Guidelines for the diagnosis and treatment of schistosomal myeloradiculopathy Orientações sobre o diagnóstico e tratamento da mielorradiculopatia associada à esquistossomose

• Published in: Revista da Sociedade Brasileira de Medicina Tropical
• Main Authors: José Roberto Lambertucci, Luciana Cristina dos Santos Silva, Ronaldo Santos do Amaral
• Format: Article in Journal/Newspaper
• Language: English
• Published: Sociedade Brasileira de Medicina Tropical (SBMT) 2007
• Subjects: Esquistossomose; Neuroesquistossomose; Mielorradiculopatia; Esteróides; Praziquantel; Schistosomiasis; Neuroschistosomiasis; Myeloradiculopathy; Steroids; Arctic medicine. Tropical medicine; RC955-962; Arctic
• Online Access: https://doi.org/10.1590/S0037-86822007000500016; https://doaj.org/article/5348f5274440421dac07280e1bfe66d7

Schistosomal myeloradiculopathy is the most severe and disabling ectopic form of Schistosoma mansoni infection. The prevalence of SMR in centres in Brazil and Africa that specialise in attending patients with non traumatic myelopathy is around 5%. The initial signs and symptoms of the disease include lumbar and/or lower limb pain, paraparesis, urinary and intestinal dysfunctions, and impotence in men. The cerebrospinal fluid of SMR patients shows an increase in protein concentration and in the number of mononuclear cells in 90% of cases; eosinophils have been reported in 40%. The use of magnetic resonance imaging is particularly valuable in the diagnosis of Schistosomal myeloradiculopathy. The exclusion of other myelopathies and systemic diseases remains mandatory. Early diagnosis and treatment with steroids and schistosomicides provide a cure for most patients, whilst delayed treatment can result in irreversible physical disabilities or death. To improve awareness concerning Schistosomal myeloradiculopathy amongst public health professionals, and to facilitate the control of the disease, the Brazilian Ministry of Health has launched a program of education and control of this ectopic form of schistosomiasis. The present paper reviews current methods for the diagnosis of SMR and outlines protocols for treatment of the disease. A mielorradiculopatia esquistossomótica é a forma ectópica mais grave da infecção pelo Schistosoma mansoni. A prevalência da mielorradiculopatia esquistossomótica em centros médicos no Brasil e em África, especializados no atendimento de pacientes com mielopatia, encontra-se em torno de 5%. Os sintomas e sinais iniciais da doença incluem: dor lombar e/ou dor em membros inferiores, paraparesia, disfunções urinária e intestinal, e impotência no homem. A análise do líqüor destes pacientes revela aumento na concentração de proteínas e no número de células mononucleares em 90% dos casos; a presença de eosinófilos foi documentada em 40%. O uso rotineiro da ressonância magnética tornou-se ...