Diagnostic profile of schistosomotic myeloradiculopathy in three hospitals of Belo Horizonte, Minas Gerais

DIAGNOSTIC PROFILE OF SCHISTOSOMOTIC MYELORADICULOPATHY IN THREE HOSPITALS OF BELO HORIZONTE, MINAS GERAIS (ABSTRACT)^*. DISSERTATION. BELO HORIZONTE, 1994.

EUSTÁQUIO CLARET DOS SANTOS^**

The involvement of the central nervous system in the course of schistosomiasis has been observed with all Schistosoma species. In cases of ectopic schistosomiasis it has been noted that Schistosoma japonicum preferentially affects the cerebrum whereas Schistosoma mansoni and Schistosoma hematobium usually localize in the spinal cord.

During a twenty years period (1972-1992) 56 patients with diagnosis of schistosomotic myeloradiculopathy were interned in three hospitals of Belo Horizonte - Minas Gerais. Data from each patient were collected retrospectively from their medical records. In all cases, the diagnosis was inferred in a presumably way and was based on the following: 1) finding of low thoracic/upper lumbar neurological symptoms; 2) positive epidemiology for schistosomiasis; 3) demonstration of exposure to schistosomiasis through parasitologic or serologic techniques; and 4) the exclusion of other known causes of myelitis.

In this series there were 44 (78.6) men and 12 (21.4%) women. Their ages ranged from 3 to 56 years old (median 28.86%). Several other demographic features ¾ such as color, schooling, occupation and origin ¾ were studied as to determine these patient's epidemiological aspects.

Of the 56 patients whose clinical histories were recorded, the most common symptoms were muscular weakness (85%), lumbar pain (76.8%), and urinary retention (75%). The most commonly sensory level was L1. One patient had a T4 sensory level while the lowest sensory level in this study was S1. There were reflex changes with reduced or absent ankle (66%) and knee jerks (51%).

The length of time between the beginning of the symptoms and the diagnosis varied from one day to 30 months.

The most frequent form of neurological involvement was myeloradicular (55.3%), followed by the myelitis (26.8%). The pseudotumoral form had only one case.

Cerebrospinal fluid (CSF) examination revealed hypercytosis ranging from a few to 699 leucocytes per mm3, with a predominance of mononuclear cells. Protein concentration was increased (72.5% of cases) and ranged from 10 to 2780 mg/dl. Eosinophil cells were recorded in 60.4% in CSF. Peripheral blood eosinophilia was present in 20.4%. Schistosoma ova were obtained from faeces in 77.4% of cases, and from rectal snips in 100% of subjects. Myelography was undertaken in 20 cases and revealed spinal block in just one. Schistosomiasis chronic intestinal form was observed in 10 cases. Systemic clinical form could not be estimated in 43 patients. The other forms (acute, hepatosplenic and hepatointestinal) had one case each one.

Corticosteroid therapy was used in 94.6% of cases (associated to specific treatment in 73.2% and, separately in 21.4%) . The best response was observed in the group that made use of corticosteroid in conjunction with schistosomicidal therapy. Due to disparity among the groups, comments could not be made about the best corticosteroid type applied or specific treatment drug.

We emphasize how important is thinking about this schistosomiasis diagnosis among patients suffering from myeloradiculopathy, and applying proper protocols to register the cases. Criteria to improve this disorder classification are suggested.

KEY WORDS: schistosomiasis, radiculopathy, myelitis.

**Address: Rua Domingos Vieira 273 / 907-10, 30150-240 Belo Horizonte MG, Brasil. E-mail: [e-mail]

*

Perfil diagnóstico da mielorradiculopatia esquistossomótica em três hospitais de Belo Horizonte, Minas Gerais (Resumo). Dissertação de Mestrado, Universidade Federal de Minas Gerais (Área: Medicina Tropical). Orientador: Manoel Otávio da Costa Rocha.

Publication Dates

• Publication in this collection
  03 Apr 2000
• Date of issue
  Dec 1999