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Neuroschistosomiasis

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Abstract

Schistosomiasis (bilharzia) is a neglected tropical disease caused by digenetic trematode platyhelminths of the genus Schistosoma. Neuroschistosomiasis is one of the most severe clinical outcomes associated with schistosome infection. Neurological complications early during the course of infection are thought to occur through in situ egg deposition following aberrant migration of adult worms to the brain or spinal cord. The presence of eggs in the CNS induces a cell-mediated Th2-driven periovular granulomatous reaction. The mass effect of thousands of eggs and the large granulomas concentrated within the brain or spinal cord explain the signs and symptoms of increased intracranial pressure, myelopathy, radiculopathy and subsequent clinical sequelae. Myelopathy (acute transverse myelitis and subacute myeloradiculopathy) of the lumbosacral region is the most common neurological manifestation of S. mansoni or S. haematobium infection, whereas acute encephalitis of the cortex, subcortical white matter, basal ganglia or internal capsule is typical of S. japonicum infection. Cerebral complications include encephalopathy with headache, visual impairment, delirium, seizures, motor deficits and ataxia, whereas spinal symptoms include lumbar pain, lower limb radicular pain, muscle weakness, sensory loss and bladder dysfunction. The finding of eggs in the stool or a positive serology, provides supportive but not direct evidence of neuroschistosomiasis. A definitive diagnosis can only be made with histopathological study showing Schistosoma eggs and granulomas. Schistosomicidal drugs (notably praziquantel), steroids and surgery are currently used for the treatment of neuroschistosomiasis. During the ‘acute phase’ of the disease, neuroschistosomiasis is treated with corticosteroids which are augmented with a course of praziquantel once female worm ovipositioning commences. Surgery should be reserved for special cases such as in those with evidence of medullary compression and in those who deteriorate despite clinical management.

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Acknowledgments

This study was supported by the United Nations Development Programme/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases (Dr. Li and Prof. McManus), the National Health and Medical Research Council of Australia (Dr. Li and Prof. McManus), the Wellcome Trust (UK) (Dr. Li and Prof. McManus), the Sandler Foundation (USA) (Prof. McManus), the Dana Foundation (USA) (Dr. Li and Prof. McManus) and the National Institute of Allergy and Infectious Diseases (Dr. Li and Prof. McManus). Dr. Li Yuesheng is a Howard Hughes Medical Institute Scholar, USA.

Conflicts of interest

We the authors declare no conflicts of interest in the preparation or publication of this review.

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Authors and Affiliations

  1. School of Public Health, Griffith University, Meadowbrook, QLD, Australia

    Allen G. Ross

  2. Griffith Health Institute, Griffith University, Southport, QLD, Australia

    Allen G. Ross & Darren J. Gray

  3. Molecular Parasitology Laboratory, Infectious Diseases Division, Queensland Institute of Medical Research, Herston, Brisbane, QLD, Australia

    Donald P. McManus, Darren J. Gray & Yue-Sheng Li

  4. Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam

    Jeremy Farrar

  5. Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada

    Richard J. Hunstman

  6. Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Yueyang, Hunan, People’s Republic of China

    Yue-Sheng Li

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  1. Allen G. Ross
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  2. Donald P. McManus
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  3. Jeremy Farrar
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  6. Yue-Sheng Li
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Correspondence to Allen G. Ross.

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Ross, A.G., McManus, D.P., Farrar, J. et al. Neuroschistosomiasis. J Neurol 259, 22–32 (2012). https://doi.org/10.1007/s00415-011-6133-7

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