RESUMEN
Neuroschistosomiasis is a severe form of presentation of schistosomiasis in which Schistosoma spp. affects the central nervous system. This is the first study performed to analyze whether there is any relationship between physical effort and the appearance of neuroschistosomiasis, through clinical, molecular and immunological evaluations. An experimental controlled study using 64 male Balb/c inbred mice divided into four groups according to presence or absence of S. mansoni infection and submitted to physical effort or resting was conducted. Thirteen weeks after exercise training, S. mansoni DNA was detected in the brain or spinal cord in about 30% of the infected animals moreover, only S. mansoni-positive samples showed positive labeling for S. mansoni antigens in the brain or spinal cord, with a striking reaction inside the microglia. However, the behavioral tests did not show any clinical symptoms of neuroschistosomiasis in animals submitted to physical effort or in resting. In animals with S. mansoni-positive DNA, immunohistochemical data revealed astrogliosis and microgliosis, elevated IL-10 levels and decreased TNF-α expression. This study demonstrated that isometric exercise does not promote neuroschistosomiasis, furthermore, ectopic forms of schistosomiasis in the central nervous system were largely asymptomatic and exhibited a Th2 immune response profile. More experimental studies are necessary in order to characterize the pathological process of experimental neuroschistosomiasis.
Asunto(s)
Neuroesquistosomiasis/fisiopatología , Neuroesquistosomiasis/terapia , Condicionamiento Físico Animal/fisiología , Animales , Encéfalo/patología , Sistema Nervioso Central/lesiones , Modelos Animales de Enfermedad , Interleucina-10/análisis , Interleucina-10/sangre , Masculino , Ratones , Ratones Endogámicos BALB C , Neuroesquistosomiasis/metabolismo , Condicionamiento Físico Animal/métodos , Schistosoma mansoni/patogenicidad , Esquistosomiasis/fisiopatología , Esquistosomiasis mansoni/fisiopatología , Médula Espinal/patología , Factor de Necrosis Tumoral alfa/análisis , Factor de Necrosis Tumoral alfa/sangreRESUMEN
Schistosomiasis is the second most common parasitic infection worldwide. North America is a nonendemic area. However, there are occasional case reports among travelers and immigrants from endemic regions. We describe a case of a 55-year-old Canadian woman who presented with first episode of seizure. Her magnetic resonance imaging scan revealed a mass-like lesion involving the left anterior temporal lobe. The lesion showed T1 hypo- and T2 hyperintense with perilesional brain edema. On post-gadolinium-enhanced T1-weighted sequence, the lesion showed multiple small nodular and linear enhancements, also called an "arborized" appearance. Initially, the lesion was thought to be a malignant tumor. She underwent left anterior temporal lobe resection. Histologic examination showed parasitic eggs with a characteristic lateral spine consistent with Schistosoma mansoni infection. Upon subsequent questioning, it was revealed that the patient lived in Ghana from the ages of 8-10 years and she visited Ghana again 10 years prior for two weeks. She recalled swimming in beaches and rivers. Latent disease, as in this case with presentation, many years or decades after presumed exposure is rare but has been reported. Characteristic magnetic resonance imaging findings may suggest the diagnosis and facilitate noninvasive work-up.
Asunto(s)
Encéfalo/diagnóstico por imagen , Neuroesquistosomiasis/diagnóstico por imagen , Encéfalo/patología , Encéfalo/cirugía , Neoplasias Encefálicas/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Neuroesquistosomiasis/complicaciones , Neuroesquistosomiasis/patología , Neuroesquistosomiasis/terapia , Convulsiones/diagnóstico por imagen , Convulsiones/etiología , Convulsiones/patología , Convulsiones/terapia , Factores de TiempoRESUMEN
PURPOSE OF REVIEW: This article discusses the assessment of the patient presenting with neurologic symptoms who has lived in or traveled through tropical or subtropical regions and reviews selected nervous system infections prevalent in the tropics and subtropics, with discussion of the epidemiology, clinical features, recommended diagnostic testing, and management. RECENT FINDINGS: Increasing travel, emigration, and population growth all facilitate the global spread of tropical neurologic infections. Neurologists worldwide should be aware of the spectrum of neurologic manifestations as well as the most appropriate approach to diagnosis and management of these infections. SUMMARY: Although many infectious tropical diseases affecting the nervous system are preventable or treatable, the burden of disease remains high, with significant socioeconomic costs associated with managing acute manifestations and chronic, often debilitating, neurologic sequelae. Tropical infections of the nervous system are often transmitted in regions where people live in poverty and where access to adequate health care is limited. As with most infections of the nervous system, timely access to proper treatment is of utmost importance, as delays are typically associated with worse outcome.
