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Guidelines for the diagnosis and treatment of schistosomal myeloradiculopathy
Lambertucci, José Roberto;Silva, Luciana Cristina dos Santos;Amaral, Ronaldo Santos do;
Revista da Sociedade Brasileira de Medicina Tropical , 2007, DOI: 10.1590/S0037-86822007000500016
Abstract: 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.
Schistosomal myeloradiculopathy due to Schistosoma mansoni: report on 23 cases
Nobre, Vandack;Silva, Luciana CS;Ribas, Jo?o G;Rayes, Abdunnabi;Serufo, JC;Lana-Peixoto, MA;Marinho, Rosana FZ;Lambertucci, JR;
Memórias do Instituto Oswaldo Cruz , 2001, DOI: 10.1590/S0074-02762001000900020
Abstract: schistosoma mansoni infection is likely to be responsible for a significant proportion of cases of myelopathy occurring in areas where schistosomiasis is endemic. the aim of this study is to describe the clinical, laboratory and therapeutic data of 23 patients with schistosomal myeloradiculopathy. the medical records of 23 patients with schistosomal myelopathy admitted to two general hospitals of belo horizonte (mg), in brazil, from 1995 to 1999, were reviewed retrospectively. seventeen patients were male (74%). the mean age for the whole group was 27 years. lower limb weakness and associated lumbar and/or lower limb pain were reported by 20 patients (87%), and 16 (70%) were unable to walk. all individuals presented urinary retention and 19 (83%) complained of intestinal dysfunction. the treatment was based on the association of antischistosomal drugs and corticosteroids. five patients (22%) presented a full response to treatment, 13 (57%) partial response without functional limitations and 4 (17%) partial improvement with limitations or no response. three out of the 4 patients who stopped steroids before 45 days of treatment developed recurrence of the symptoms and signs of myelopathy. our cases demonstrate the severe presentation of the disease and the data disclosed here suggest that treatment with steroids should be kept for months after clinical improvement.
Schistosomal myeloradiculopathy due to Schistosoma mansoni: report on 23 cases  [cached]
Nobre Vandack,Silva Luciana CS,Ribas Jo?o G,Rayes Abdunnabi
Memórias do Instituto Oswaldo Cruz , 2001,
Abstract: Schistosoma mansoni infection is likely to be responsible for a significant proportion of cases of myelopathy occurring in areas where schistosomiasis is endemic. The aim of this study is to describe the clinical, laboratory and therapeutic data of 23 patients with schistosomal myeloradiculopathy. The medical records of 23 patients with schistosomal myelopathy admitted to two general hospitals of Belo Horizonte (MG), in Brazil, from 1995 to 1999, were reviewed retrospectively. Seventeen patients were male (74%). The mean age for the whole group was 27 years. Lower limb weakness and associated lumbar and/or lower limb pain were reported by 20 patients (87%), and 16 (70%) were unable to walk. All individuals presented urinary retention and 19 (83%) complained of intestinal dysfunction. The treatment was based on the association of antischistosomal drugs and corticosteroids. Five patients (22%) presented a full response to treatment, 13 (57%) partial response without functional limitations and 4 (17%) partial improvement with limitations or no response. Three out of the 4 patients who stopped steroids before 45 days of treatment developed recurrence of the symptoms and signs of myelopathy. Our cases demonstrate the severe presentation of the disease and the data disclosed here suggest that treatment with steroids should be kept for months after clinical improvement.
Clinical-epidemiologic profile of the schistosomal myeloradiculopathy in Pernambuco, Brazil
Araújo, Karina Concei??o GM de;Silva, Cristiana da Rosa e;Santos, Alexsandra Glória A dos;Barbosa, Constan?a Sim?es;Ferrari, Teresa CA;
Memórias do Instituto Oswaldo Cruz , 2010, DOI: 10.1590/S0074-02762010000400017
Abstract: this was a retrospective descriptive study on a series of cases of schistosomal myeloradiculopathy (smr) and the aim was to investigate the incidence of this disease and its clinical and epidemiological characteristics in cases diagnosed at three healthcare units in pernambuco, brazil between 1994-2006. the data were collected by reviewing the medical records from both the neurological and paediatric outpatient clinics and wards of the hospital clinics, hospital of the restoration and pernambuco mother and child institute. to gather the data, a spinal cord schistosomiasis evaluation protocol was used. the diagnoses were based on positive epidemiological evidence of schistosomiasis, clinical findings and laboratory tests (stool parasitological examination or rectal biopsies, magnetic resonance imaging findings and cerebrospinal fluid investigations). a total of 139 cases aged between 2-83 years were found. the most important determinants of smr were male sex (66.2%), contact with fresh water (91%), origin in endemic regions (39.5%), lower-limb muscle weakness (100%), sensory level at the lower thoracic medulla (40.3%), myeloradicular form (76%) and presence of eggs in the stool parasitological examination (48%). this sample indicates the need for intervention policies guided by diagnostic standardization, thereby avoiding disease under-notification.
