Neurological complications of Schistosoma infection.
Schistosomiasis is a parasitic disease caused by blood flukes of the genus Schistosoma. Currently more than 200 million people worldwide are affected. Neuroschistosomiasis constitutes a severe presentation of the disease. Neurological symptoms result from the inflammatory response of the host to egg deposition in the brain and spinal cord. Neurological complications of cerebral schistosomiasis include delirium, loss of consciousness, seizures, dysphasia, visual field impairment, focal motor deficits and ataxia. Cerebral and cerebellar tumour-like neuroschistosomiasis can present with increased intracranial pressure, headache, nausea and vomiting, and seizures. Myelopathy (acute transverse myelitis and subacute myeloradiculopathy) is the most common neurological complication of Schistosoma mansoni infection. Schistosomal myelopathy tends to occur early after infection and is more likely to be symptomatic than cerebral schistosomiasis. The conus medullaris and cauda equina are the most common sites of involvement. Severe schistosomal myelopathy can provoke a complete flaccid paraplegia with areflexia, sphincter dysfunction and sensory disturbances. Schistosomicidal drugs, steroids and surgery are the currently available treatments for neuroschistosomiasis. Rehabilitation and multidisciplinary team care are needed in severely disabled patients.
Carod-Artal
Francisco Javier
FJ
Department of Neurology, The Sarah Network of Rehabilitation Hospitals, Sarah Hospital, SMHS quadra 501 conjunto A, CEP 7330-150, Brasilia DF, Brazil. javier@sarah.br <javier@sarah.br>
D000349:Africa / Q000453:epidemiology; D000818:Animals; D001927:Brain Diseases / Q000469:parasitology* / Q000473:pathology / Q000503:physiopathology; D015897:Comorbidity; D003937:Diagnosis, Differential; D005938:Glucocorticoids / Q000627:therapeutic use; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology / Q000469:parasitology; D008279:Magnetic Resonance Imaging; D008297:Male; D008877:Middle East / Q000453:epidemiology; D009188:Myelitis, Transverse; D020818:Neuroschistosomiasis / Q000175:diagnosis / Q000453:epidemiology / Q000469:parasitology*; D011223:Praziquantel / Q000627:therapeutic use; D015995:Prevalence; D012547:Schistosoma / Q000254:growth & development / Q000276:immunology / Q000472:pathogenicity; D012556:Schistosomicides / Q000627:therapeutic use; D013020:South America / Q000453:epidemiology; D013118:Spinal Cord Diseases / Q000469:parasitology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
D005938:Glucocorticoids; D012556:Schistosomicides; D011223:Praziquantel