neuroschistosomiasis

What is Neuroschistosomiasis?

Neuroschistosomiasis is a rare but serious medical condition caused by the infection of the nervous system by a type of parasitic worm, specifically from the genus Schistosoma. This infection can lead to severe neurological complications and is often associated with increased intracranial pressure, myelopathy, and radiculopathy.

Causes and Symptoms

The condition occurs when eggs from the schistosome worms are deposited in the brain or spinal cord vessels, leading to granuloma formation and subsequent inflammation. This can cause a range of symptoms, including:

• Abdominal pain
• Diarrhea
• Bloody stool
• Blood in the urine (hematuria)
• Liver damage
• Kidney problems

In severe cases, neuroschistosomiasis can lead to acute neurological complications, such as meningitis and eosinophilic meningitis.

Prevalence and Impact

Neuroschistosomiasis is a neglected and under-recognized disease, particularly in endemic areas. It is estimated that the condition causes significant morbidity and mortality in the developing world, with cerebral complications being more prevalent than spinal cord involvement.

Early Diagnosis and Treatment

Early diagnosis and treatment are crucial for improving outcomes in neuroschistosomiasis patients. The prognosis largely depends on prompt medical attention, making it essential to recognize the symptoms and seek medical care if suspected.

References:

• [1] According to search result 4, Neuroschistosomiasis is a neglected and under-recognized disease.
• [2] As per search result 12, neuroschistosomiasis includes signs and symptoms of increased intracranial pressure, myelopathy, and radiculopathy.
• [3] Search result 14 states that cerebral complications are more prevalent than the spine, accounting for 2.3% of all cases.
• [4] As per search result 10, neuroschistosomiasis is a severe disorder in which prognosis depends largely on early diagnosis and treatment.

Note: The information provided is based on the search results within the context.

Common Signs and Symptoms of Neuroschistosomiasis

Neuroschistosomiasis, a rare parasitic infection caused by the Schistosoma parasite, can manifest in various ways. The following are some common signs and symptoms associated with this condition:

• Cerebral Complications: Encephalopathy (brain inflammation), headache, visual impairment, delirium, seizures, motor deficits, and ataxia (loss of coordination) [1][2]
• Elevated Intracranial Pressure: Headache, nausea, vomiting, and papilledema (swelling of the optic disc) are common presentations of acute neuroschistosomiasis [3][4]
• Motor Deficits and Visual Abnormalities: Severe and persistent headache, motor deficits, visual abnormalities, seizures, altered mental status, vertigo, speech disturbances, and nystagmus (abnormal eye movement) [5][6]
• Spinal Involvement: Low back pain, lower-limb muscle weakness, paresthesia (tingling or numbness), and gait disorder have been described in some cases [7]

It's essential to note that the duration of symptoms can vary from a few days to several weeks. If you suspect neuroschistosomiasis, it is crucial to seek medical attention promptly.

References:

[1] AG Ross (2012) - Cerebral complications include encephalopathy with headache, visual impairment, delirium, seizures, motor deficits and ataxia...

[2] by FJ Carod-Artal (2008) - Cerebral and cerebellar tumour-like neuroschistosomiasis can present with increased intracranial pressure, headache, nausea and vomiting, and seizures.

[3] by ALC Domingues (2020) - Low back pain, lower-limb muscle weakness, some kind of lower-limb paresthesia (symmetric or asymmetric) and gait disorder have been described...

[4] by CM Nascimento-Carvalho (2005) - Headache, papilledema, visual abnormalities, speech disturbances, nystagmus and ataxia are common manifestations16.

[5] by OAM Carvalho (2013) - Seizures (partial or generalized), signs and symptoms of intracranial hypertension, focal signs (in the pseudotumoral form), acute headache, visual disturbances...

[6] by AG Ross (2012) - Cerebral complications include encephalopathy with headache, visual impairment, delirium, seizures, motor deficits and ataxia...

[7] by ALC Domingues (2020) - Low back pain, lower-limb muscle weakness, some kind of lower-limb paresthesia (symmetric or asymmetric) and gait disorder have been described...

Diagnostic Tests for Neuroschistosomiasis

Neuroschistosomiasis, a severe clinical syndrome associated with schistosome infection, requires accurate and timely diagnosis to ensure effective treatment and management. The diagnostic tests for neuroschistosomiasis can be categorized into several types:

• Microscopic Examination of Excreta: This is the gold standard diagnostic test, which involves examining stool or urine samples for Schistosoma eggs. However, this method requires the adult worms to be producing eggs, and its sensitivity may vary depending on the timing of sample collection [10][14].
• Serological Tests: These tests can diagnose less advanced infections by detecting antibodies against schistosomes in blood or cerebrospinal fluid samples [10][12].
• Antigen Detection: This method involves detecting specific antigens associated with schistosome infection in bodily fluids, such as blood or urine [13].
• Molecular Tests: Polymerase chain reaction (PCR) can be used to detect Schistosoma DNA in cerebrospinal fluid or other bodily fluids, providing a more sensitive and specific diagnosis [8][13].
• Imaging Studies: Imaging techniques like MRI or CT scans can help identify lesions or abnormalities in the central nervous system associated with neuroschistosomiasis [3][4][5].
• Biopsy: A biopsy of the affected tissue or lesion can provide direct evidence of schistosome infection and is considered a definitive diagnostic test [6][9].

