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Schistosomiasis
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Neuroschistosomiasis (NS)
            • Synonyms

              • Bilharziasis
              • Katayama fever = acute schistosomiasis
            • Definitions

              • CNS infection from parasitic trematodes (blood flukes) of genus Schistosoma
              • Complex life cycle
                • Infect particular species of freshwater snails within endemic areas
                • Infected snails release free-swimming larvae (cercariae), which attach to host mammal
                • Cercariae migrate through skin to dermal veins → pulmonary vasculature
                • Cercariae metamorphose to "schistosomula" → losing forked tails, developing lipid teguments, incorporating host proteins (major histocompatibility complexes and blood group antigens)
                • Migrate through lung capillaries → portal veins where they mature
                • Male and female pair off and migrate together, produce eggs
                  • S. mansoni, S. japonicum → mesenteric veins
                  • S. haematobium → vesicular (bladder) veins
                • Eggs are antigenic and induce inflammatory response
                  • Migrate through bowel or bladder wall and shed in feces, urine
                • Shed eggs mature into free-swimming "miracidia" → infect freshwater snail
                  • 2 generations of "sporocysts" multiply in snail intermediate host

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nonvascular Interventions

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        Selected References

                                        1. Chauvin A et al: Acute paraplegia due to schistosomiasis: an uncommon cause in developed countries. J Neurovirol. 25(3):434-7, 2019
                                        2. Ashour AM et al: Spinal schistosomiasis: cases in Egyptian population. J Craniovertebr Junction Spine. 9(1):76-80, 2018
                                        3. Kim JK et al: High-level cervical spinal cord stimulation used to treat intractable pain arising from transverse myelitis caused by schistosomiasis. J Korean Neurosurg Soc. 47(2):151-4, 2010
                                        4. Vidal CH et al: Epidemiological aspects in neuroschistosomiasis. Arq Neuropsiquiatr. 68(1):72-5, 2010
                                        5. Wang P et al: Research development of the pathogenesis pathways for neuroschistosomiasis. Neurosci Bull. 26(2):168-74, 2010
                                        6. Felipe L et al: Vestibular-evoked myogenic potential (VEMP) in the evaluation of schistosomal myeloradiculopathy. Am J Trop Med Hyg. 81(4):551-4, 2009
                                        7. Carod-Artal FJ: Neurological complications of Schistosoma infection. Trans R Soc Trop Med Hyg. 102(2):107-16, 2008
                                        8. Ferrari TC et al: Immune response and pathogenesis of neuroschistosomiasis mansoni. Acta Trop. 108(2-3):83-8, 2008
                                        9. Cohen-Gadol AA et al: Spinal cord biopsy: a review of 38 cases. Neurosurgery. 52(4): 806-15; discussion 815-6, 2003
                                        10. Olson S et al: Spinal schistosomiasis. J Clin Neurosci. 9(3):317-20, 2002
                                        11. Samandouras G et al: Schistosoma haematobium presenting as an intrinsic conus tumour. Br J Neurosurg. 16(3): 296-300, 2002
                                        12. Junker J et al: Cervical intramedullar schistosomiasis as a rare cause of acute tetraparesis. Clin Neurol Neurosurg. 103(1): 39-42, 2001
                                        13. Leite CC et al: Clinics in diagnostic imaging (52). Spinal cord schistosomiasis. Singapore Med J. 41(8): 417-9, 2000
                                        14. Mazyad MA et al: Spinal cord schistosomiasis and neurologic complications. J Egypt Soc Parasitol. 29(1): 179-82, 1999
                                        15. Bennett G et al: Schistosomal myelitis: findings at MR imaging. Eur J Radiol. 27(3): 268-70, 1998
                                        16. Murphy KJ et al: Spinal cord infection: myelitis and abscess formation. AJNR Am J Neuroradiol. 19(2): 341-8, 1998
                                        17. Pittella JE: Neuroschistosomiasis. Brain Pathol. 7(1): 649-62, 1997
                                        18. Ueki K et al: Schistosoma mansoni infection involving the spinal cord. Case report. J Neurosurg. 82(6): 1065-7, 1995
                                        19. Haribhai HC et al: Spinal cord schistosomiasis. A clinical, laboratory and radiological study, with a note on therapeutic aspects. Brain. 114 ( Pt 2): 709-26, 1991
                                        20. Bloom K et al: Paraplegia from schistosomiasis. Paraplegia. 28(7): 455-9, 1990
                                        21. Bac DJ et al: Schistosomiasis in ectopic or unusual sites. A report of 5 cases. S Afr Med J. 72(10): 717-8, 1987
                                        22. Scrimgeour EM et al: Involvement of the central nervous system in Schistosoma mansoni and S. haematobium infection. Brain. 108 ( Pt 4):1023-38, 1985
                                        23. Queiroz LS et al: Massive spinal cord necrosis in schistosomiasis. Arch Neurol. 36(8): 517-9, 1979
                                        24. Norfray JF et al: Schistosomiasis of the spinal cord. Surg Neurol. 9(1): 68-71, 1978
                                        25. Siddorn JA: Schistosomiasis and anterior spinal artery occlusion. Am J Trop Med Hyg. 27(3): 532-4, 1978
                                        26. Lechtenberg R et al: Schistosomiasis of the spinal cord. Neurology. 27(1): 55-9, 1977
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Neuroschistosomiasis (NS)
                                                  • Synonyms

