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Mohandas P, Sarkar H, Jain D, Sundaram VKG. A case report of conus intramedullary mansoni neuroschistosomiasis. Surg Neurol Int 2023; 14:139. [PMID: 37151453 PMCID: PMC10159276 DOI: 10.25259/sni_47_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/17/2023] [Indexed: 05/09/2023] Open
Abstract
Background Conus schistosomiasis is an extremely rare entity in which patients present with a wide range of neurological symptoms such as low back pain, paresthesia, fever, myalgia, paraparesis, and paraplegia. This neglected tropical parasitic disease causes significant neurological morbidity. The migration of parasitic worms and their eggs into the central nervous system can lead to profound and life-altering disabilities. Early, accurate diagnosis, and treatment can lead to the complete resolution of symptoms. Case Description A 5-year-old boy from South Sudan presented with complaints of sudden onset, progressive bilateral lower limb weakness for the past month, inability to walk or stand without assistance, and urinary incontinence. Magnetic resonance imaging spine showed an irregular enhancing lesion within the conus. The various possibilities, such as Astrocytoma, and granulomatous disorders were considered. However, a biopsy revealed the lesion to be Conus schistosomiasis, a rare condition with only a few cases reported in children. Typical clinicoradiological presentation and the treatment paradigm have been discussed in this manuscript. Appropriate management of this lesion can avert surgical intervention needed for either a diagnosis or treatment. Conclusion This case report aims to emphasize the importance of considering schistosomiasis as an important differential diagnosis of a conus intramedullary lesion, especially in patients from tropical endemic countries. The neurological recovery in this infestation is directly related to early diagnosis and treatment. Therefore, it is essential to recognize this entity, as early detection and management would result in significant neurological improvement without undergoing surgery.
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Affiliation(s)
- Prithvi Mohandas
- Department of Orthopedic Surgery, Madras Institute of Orthopedics and Traumatology (M.I.O.T) International, Chennai, Tamil Nadu, India
| | - Hrishikesh Sarkar
- Department of Neurosurgery, Madras Institute of Orthopedics and Traumatology (M.I.O.T) International, Chennai, Tamil Nadu, India
- Corresponding author: Hrishikesh Sarkar, Director of Department of Neurosurgery, Madras Institute of Orthopedics and Traumatology (M.I.O.T) International, Chennai, Tamil Nadu, India.
| | - Deepti Jain
- Department of Pathology, Madras Institute of Orthopedics and Traumatology (M.I.O.T) International, Chennai, Tamil Nadu, India
| | - Vanaja Kate Garfin Sundaram
- Department of Neurosurgery, Madras Institute of Orthopedics and Traumatology (M.I.O.T) International, Chennai, Tamil Nadu, India
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Domingues ALC, Barbosa CS, Agt TFA, Mota AB, Franco CMR, Lopes EP, Loyo R, Gomes ECS. Spinal neuroschistosomiasis caused by Schistoma mansoni: cases reported in two brothers. BMC Infect Dis 2020; 20:724. [PMID: 33008310 PMCID: PMC7530957 DOI: 10.1186/s12879-020-05428-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background Spinal neuroschistosomiasis (SN) is one of the most severe clinical presentations of schistosomiasis infection and an ectopic form of the disease caused by any species of Schistosoma. In Brazil, all cases of this clinical manifestation are related to Schistosoma mansoni, the only species present in the country. Although many cases have been reported in various endemic areas in Brazil, this is the first time in the literature that SN is described in two brothers. Case presentation Two cases of SN were accidentally diagnosed during an epidemiological survey in an urban area endemic for schistosomiasis transmission. Both patients complained of low back pain and muscle weakness in the lower limbs. Sphincter dysfunction and various degrees of paresthesia were also reported. The patients’ disease was classified as hepato-intestinal stage schistosomiasis mansoni at the onset of the chronic form. A positive parasitological stool test for S. mansoni, clinical evidence of myeloradicular damage and exclusion of other causes of damage were the basic criteria for diagnosis. After treatment with praziquantel and corticosteroid, the patients presented an improvement in symptoms, although some complaints persisted. Conclusions It is important to consider SN when patients come from areas endemic for transmission of schistosomiasis mansoni. Clinical physicians and neurologists should consider this diagnostic hypothesis, because recovery from neurological injuries is directly related to early treatment. As, described here in two brothers, a genetic predisposition may be related to neurological involvement. Primary care physicians should thus try to evaluate family members and close relatives in order to arrive at prompt schistosomiasis diagnosis in asymptomatic individuals and propose treatment in an attempt to avoid progression to SN.
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Affiliation(s)
- Ana Lúcia Coutinho Domingues
- Department of Gastroenterology, Clinical Hospital, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Constança Simões Barbosa
- Department of Parasitology, Schistosomiasis Reference Laboratory, Aggeu Magalhães Institute, Fiocruz - Ministry of Health, Recife, PE, 50740-465, Brazil
| | - Thiago Frederico Andrade Agt
- Department of Neurology, Clinical Hospital, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Andréia Braga Mota
- Department of Neurology, Clinical Hospital, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Clélia Maria Ribeiro Franco
- Department of Neurology, Clinical Hospital, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Edmundo Pessoa Lopes
- Department of Gastroenterology, Clinical Hospital, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Rodrigo Loyo
- Department of Parasitology, Schistosomiasis Reference Laboratory, Aggeu Magalhães Institute, Fiocruz - Ministry of Health, Recife, PE, 50740-465, Brazil
| | - Elainne Christine Souza Gomes
- Department of Parasitology, Schistosomiasis Reference Laboratory, Aggeu Magalhães Institute, Fiocruz - Ministry of Health, Recife, PE, 50740-465, Brazil.
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