Key Points

• Accurate diagnosis of neuroschistosomiasis is crucial for effective treatment and management.
• The choice of diagnostic test depends on the clinical presentation, availability of resources, and the stage of infection.
• A combination of diagnostic tests may be necessary to confirm the diagnosis.

References

[1] Making the diagnosis can be difficult because diagnostic modalities are limited. [2] Microscopic examination of excreta (stool, urine) is the gold standard diagnostic test but requires the adult worms to be producing eggs; serological tests can diagnose less advanced infections [3] Cerebrospinal fluid examination usually shows an inflammatory pattern, and MRI demonstrates findings of an inflammatory spinal cord lesion. [4] The diagnostic evaluation of cerebral neuroschistosomiasis must include an imaging study, ideally MRI. [5] The diagnosis usually involves imaging of the central nervous system and identification of eggs. [6] Frameless stereotactic biopsy of the affected tissue or lesion can provide direct evidence of schistosome infection. [7] Schistosomes in biopsied central nervous system lesions, and/or a positive antibody test or polymerase chain reaction in cerebrospinal fluid are also diagnostic. [8] Zenk S, Wichmann D, Ammann B, Kern P, Fleischer B, Tannich E, Poppert S. 2014. Diagnosis of neuroschistosomiasis by antibody testing. [9] Neuroschistosomiasis is diagnosed if there is infection at an extraneural site along with clinical and radiographic evidence of neurologic involvement. [10] Microscopic examination of excreta (stool, urine) is the gold standard diagnostic test but requires the adult worms to be producing eggs; serological tests can diagnose less advanced infections [11] Neuroschistosomiasis, referring to schistosomal involvement of the CNS, when symptomatic, is a severe disorder in which prognosis depends largely on early diagnosis and treatment. [12] Diagnostic tests with low sensitivity may miss infected individuals who thus remain undiagnosed but continue to contribute substantially to disease transmission, thereby hindering the efficiency of control efforts. [13] Neuroschistosomiasis is diagnosed if there is infection at an extraneural site along with clinical and radiographic evidence of neurologic involvement. [14] Microscopic examination of excreta (stool, urine) is the gold standard diagnostic test but requires the adult worms to be producing eggs; serological tests can diagnose less advanced infections

Differential Diagnosis of Neuroschistosomiasis

Neuroschistosomiasis, a parasitic infection caused by Schistosoma species, can manifest as myelitis or encephalitis. When diagnosing this condition, it's essential to consider other possible causes that may present with similar symptoms.

Other Conditions to Consider:

• Solitary intracranial lesions: These can be caused by various conditions such as tumors, cysts, or abscesses.
• Myeloradiculopathy: This refers to inflammation of the spinal cord and its surrounding tissues, which can be caused by conditions like multiple sclerosis, transverse myelitis, or vasculitis.
• Altered mental status: This can be caused by a range of conditions including infections, metabolic disorders, or neurological diseases.

Differential Diagnoses:

According to Table 1 in the provided context, other conditions that should be considered in the differential diagnosis of neuroschistosomiasis include:

• Myeloradiculopathy
• Solitary intracranial masses
• Other granulomatous diseases (such as TB and syphilis)
• Neoplasms

Diagnostic Considerations:

A definitive diagnosis of neuroschistosomiasis usually requires a combination of clinical findings, imaging studies, and laboratory tests. The presence of eggs in the stool or positive serology can provide supportive evidence, but direct evidence is typically obtained through brain biopsy.

Imaging Studies:

Brain MRI is considered the gold standard study for diagnosing CNS involvement in neuroschistosomiasis. Characteristic findings on MRI include single or multiple lesions in the brain or spinal cord.

Laboratory Tests:

Serology tests, such as ELISA, can be used to diagnose schistosomal infection. PCR amplification of schistosome DNA from cerebrospinal fluid has also been used successfully in diagnosing neuroschistosomiasis.

Conclusion:

In conclusion, differential diagnosis of neuroschistosomiasis requires careful consideration of other possible causes that may present with similar symptoms. A combination of clinical findings, imaging studies, and laboratory tests is typically required to make a definitive diagnosis.

References:

• Kumbla S., Wray A., Steer A. Pediatric neuroschistosomiasis: A case report and review of the literature. J. Pediatr. Infect. Dis. Soc. 2019;8:489–491. doi: 10.1093/jpids ...