Neuroschistosomiasis

Abstract

Neuroschistosomiasis, the involvement of the central nervous system by schistosome, is a neglected and under-recognized disease. This chapter provides an overview of the clinical features, pathogenetic mechanisms of this infection, as well as perspectives. The presentation of neuroschistosomiasis ranges from asymptomatic to different clinical pictures of varying severity. Acute schistosomal encephalopathy presents as an acute diffuse encephalopathy. Pseudotumoral encephalic schistosomiasis manifests as a slow-growth tumor-like lesion, and spinal cord schistosomiasis as an acute/subacute lower spinal cord syndrome. The latter two forms result mostly from egg deposition in the central nervous system, while the pathogenesis of acute schistosomal encephalopathy is unclear. Schistosoma mansoni or S. haematobium infection involves more frequently the spinal cord, while S. japonicum infection targets preferentially the brain. The diagnosis of neuroschistosomiasis is largely based on clinical features. Imaging methods demonstrate nonspecific findings. Serum anti-schistosome antibody tests are of limited diagnostic value, but results in the cerebrospinal fluid are promising. Neuroschistosomiasis is treated with praziquantel and a steroid. Surgery is performed in specific cases. The outcome of neuroschistosomiasis is largely dependent on early treatment and is worse in spinal cord schistosomiasis than in the other forms. Several aspects of neuroschistosomiasis remain to be clarified.