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Neuroschistosomiasis mansoni: Literature Review and Guidelines

Vale, Thiago C. MD*; de Sousa-Pereira, Sílvio R. MD*; Ribas, João G. R. MD; Lambertucci, José R. PhD

doi: 10.1097/NRL.0b013e3182704d1e
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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.

*Neurology Division, University Hospital, Federal University of Minas Gerais (UFMG)

Radiology Division, Sarah Kubitschek Hospital

Infectious Diseases Division, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil

Supported partially by CNPq/Brazil.

T.C.V.: wrote the first draft of the paper and modified and reviewed all subsequent drafts. S.R.S.P.: modified and reviewed the first draft. J.G.R.R.: reviewed the first draft and described the figures. J.R.L.: modified and reviewed the first draft and all subsequent drafts, as well as elaborated the transmission cycle and guidelines.

This paper has been approved by the Federal University of Minas Gerais Ethics Committee.

The authors declare no conflict of interest.

Reprints: José R. Lambertucci, PhD, Infectious Diseases Division, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Avenida Alfredo Balena 190, CEP 30130-100 Belo Horizonte (MG), Minas Gerais, Brazil. E-mail: lamber@uai.com.br.

© 2012 Lippincott Williams & Wilkins, Inc.