Cerebral Schistosomiasis Due to Schistosoma haematobium Confirmed by PCR Analysis of Brain Specimen

Abstract

The case of a 25-year-old Japanese male who had cerebral schistosomiasis caused by Schistosoma haematobium is reported here. Although serum antibody tests showed a cross-reaction with other helminths and no ova were excreted in urine or feces, the existence of Schistosoma haematobium in the brain was confirmed by PCR analysis. CASE REPORTIn October 2009, a 25-year-old Japanese man was admitted to a local community hospital in Japan with a 1-week history of mild headache and sporadic paraphasia. He had worked as an agricultural consultant in the Republic of Malawi from April 2007 to June 2009. During his stay, he lived with local residents, consumed water from a well, and had swum in a lake at least twice. He had been in excellent health until October 2009, except for a Giardia lamblia infection in 2008. At the community hospital, a computed tomography (CT) scan of the patient's head showed four hyperdense and edematous lesions in the left parietal lobe, and these lesions were suspected to be related to tropical infectious diseases due to the fact that the onset of his symptoms appeared soon after his return from the Republic of Malawi. Subsequently, the patient was referred to our institution for further workup.Upon presentation to our institute, the patient's temperature was 36.8°C, his pulse was 60 beats per minute (bpm), and his blood pressure was 120/70 mm Hg. Although the patient was alert and appropriate at a glance, verbal paraphasia was occasionally observed. Laboratory evaluation revealed the following: white blood cell count, 8,780/l (67.5% neutrophils, 25.0% lymphocytes, 1.5% eosinophils); serum C-reactive protein, 0.03 mg/dl; IgE, 18 U/ml; HIV antibody negative; toxoplasma IgM and IgG negative; and Entamoeba antibody negative. A magnetic resonance imaging (MRI) scan of the brain with gadolinium enhancement showed a couple of ill-defined, heterogeneously enhancing lesions. They were each approximately 10 mm in diameter, in the left parietal lobe, with increased intensity of the signal on the T1-weighted image (Fig. 1). A lumbar puncture was not performed. The patient's headache and nausea worsened rapidly, and we were obliged to relieve his symptoms as soon as possible. Based on the clinical presentation and characteristic imaging finding, we clinically concluded that the cerebral lesions were neurocysticercosis. Albendazole (15 mg/kg of body weight per day) was administered with dexamethasone (0.1 mg/kg per day) for a total of 8 days. The patient's headache and nausea then subsided, and the verbal paraphasia disappeared. The findings from an MRI scan of the brain were improved but still remained.One week after the initiation of treatment, the results of the commercially available serum enzyme-linked immunosorbent assay (ELISA; SRL, Tokyo, Japan), which can detect IgG antibody for 12 helminthic diseases as a screening (22), were reported: Spirometra erinacei (also known as Spirometra mansoni) antibody on admission was positive, whereas Taenia solium antibody was negative. Schistosoma species are not ...

Parasitoses of the human central nervous system

“…Neuroschistosomiasis is caused by haematogenic invasion of the CNS with eggs from the blood-vessel-dwelling trematode Schistosoma mansoni (Vale et al , 2011), S. japonicum (Ferrari & Moreira, 2011) or S. haematobium (Imai et al , 2011). Other routes of CNS invasion include retrograde venous spread by way of Batons's plexus or migration of worms through the brain (Abdel Razek et al , 2011).…”

“…The CSF may be normal or may show non-specific abnormalities (Ferrari & Moreira, 2011). The diagnosis is confirmed by PCR of the CSF, which may be positive even if serum antibodies are absent or show cross-reaction with other helminthes, and in cases where no ova are excreted via the urine or faeces (Imai et al , 2011). In acute schistosomal encephalopathy, imaging may show cerebral oedema and multiple, small, contrast-enhancing lesions in the frontal, temporal or occipital lobes, or the brainstem (Ferrari & Moreira, 2011).…”

Diagnosis of neuroschistosomiasis by antibody specificity index and semi-quantitative real-time PCR from cerebrospinal fluid and serum

“…specific DNA in CSF compared to serum made such contamination unlikely. Although PCR has previously been used to confirm Schistosoma DNA in brain tissue (Imai et al , 2011), the use of semi-quantification of Schistosoma DNA has not been reported for the confirmation of intrathecal Schistosoma cells.…”

Parasitic (Helminthic) cardiomyopathy: A review and pooled analysis of pathophysiology, diagnosis and clinical management

“…Serological assays are also useful in diagnosing infection by assessing blood serum and cerebrospinal fluid (CSF) to detect antibodies that remain positive for a long time after the resolution of primary infection [96,97]. Eosinophil count and molecular detection of schistosomal DNA by PCR in sera of infected patients may support infection by Schistosoma [98,99]. However, these diagnostic methods cannot assess the severity of the disease and resulting complications as well as clinical signs and symptoms are non-specific and non-reliable in assessing disease severity [100].…”