium (99m)Tc-pertechnetate in mice. Nucl Med Biol 2016; 43:581-586. [PMID: 27438409 DOI: 10.1016/j.nucmedbio.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 05/31/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Technetium-99m ((99m)Tc) is a radionuclide commonly used in nuclear medicine to obtain (99m)Tc-radiopharmaceuticals, which can be used to evaluate either physiological processes or changes related to diseases. It is also used in some experimental studies. Streptozotocin (STZ) administration to rodents causes lesions in very early stages and induces severe and permanent diabetes. Most morbidity of schistosomiasis mansoni is attributed to a granulomatous inflammatory response and associated liver fibrosis. This study was designed to investigate whether STZ administration and schistosomiasis modify the biodistribution of the radiopharmaceutical sodium (99m)Tc-pertechnetate. METHODS Adult female mice were infected by exposure to 100Schistosoma mansoni cercariae (BH strain, Belo Horizonte, Brazil) and euthanized after nine weeks. STZ was administered by a single intraperitoneal injection of 100mg/kg body weight, 3 or 15days before euthanasia. Each animal received 100μl of sodium (Na) (99m)Tc-pertechnetate ((99m)TcO4(-)) (740kBq). The animals were divided into four groups: A, uninfected; B, infected; C, uninfected + STZ; and D, infected + STZ. Blood, brain, thyroid, heart, lungs, liver, spleen, pancreas and kidneys were removed. The radioactivity was counted and the percentage of the injected dose of Na(99m)TcO4 per gram of the organ (% ID/g) was determined. RESULTS Three days after the STZ injection, there was a decrease of Na(99m)TcO4 uptake by the liver, lungs, pancreas and kidneys (p<0.05) in group D when compared with group A. After 15days, the decrease of Na(99m)TcO4 uptake occurred also in the brain, thyroid, heart, spleen and blood (p<0.05) in group D. CONCLUSION We demonstrated modifications on the biodistribution of Na(99m)TcO4 due to STZ administration and schistosomiasis, possibly due to physiological alterations in some organs. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE The biodistribution of radiopharmaceutical Na(99m)TcO4 should be carefully evaluated in subjects with diabetes and/or schistosomiasis infection.
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Affiliation(s)
- Vanessa Coelho Góes
- Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Av. Professor Manoel de Abreu, 444, 5° Andar, Vila Isabel, 20511-070 Rio de Janeiro, RJ, Brazil
| | - Renata Heisler Neves
- Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Av. Professor Manoel de Abreu, 444, 5° Andar, Vila Isabel, 20511-070 Rio de Janeiro, RJ, Brazil
| | - Adriano Arnóbio
- Laboratório de Radiofarmácia Experimental, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Av. 28 de Setembro, 87, 4° Andar fundos, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
| | - Mario Bernardo-Filho
- Laboratório de Radiofarmácia Experimental, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Av. 28 de Setembro, 87, 4° Andar fundos, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
| | - José Roberto Machado-Silva
- Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Av. Professor Manoel de Abreu, 444, 5° Andar, Vila Isabel, 20511-070 Rio de Janeiro, RJ, Brazil.
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Sah VK, Wang L, Min X, Rizal R, Feng Z, Ke Z, Deng M, Li L, Li H. Human schistosomiasis: A diagnostic imaging focused review of a neglected disease. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jrid.2015.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Shih RY, Koeller KK. Bacterial, Fungal, and Parasitic Infections of the Central Nervous System: Radiologic-Pathologic Correlation and Historical Perspectives. Radiographics 2015; 35:1141-69. [PMID: 26065933 DOI: 10.1148/rg.2015140317] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Despite remarkable progress in prevention and treatment, infectious diseases affecting the central nervous system remain an important source of morbidity and mortality, particularly in less-developed countries and in immunocompromised persons. Bacterial, fungal, and parasitic pathogens are derived from living organisms and affect the brain, spinal cord, or meninges. Infections due to these pathogens are associated with a variety of neuroimaging patterns that can be appreciated at magnetic resonance imaging in most cases. Bacterial infections, most often due to Streptococcus, Haemophilus, and Neisseria species, cause significant meningitis, whereas the less common cerebritis and subsequent abscess formation have well-documented progression, with increasingly prominent altered signal intensity and corresponding contrast enhancement. Atypical bacterial infections are characterized by the development of a granulomatous response, classically seen in tuberculosis, in which the tuberculoma is the most common parenchymal form of the disease; spirochetal and rickettsial diseases are less common. Fungal infections predominate in immunocompromised hosts and are caused by yeasts, molds, and dimorphic fungi. Cryptococcal meningitis is the most common fungal infection, whereas candidiasis is the most common nosocomial infection. Mucormycosis and aspergillosis are characterized by angioinvasiveness and are associated with high morbidity and mortality among immunocompromised patients. In terms of potential exposure in the worldwide population, parasitic infections, including neurocysticercosis, toxoplasmosis, echinococcosis, malaria, and schistosomiasis, are the greatest threat. Rare amebic infections are noteworthy for their extreme virulence and high mortality. The objective of this article is to highlight the characteristic neuroimaging manifestations of bacterial, fungal, and parasitic diseases, with emphasis on radiologic-pathologic correlation and historical perspectives.