Asunto(s)
Dengue , Malaria Cerebral , Neurocisticercosis , Neuroesquistosomiasis , Clima Tropical , Tuberculosis , Dengue/diagnóstico , Dengue/terapia , Humanos , Malaria Cerebral/diagnóstico , Malaria Cerebral/terapia , Neurocisticercosis/diagnóstico , Neurocisticercosis/terapia , Neuroesquistosomiasis/diagnóstico , Neuroesquistosomiasis/terapia , Tuberculosis/diagnóstico , Tuberculosis/terapiaRESUMEN
BACKGROUND: Schistosomiasis is a tropical disease caused by worms of the genus Schistosoma. It is endemic in the Caribbean Islands, the middle east, eastern Asia, South America, and Africa. In nonendemic areas, physicians should be aware of this condition in travelers returning from endemic areas and in immigrants. The main disease-causing species are Schistosoma haematobium, Schistosoma mansoni, and Schistosoma japonicum. Neuroschistosomiasis is an ectopic form of the disease that is mainly associated with S. japonicum infection. Involvement of the central nervous system (CNS) in S. mansoni infection is neglected and underestimated. Neuroschistosomiasis mansoni can be classified into cerebral, spinal, and encephalomyelitic forms in the course of an acute or chronic infection. REVIEW SUMMARY: We review the CNS involvement by S. mansoni infection with an emphasis on life cycle, epidemiology, pathophysiology and immunology, clinical manifestations, diagnostic criteria, differential diagnosis, current treatment guidelines, and prognosis. CONCLUSIONS: Although an underreported CNS infection, found mainly in underdeveloped countries, neuroschistosomiasis mansoni still causes significant incapacity and morbidity. Hence, neurologists should become familiar with this infection worldwide and include it in the differential diagnosis of CNS involvement in travelers returning from endemic areas and in immigrants.
Asunto(s)
Neuroesquistosomiasis , Guías de Práctica Clínica como Asunto , Schistosoma mansoni , Animales , Humanos , Estadios del Ciclo de Vida , Neuroesquistosomiasis/diagnóstico , Neuroesquistosomiasis/epidemiología , Neuroesquistosomiasis/fisiopatología , Neuroesquistosomiasis/terapia , ViajeAsunto(s)
Esquistosomiasis/diagnóstico , Esquistosomiasis/terapia , Enfermedad Aguda , Enfermedad Crónica , Femenino , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/terapia , Enfermedades de los Genitales Masculinos/diagnóstico , Enfermedades de los Genitales Masculinos/terapia , Humanos , Parasitosis Intestinales/diagnóstico , Parasitosis Intestinales/terapia , Imagen por Resonancia Magnética , Masculino , Neuroesquistosomiasis/diagnóstico , Neuroesquistosomiasis/terapia , Esquistosomiasis Urinaria/diagnóstico , Esquistosomiasis Urinaria/terapia , Tomografía Computarizada por Rayos XRESUMEN
We describe a case of cerebral schistosomiasis, caused by Asian (oriental) Schistosoma japonicum trematode blood flukes, in a young Chinese patient and its management. We also provide a brief update for physicians on the clinical features, diagnosis and treatment of schistosomiasis, with particular emphasis on neuroschistosomiasis, the most severe clinical outcome associated with this parasitic infection.
