Spinal cord schistosomiasis: Fifteen years experience

Background: After malaria, Schistosomiasis is the second most prevalent tropical disease. The prevalence of oviposition in the CNS of infected persons varies from 0.3 to 30%. The conus medullaris is a primary site of Schistosomiasis either granulomatous or acute necrotizing myelitis. Objective: To report the clinical, radiological and laboratory results of spinal cord Schistosomiasis (SCS) and to design proper therapeutic regimens. Methods: Seventeen patients, 13 males and 4 females, with SCS were enrolled between 1994 and 2009 at Mansoura University Hospitals. Their median age at diagnosis was 19 years (13 to 30 years). Independent neurological, radiological and laboratory assessments were performed for both groups apart from pathological confirmation that was done early in eight patients (group 1). In group 2, 9 patients, indirect hemagglutination test (IHA) for bilharziasis in blood and CSF was performed. Higher positive titer in CSF than serum indicated SCS plus induction of antibilharzial and corticosteroids for 12 months with 3-year follow up. Results: Rate of neurological symptoms of granulomatous intramedullary cord lesion was assessed independently in 16 cases and acute paraparesis in one case. All patients had positive IHA against S. mansoni with median CSF and serum ranges 1/640 and 1/320 respectively. Seven patients (41.18%) had complete recovery, eight patients (47.06%) showed partial recovery and no response was reported in two patients (11.76%) (p=0.005). No recorded mortality in the current registry. Conclusion: Rapid diagnosis of SCS with early medical therapies for 12 months is a crucial tool to complete recovery.