Spinal neuroschistosomiasis caused by Schistoma mansoni : cases reported in two brothers
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CASE REPORT
Open Access
Spinal neuroschistosomiasis caused by Schistoma mansoni: cases reported in two brothers Ana Lúcia Coutinho Domingues1, Constança Simões Barbosa2, Thiago Frederico Andrade Agt3, Andréia Braga Mota3, Clélia Maria Ribeiro Franco3, Edmundo Pessoa Lopes1, Rodrigo Loyo2 and Elainne Christine Souza Gomes2*
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. Keywords: Spinal neuroschistosomiasis, Schistosomal myeloradiculopathy, Schistosoma mansoni, Case report, Diagnosis
* Correspondence: [email protected] 2 Department of Parasitology, Schistosomiasis Reference Laboratory, Aggeu Magalhães Institute, Fiocruz - Ministry of Health, Recife, PE 50740-465, Brazil Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative C
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