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Affiliation(s)
- Robert Y Shih
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (R.Y.S., K.K.K.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.); and Department of Radiology, Mayo Clinic, Rochester, Minn (K.K.K.)
| | - Kelly K Koeller
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (R.Y.S., K.K.K.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.); and Department of Radiology, Mayo Clinic, Rochester, Minn (K.K.K.)
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Increased IL-17, a Pathogenic Link between Hepatosplenic Schistosomiasis and Amyotrophic Lateral Sclerosis: A Hypothesis. Case Reports Immunol 2014; 2014:804761. [PMID: 25379310 PMCID: PMC4207377 DOI: 10.1155/2014/804761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/15/2014] [Indexed: 01/05/2023] Open
Abstract
The immune system protects the organism from foreign invaders and foreign substances and is involved in physiological functions that range from tissue repair to neurocognition. However, an excessive or dysregulated immune response can cause immunopathology and disease. A 39-year-old man was affected by severe hepatosplenic schistosomiasis mansoni and by amyotrophic lateral sclerosis. One question that arose was, whether there was a relation between the parasitic and the neurodegenerative disease. IL-17, a proinflammatory cytokine, is produced mainly by T helper-17 CD4 cells, a recently discovered new lineage of effector CD4 T cells. Experimental mouse models of schistosomiasis have shown that IL-17 is a key player in the immunopathology of schistosomiasis. There are also reports that suggest that IL-17 might have an important role in the pathogenesis of amyotrophic lateral sclerosis. It is hypothesized that the factors that might have led to increased IL-17 in the hepatosplenic schistosomiasis mansoni might also have contributed to the development of amyotrophic lateral sclerosis in the described patient. A multitude of environmental factors, including infections, xenobiotic substances, intestinal microbiota, and vitamin D deficiency, that are able to induce a proinflammatory immune response polarization, might favor the development of amyotrophic lateral sclerosis in predisposed individuals.
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Lambertucci JR. Revisiting the concept of hepatosplenic schistosomiasis and its challenges using traditional and new tools. Rev Soc Bras Med Trop 2014; 47:130-6. [PMID: 24861284 DOI: 10.1590/0037-8682-0186-2013] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 01/22/2014] [Indexed: 12/19/2022] Open
Abstract
Different aspects of hepatosplenic schistosomiasis are revisited here. Manson's schistosomiasis causes periportal fibrosis and portal hypertension in approximately 6% of infected subjects, usually with preservation of their hepatic function. The assessment of liver involvement is of major importance in determining the prognosis and risk of complications from schistosomiasis, such as upper digestive bleeding secondary to variceal rupture. For many years, the diagnosis of hepatosplenic schistosomiasis and liver fibrosis was made by abdominal palpation and the finding of liver and/or spleen enlargement. However, there is no consensus regarding the clinical parameters of the liver and spleen to be considered in this physical evaluation. For the last three decades, abdominal ultrasound (US) has become the best imaging technique to evaluate liver fibrosis caused by schistosomiasis mansoni. However, US is a subjective procedure and is therefore examiner-dependent. Magnetic resonance imaging (MRI) findings have provided valuable information in addition to ultrasound and clinical examination. The combination of a comprehensive history and physical examination, basic laboratory tests (a stool examination for Schistosoma mansoni eggs and a blood cell count), biomarkers for liver fibrosis/portal hypertension and imaging methods seem to offer the best approach for evaluating patients with this disease. In situations where research is involved or in patients with severe disease, MRI may be considered.