                                                    • Bilharziasis
                                                    • Katayama fever = acute schistosomiasis
                                                  • Definitions

                                                    • CNS infection from parasitic trematodes (blood flukes) of genus Schistosoma
                                                    • Complex life cycle
                                                      • Infect particular species of freshwater snails within endemic areas
                                                      • Infected snails release free-swimming larvae (cercariae), which attach to host mammal
                                                      • Cercariae migrate through skin to dermal veins → pulmonary vasculature
                                                      • Cercariae metamorphose to "schistosomula" → losing forked tails, developing lipid teguments, incorporating host proteins (major histocompatibility complexes and blood group antigens)
                                                      • Migrate through lung capillaries → portal veins where they mature
                                                      • Male and female pair off and migrate together, produce eggs
                                                        • S. mansoni, S. japonicum → mesenteric veins
                                                        • S. haematobium → vesicular (bladder) veins
                                                      • Eggs are antigenic and induce inflammatory response
                                                        • Migrate through bowel or bladder wall and shed in feces, urine
                                                      • Shed eggs mature into free-swimming "miracidia" → infect freshwater snail
                                                        • 2 generations of "sporocysts" multiply in snail intermediate host

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Nonvascular Interventions

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              Selected References

                                                                              1. Chauvin A et al: Acute paraplegia due to schistosomiasis: an uncommon cause in developed countries. J Neurovirol. 25(3):434-7, 2019
                                                                              2. Ashour AM et al: Spinal schistosomiasis: cases in Egyptian population. J Craniovertebr Junction Spine. 9(1):76-80, 2018
                                                                              3. Kim JK et al: High-level cervical spinal cord stimulation used to treat intractable pain arising from transverse myelitis caused by schistosomiasis. J Korean Neurosurg Soc. 47(2):151-4, 2010
                                                                              4. Vidal CH et al: Epidemiological aspects in neuroschistosomiasis. Arq Neuropsiquiatr. 68(1):72-5, 2010
                                                                              5. Wang P et al: Research development of the pathogenesis pathways for neuroschistosomiasis. Neurosci Bull. 26(2):168-74, 2010
                                                                              6. Felipe L et al: Vestibular-evoked myogenic potential (VEMP) in the evaluation of schistosomal myeloradiculopathy. Am J Trop Med Hyg. 81(4):551-4, 2009
                                                                              7. Carod-Artal FJ: Neurological complications of Schistosoma infection. Trans R Soc Trop Med Hyg. 102(2):107-16, 2008
                                                                              8. Ferrari TC et al: Immune response and pathogenesis of neuroschistosomiasis mansoni. Acta Trop. 108(2-3):83-8, 2008
                                                                              9. Cohen-Gadol AA et al: Spinal cord biopsy: a review of 38 cases. Neurosurgery. 52(4): 806-15; discussion 815-6, 2003
                                                                              10. Olson S et al: Spinal schistosomiasis. J Clin Neurosci. 9(3):317-20, 2002
                                                                              11. Samandouras G et al: Schistosoma haematobium presenting as an intrinsic conus tumour. Br J Neurosurg. 16(3): 296-300, 2002
                                                                              12. Junker J et al: Cervical intramedullar schistosomiasis as a rare cause of acute tetraparesis. Clin Neurol Neurosurg. 103(1): 39-42, 2001
                                                                              13. Leite CC et al: Clinics in diagnostic imaging (52). Spinal cord schistosomiasis. Singapore Med J. 41(8): 417-9, 2000
                                                                              14. Mazyad MA et al: Spinal cord schistosomiasis and neurologic complications. J Egypt Soc Parasitol. 29(1): 179-82, 1999
                                                                              15. Bennett G et al: Schistosomal myelitis: findings at MR imaging. Eur J Radiol. 27(3): 268-70, 1998
                                                                              16. Murphy KJ et al: Spinal cord infection: myelitis and abscess formation. AJNR Am J Neuroradiol. 19(2): 341-8, 1998
                                                                              17. Pittella JE: Neuroschistosomiasis. Brain Pathol. 7(1): 649-62, 1997
                                                                              18. Ueki K et al: Schistosoma mansoni infection involving the spinal cord. Case report. J Neurosurg. 82(6): 1065-7, 1995
                                                                              19. Haribhai HC et al: Spinal cord schistosomiasis. A clinical, laboratory and radiological study, with a note on therapeutic aspects. Brain. 114 ( Pt 2): 709-26, 1991
                                                                              20. Bloom K et al: Paraplegia from schistosomiasis. Paraplegia. 28(7): 455-9, 1990
                                                                              21. Bac DJ et al: Schistosomiasis in ectopic or unusual sites. A report of 5 cases. S Afr Med J. 72(10): 717-8, 1987
                                                                              22. Scrimgeour EM et al: Involvement of the central nervous system in Schistosoma mansoni and S. haematobium infection. Brain. 108 ( Pt 4):1023-38, 1985
                                                                              23. Queiroz LS et al: Massive spinal cord necrosis in schistosomiasis. Arch Neurol. 36(8): 517-9, 1979
                                                                              24. Norfray JF et al: Schistosomiasis of the spinal cord. Surg Neurol. 9(1): 68-71, 1978
                                                                              25. Siddorn JA: Schistosomiasis and anterior spinal artery occlusion. Am J Trop Med Hyg. 27(3): 532-4, 1978
                                                                              26. Lechtenberg R et al: Schistosomiasis of the spinal cord. Neurology. 27(1): 55-9, 1977