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
Chauvin A et al: Acute paraplegia due to schistosomiasis: an uncommon cause in developed countries. J Neurovirol. 25(3):434-7, 2019
Ashour AM et al: Spinal schistosomiasis: cases in Egyptian population. J Craniovertebr Junction Spine. 9(1):76-80, 2018
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
Vidal CH et al: Epidemiological aspects in neuroschistosomiasis. Arq Neuropsiquiatr. 68(1):72-5, 2010
Wang P et al: Research development of the pathogenesis pathways for neuroschistosomiasis. Neurosci Bull. 26(2):168-74, 2010
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
Carod-Artal FJ: Neurological complications of Schistosoma infection. Trans R Soc Trop Med Hyg. 102(2):107-16, 2008
Ferrari TC et al: Immune response and pathogenesis of neuroschistosomiasis mansoni. Acta Trop. 108(2-3):83-8, 2008
Cohen-Gadol AA et al: Spinal cord biopsy: a review of 38 cases. Neurosurgery. 52(4): 806-15; discussion 815-6, 2003
Olson S et al: Spinal schistosomiasis. J Clin Neurosci. 9(3):317-20, 2002
Samandouras G et al: Schistosoma haematobium presenting as an intrinsic conus tumour. Br J Neurosurg. 16(3): 296-300, 2002
Junker J et al: Cervical intramedullar schistosomiasis as a rare cause of acute tetraparesis. Clin Neurol Neurosurg. 103(1): 39-42, 2001
Leite CC et al: Clinics in diagnostic imaging (52). Spinal cord schistosomiasis. Singapore Med J. 41(8): 417-9, 2000
Mazyad MA et al: Spinal cord schistosomiasis and neurologic complications. J Egypt Soc Parasitol. 29(1): 179-82, 1999
Bennett G et al: Schistosomal myelitis: findings at MR imaging. Eur J Radiol. 27(3): 268-70, 1998
Murphy KJ et al: Spinal cord infection: myelitis and abscess formation. AJNR Am J Neuroradiol. 19(2): 341-8, 1998
Ueki K et al: Schistosoma mansoni infection involving the spinal cord. Case report. J Neurosurg. 82(6): 1065-7, 1995
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
Bloom K et al: Paraplegia from schistosomiasis. Paraplegia. 28(7): 455-9, 1990
Bac DJ et al: Schistosomiasis in ectopic or unusual sites. A report of 5 cases. S Afr Med J. 72(10): 717-8, 1987
Scrimgeour EM et al: Involvement of the central nervous system in Schistosoma mansoni and S. haematobium infection. Brain. 108 ( Pt 4):1023-38, 1985
Queiroz LS et al: Massive spinal cord necrosis in schistosomiasis. Arch Neurol. 36(8): 517-9, 1979
Norfray JF et al: Schistosomiasis of the spinal cord. Surg Neurol. 9(1): 68-71, 1978
Siddorn JA: Schistosomiasis and anterior spinal artery occlusion. Am J Trop Med Hyg. 27(3): 532-4, 1978
Lechtenberg R et al: Schistosomiasis of the spinal cord. Neurology. 27(1): 55-9, 1977
Related Anatomy
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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
Chauvin A et al: Acute paraplegia due to schistosomiasis: an uncommon cause in developed countries. J Neurovirol. 25(3):434-7, 2019
Ashour AM et al: Spinal schistosomiasis: cases in Egyptian population. J Craniovertebr Junction Spine. 9(1):76-80, 2018
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
Vidal CH et al: Epidemiological aspects in neuroschistosomiasis. Arq Neuropsiquiatr. 68(1):72-5, 2010
Wang P et al: Research development of the pathogenesis pathways for neuroschistosomiasis. Neurosci Bull. 26(2):168-74, 2010
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
Carod-Artal FJ: Neurological complications of Schistosoma infection. Trans R Soc Trop Med Hyg. 102(2):107-16, 2008
Ferrari TC et al: Immune response and pathogenesis of neuroschistosomiasis mansoni. Acta Trop. 108(2-3):83-8, 2008
Cohen-Gadol AA et al: Spinal cord biopsy: a review of 38 cases. Neurosurgery. 52(4): 806-15; discussion 815-6, 2003
Olson S et al: Spinal schistosomiasis. J Clin Neurosci. 9(3):317-20, 2002
Samandouras G et al: Schistosoma haematobium presenting as an intrinsic conus tumour. Br J Neurosurg. 16(3): 296-300, 2002
Junker J et al: Cervical intramedullar schistosomiasis as a rare cause of acute tetraparesis. Clin Neurol Neurosurg. 103(1): 39-42, 2001
Leite CC et al: Clinics in diagnostic imaging (52). Spinal cord schistosomiasis. Singapore Med J. 41(8): 417-9, 2000
Mazyad MA et al: Spinal cord schistosomiasis and neurologic complications. J Egypt Soc Parasitol. 29(1): 179-82, 1999
Bennett G et al: Schistosomal myelitis: findings at MR imaging. Eur J Radiol. 27(3): 268-70, 1998
Murphy KJ et al: Spinal cord infection: myelitis and abscess formation. AJNR Am J Neuroradiol. 19(2): 341-8, 1998
Ueki K et al: Schistosoma mansoni infection involving the spinal cord. Case report. J Neurosurg. 82(6): 1065-7, 1995
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
Bloom K et al: Paraplegia from schistosomiasis. Paraplegia. 28(7): 455-9, 1990
Bac DJ et al: Schistosomiasis in ectopic or unusual sites. A report of 5 cases. S Afr Med J. 72(10): 717-8, 1987
Scrimgeour EM et al: Involvement of the central nervous system in Schistosoma mansoni and S. haematobium infection. Brain. 108 ( Pt 4):1023-38, 1985
Queiroz LS et al: Massive spinal cord necrosis in schistosomiasis. Arch Neurol. 36(8): 517-9, 1979
Norfray JF et al: Schistosomiasis of the spinal cord. Surg Neurol. 9(1): 68-71, 1978
Siddorn JA: Schistosomiasis and anterior spinal artery occlusion. Am J Trop Med Hyg. 27(3): 532-4, 1978
Lechtenberg R et al: Schistosomiasis of the spinal cord. Neurology. 27(1): 55-9, 1977
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