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Affiliation(s)
- José Roberto Lambertucci
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BRAZIL
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Abstract
Schistosomiasis is increasingly encountered among travelers returning from the tropics, mainly from Africa. Schistosoma-infected travelers have served as sentinels for the existence of unknown foci of transmission even outside Africa. Acute schistosomiasis (also termed Katayama syndrome) is the common manifestation among travelers and may follow exposure to any of the Schistosoma species. Neuroschistosomiasis is a rare complication but may result in severe disability. Diagnosis in travelers is hampered by the poor sensitivity of microscopy in urine and stool, especially during acute infections, while seroconversion may be delayed for a period of weeks. During acute schistosomiasis, symptomatic treatment is the only available therapy, while for chronic schistosomiasis, praziquantel is the only drug available, despite reports of emerging resistance to it. Since the potential for exposure to Schistosoma through travel will probably continue to increase, it is clear that new, sensitive diagnostic methods and drugs affecting the parasite in all its stages are needed.
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Brain MR imaging changes in patients with hepatic schistosomiasis japonicum without liver dysfunction. Neurotoxicology 2013; 35:101-5. [PMID: 23298871 DOI: 10.1016/j.neuro.2012.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/15/2012] [Accepted: 12/20/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The hyperintense signal on T1-weighted magnetic resonance (MR) images in the globus pallidus and substantia nigra of the brain can be found in patients with liver cirrhosis. The abnormality has been considered resulting from the manganese (Mn) deposition caused by liver failure and portal-systemic shunting. However, similar finding may also be found in hepatic schistosomiasis patients, who lack the biochemical evidence of liver dysfunction. OBJECTIVES To describe the brain MR imaging findings in patients with hepatic schistosomiasis japonicum (HSJ) without liver dysfunction. METHODS Brain MR and CT images of 18 patients with HSJ without liver dysfunction and 9 healthy volunteers were reviewed by two radiologists in consensus. The signal index (SI) in globus pallidus was obtained on T1-weighted images. Whole blood Mn, serum iron, serum calcium, and other laboratory tests of liver function were investigated. RESULTS Symmetric hyperintense signal in the globus pallidus and substantia nigra was observed in 15 of 18 HSJ patients (83.3%) and in none of controls on T1 weighted imaging. No abnormal CT findings were seen in both groups. Blood Mn level in patients was significantly higher than controls (p<0.05). Significant correlations were demonstrated between blood Mn and SI (p<0.05). No significantly abnormal results of serum iron, serum calcium and other laboratory tests were shown (p>0.05). CONCLUSION The portal-systemic shunting leading to Mn deposition may be the main cause of the basal ganglia hyperintense signal on T1-weighted MR imaging, which is a frequent finding in patients with HSJ without liver dysfunction.
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Abstract
Schistosomiasis is a parasitic disease caused by blood flukes of the genus Schistosoma. Currently 200 million people worldwide are infected. Neurological manifestations are a result of the inflammatory response of the host to egg deposition in the brain and spinal cord and is usually seen in patients with recent infection with no evidence of systemic illness. Cerebral and cerebellar disease can result in headache, seizure, and increased intracranial pressure. Cerebral schistosomiasis is more common in Schistosoma japonicum, but increasing cases due to Schistosoma mansoni are being reported in the literature. Other complications of cerebral schistosomiasis include delirium, loss of consciousness, visual field impairment, focal motor deficits, and ataxia. Myelopathy is the most common neurological manifestation of Schistosoma mansoni and the conus medullaris and cauda equine are the most common sites of involvement. Severe disease can result in flaccid paraplegia with areflexia, sphincter dysfunction, and sensory disturbance. Early recognition and prompt treatment are essential when physicians are faced with schistosomiasis involving the central nervous system. Schistosomicidal drugs, such as praziquantel, steroids and surgery, are the mainstay of therapy for this severe form of schistosomiasis.
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Affiliation(s)
- Christina Marie Coyle
- Albert Einstein College of Medicine and the Jacobi Medical Center, Bronx, New York, NY, USA.
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