Schistosomal myeloradiculopathy in a low-prevalence area: 27 cases (14 autochthonous) in Campinas, São Paulo, Brazil

Freitas, André Ricardo Ribas; Oliveira, Augusto César Penalva de; Silva, Luiz Jacintho da

doi:10.1590/s0074-02762010000400009

Cited by 12 publications

(24 citation statements)

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“…This difficulty in finding the eggs is not casual, nor an abnormal occurrence. It is part of the disease's laboratory findings pattern [26]. Despite having already done some serological examinations that could have confirmed infection by the parasites even without finding eggs, the diagnosis of spinal cord schistosomiasis was still very complicated and controversial at that time, specially because there were no detailed imaging examinations.…”

Section: Spinal Cord Schistosomiasismentioning

confidence: 99%

“…In another, similar study performed at the Sarah Kubitschek Hospital, in Brazil, with 231 patients, this etiology corresponded to close to 6% of the patients (13 cases) of non-traumatic medullar lesion seen in 4.5 years [36]. There are several indications that this disease has been under-diagnosed [46][47][48][49] in endemic areas because of the difficulty of access to more sophisticated diagnostic methods and, in more developed areas, because of the lack of knowledge on the part of the doctors about this disease [26]. This situation has been changing in the last years, particularly in Brazil, due to the improvement in diagnostic tools and better access to medical attention in the country.…”

Section: Spinal Cord Schistosomiasismentioning

confidence: 99%

“…Knowledge of the epidemiological profile of the patient with spinal cord schistosomiasis can be obtained based on case reports or serial cases [26,42,[50][51][52]. Spinal cord schistosomiasis occurs more frequently in male patients, with ages between 15 and 50, having low worm burden, up until then not presenting symptomatic neuroschistosomiasis, presenting intestinal and hepatointestinal forms, living in non-endemic areas (who had an eventual exposure to risk of infection) or in endemic areas.…”

Section: Spinal Cord Schistosomiasismentioning

confidence: 99%

“…Other patients, aside from not having digestive symptoms, are not frequently exposed to the risk of transmission, making the diagnosis even harder. Examples of said patient profile are tourists who have been only sporadically exposed in areas of schistosomiasis transmission [27,56,57], patients who live in urban areas who, usually, have sporadic contact with transmission focuses [58], residents of areas that are recent focuses of transmission [56], and residents of areas with low prevalence for schistosomiasis [26].…”

Section: Spinal Cord Schistosomiasismentioning

confidence: 99%

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Spinal Cord Schistosomiasis

Freitas¹,

Angerami²

2013

Parasitic Diseases - Schistosomiasis

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share the same pattern in reproductive cycle, the transmission occurring through eggs, a proportion of which are eliminated through urine (S. haematobium) or feces (S. mansoni, S. japonicum and others). These eggs release larvae (miracidium) that infect freshwater molluscs in which the parasites multiply through asexual reproduction. These molluscs release aquatic larvae (cercariae) that actively penetrate the skin of a new, vertebrate host. These larvae become adults that inhabit inside the veins in the digestive system (S. mansoni and S. japonicum) and of the urinary system (S. haematobium). The geographic distribution of each species is varied and depends on the presence of molluscs capable of serving as hosts (each Schistosoma species has different molluscs as hosts). Precarious sanitary conditions also contribute in the definition of locations where schistosomiasis occurs [14]. Schistosoma mansoni occurs in 74 countries located in Africa, the Middle East, South America and the Caribbean. Its eggs measure about 60 x 140 μm, with lateral spine and are eliminated in the feces, being a main cause of intestinal, hepatosplenic, cardiopulmonary and cerebral diseases, aside from being the main cause of spinal cord schistosomiasis. S. haematobium occurs in Africa and in the Middle East and its eggs measure about 60 x 150 μm, with terminal spine, are eliminated in the urine and on rare occasions in the feces, being the mains cause of urinary diseases and spinal cord schistosomiasis. S. japonicum, S. mekongi and S. malayensis occur in Asia (they are also called S. japonicum-like); eggs measure about 60 x 100 μm, lack spine and are eliminated in the feces, causing hepatic diseases, cerebral neuroschistosomiasis, although there have been rare reports of cases in which spinal cord schistosomiasis was caused by S. japonicum. S. intercalatum occurs in Africa. Eggs are eliminated in the feces. It causes mild intestinal disease but not neuroschistosomiasis, being the least important species, clinically. The presence of spines in the eggs of S. mansoni and S. haematobium might explain why medullar and cerebral neuroschistosomiasis are more common in these species. Spine makes it more difficult for the eggs to travel through the vertebral veins, causing them to be stuck in the lumbar or thoracic spinal cord. S. japonium's eggs, being smaller and lacking spine, migrate more easily to the brain through these veins, crossing the spinal cord without sticking to it. There are, still, species belonging to the Schistosomatidae family (ex: Trichobilharzia regenti) that can cause cercarial dermatitis (or summer's itch) without, however, reaching adult life in men and, therefore, not having any major clinical importance. 2. Clinical forms of schistosomiasis 2.1. Acute phase Acute forms are basically cercarial dermatitis or summer's itch, cutaneous lesion secondary to the penetration of the skin by the cercaria, and Katayama's fever (or syndrome), which is also called acute or toxemic schistosomiasis and occurs, in genera, after three to ...

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Section: Spinal Cord Schistosomiasismentioning

confidence: 99%

Section: Spinal Cord Schistosomiasismentioning

confidence: 99%

Section: Spinal Cord Schistosomiasismentioning

confidence: 99%

Section: Spinal Cord Schistosomiasismentioning

confidence: 99%

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Spinal Cord Schistosomiasis

Freitas¹,

Angerami²

2013

Parasitic Diseases - Schistosomiasis

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“…Most patients have no clinical evidence of hepatosplenic schistosomiasis and the diagnosis is often made following Spinal cord damage [6]. SCS typical clinical triad which is found in more than 90% of patients is diminishing of muscular strength, sensory alterations in the lower limbs and bladder dysfunction [7] [8].…”

Section: Introductionmentioning

confidence: 99%

Spinal Cord Schistosomiasis: Report on Seven Adult Patients

Ragab¹,

Ismail²

2019

OJMN

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Background: Spinal Cord Schistosomiasis (SCS) is the most disabling ectopic form of Schistosomal infection. It may or may not have clinical manifestations. They include low back pain and/or lower limb pain and weakness, and double incontinence. Early diagnosis and treatment provide a good outcome. Aim: To describe the clinical, radiologic, and therapeutic data of 7 patients with Spinal Schistosomiasis. Patients and Methods: In this retrospective clinical case study, the medical records of 7 patients with spinal cord pathologies admitted to Aswan University Hospital from May 2014 to May 2017 were reviewed. All were male aged from 17 to 30 years old (mean ± SD, 20 ± 9.5 yr.; median 21 yr.), with neurological deficit in the form of lower limb weakness and sphincter disturbance. All were treated by decompressive laminectomy and debulking of the intramedullary lesion followed by medical treatment. Results: The outcome of our patients was good as 4/7 patients (57%) presented a full recovery, 3/7 patients (43%) presented a partial recovery without functional limitations and none presented a partial recovery with limitations or no response. Conclusion: High index of suspicion should be raised in the differential diagnosis of patients with clinical or radiological evidence of Spinal Cord Schistosomiasis, as early diagnosis can guarantee a better prognosis and avoid the occurrence of serious sequels. The association of corticosteroids and antischistosomal drugs is related to the best outcome. The role of surgery is decompression, particularly in the granulomatous or pseudotumoral form, and to obtain material for definite histopathological diagnosis in doubtful cases.

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