Asunto(s)
Neuroesquistosomiasis/diagnóstico , Adolescente , Animales , China , Femenino , Humanos , Neuroesquistosomiasis/parasitología , Neuroesquistosomiasis/terapia , Schistosoma japonicum/aislamiento & purificaciónRESUMEN
BACKGROUND: Neuroschistosomiasis is a severe presentation of schistosomal infection. Currently however, spinal cord schistosomiasis japonica is clinically rare, and very few cases are reported. METHODS: The purpose of this study is to retrospectively analyze the diagnosis and treatment of 4 patients who presented with a lower cord syndrome of acute progression characterized by motor, sensory, and autonomic dysfunctions. The patients were examined by MRI, and the biochemical and immunologic changes of blood and CSF of the patients were also analyzed before surgery. Treatments including surgical resection and antischistosomal drugs followed by a histologic examination were used to confirm the diagnosis. RESULTS: Spinal cord schistosomiasis japonica is a very rare disease. Magnetic resonance imaging can obtain precise position fixing, although it is hard to make preoperative qualitative determination. Postoperative follow-up assessment indicated that the symptoms of 4 patients had improved without further treatment. CONCLUSIONS: The main clinical manifestations of spinal cord schistosomiasis japonica have some common features, and MRI is useful and important in diagnosing the disease. The most effective treatment for the disease that shows radiological evidence of spinal cord or conus compression and inefficacious expectant treatment by other methods is to excise it totally and apply antischistosomal drugs.
Asunto(s)
Neuroesquistosomiasis/diagnóstico , Neuroesquistosomiasis/terapia , Esquistosomiasis Japónica/diagnóstico , Esquistosomiasis Japónica/terapia , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/terapia , Adulto , Femenino , Humanos , Vértebras Lumbares , Masculino , Vértebras TorácicasRESUMEN
A prospective study was conducted on 63 patients with schistosomal myeloradiculopathy admitted to a university hospital in Brazil. They were evaluated according to a protocol and treated with corticosteroid and praziquantel. The disease, in general, presented as a lower cord syndrome of acute progression characterized by motor, sensory and autonomic dysfunctions. The severity of the clinical picture was different among the patients, but the symptoms were quite constant. Cerebrospinal fluid examination showed an inflammatory pattern with or without eosinophils and/or IgG against schistosomal antigens. The most frequent alterations detected by imaging methods were enlargement of the medullary cone and of the roots of the cauda equina. Schistosome egg counts suggested a low parasite burden in 71.6% of the cases. Outcome was favorable in 38 (60.3%) patients and improvement usually started within the first 48 h after commencing on corticoid and was faster during the early period of treatment.
Asunto(s)
Neuroesquistosomiasis/terapia , Adolescente , Adulto , Anciano , Antiinflamatorios/uso terapéutico , Antiplatelmínticos/uso terapéutico , Biopsia , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Humanos , Inmunoglobulina G/análisis , Dolor de la Región Lumbar/epidemiología , Dolor de la Región Lumbar/etiología , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Músculo Esquelético/fisiopatología , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/fisiopatología , Examen Neurológico , Neuroesquistosomiasis/diagnóstico , Neuroesquistosomiasis/parasitología , Dolor/etiología , Dimensión del Dolor , Selección de Paciente , Praziquantel/uso terapéutico , Prednisona/uso terapéutico , Estudios Prospectivos , Radiculopatía/parasitología , Radiculopatía/fisiopatología , Reflejo de Estiramiento/fisiología , Médula Espinal/parasitología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The diagnosis and management of parasitic diseases of the central nervous system (CNS) is difficult, even for infectious diseases physicians and neurologists. Furthermore, few overviews of the spectrum of causative helminths and clinical syndromes have been published. In the present study, we review the seven most common parasitic diseases of the CNS: (i) cysticercosis, (ii) neuroschistosomiasis, (iii) paragonimiasis, (iv) angiostrongyliasis, (v) hydatid disease, (vi) sparganosis and (vii) gnathostomiasis. Major syndromes of parasitic disease of the CNS and their differential causes are discussed, including: (i) cystic lesions, (ii) enhancing granulomas (with and without creeping subcutaneous eruptions), (iii) eosinophilic meningoencephalitis and (iv) spinal cord disease. Specific risk factors that predispose to these infections are also discussed and particular attention is drawn to the situation in Australia.