Clinical-epidemiological profile of children with schistosomal myeloradiculopathy attended at the Instituto Materno-Infantil de Pernambuco
Araújo, Karina Concei??o GM;Silva, Cristiana da Rosa e;Barbosa, Constan?a Sim?es;Ferrari, Teresa CA;
Memórias do Instituto Oswaldo Cruz , 2006, DOI: 10.1590/S0074-02762006000900024
Abstract: the most critical phase of exposure to schistosomal infection is the infancy, because of the more frequent contact with contaminated water and the immaturity of the immune system. one of the most severe presentations of this parasitosis is the involvement of the spinal cord, which prognosis is largely dependent on early diagnosis and treatment. reports on this clinical form of schistosomiasis in children are rare in the literature. we present here the clinical-epidemiological profile of schistosomal myeloradiculopathy (smr) from ten children who were admitted at the instituto materno-infantil de pernambuco over a five-year period. they were evaluated according to an investigation protocol. most of these patients presented an acute neurological picture which included as the main clinical manifestations: sphincteral disorders, low back and lower limbs pain, paresthesia, lower limbs muscle weakness and absence of deep tendon reflex, and impairment of the gait. the diagnosis was presumptive in the majority of the cases. this study emphasizes the importance of considering the diagnosis of smr in pediatric patients coming from endemic areas who present a low cord syndrome, in order to start the appropriate therapy and avoid future complications.
First occurrence of an autochthonous canine case of Leishmania (Leishmania) infantum chagasi in the municipality of Campinas, State of S?o Paulo, Brazil
Savani, Elisa San Martin Mouriz;Presotto, Douglas;Roberto, Thais;Camargo, Maria Cecília Gibrail de Oliveira;D'auria, Sandra Regina Nicoletti;Sacramento, Débora Veiga;
Revista do Instituto de Medicina Tropical de S?o Paulo , 2011, DOI: 10.1590/S0036-46652011000400010
Abstract: an autochthonous case of visceral leishmaniasis is reported in a dog (canis familiaris) as an apparently natural infection in a non-endemic area. dna obtained from spleen and liver samples produced the expected fragment in a leishmania-specific rdna-based nested-pcr assay. the pcr product, a 490 bp fragment, was sequenced and the nucleotide sequence was identical to that of leishmania (leishmania) infantum chagasi. these results are surprising since no autochthonous human or canine cases of visceral leishmaniasis have ever been reported in this municipality. this case suggests that natural transmission of this disease is occurring in this area.
Schistosomal hepatopathy
Andrade, Zilton A;
Memórias do Instituto Oswaldo Cruz , 2004, DOI: 10.1590/S0074-02762004000900009
Abstract: gross anatomical features and a complex set of vascular changes characterize schistosomal hepatopathy as a peculiar form of chronic liver disease, clinically known as "hepatosplenic schistosomiasis". it differs from hepatic cirrhosis, although clinical and pathological aspects may sometimes induce confusion between these two conditions. intrahepatic portal vein obstruction and compensatory arterial hypertrophy render the hepatic parenchyma vulnerable to ischemic insult. this may lead to focal necrosis, which may give place to focal post-necrotic scars. these events are of paramount importance for the clinico-pathological evolution of schistosomal hepatopathy. although portal fibrosis due to schistosomiasis sometimes reveals numerous myofibroblasts, it does not mean that such fibrosis belongs to a peculiar type. damage to the muscular walls of the portal vein may be followed by dissociation of smooth muscle cells and their transition toward myofibroblasts, which appear only as transient cells in schistosomal portal fibrosis. studies made with plastic vascular casts, especially those with the murine model of "pipestem" fibrosis have helped to reveal the mechanisms involved in systematized portal fibrosis formation. however, the factors involved in the pathogenesis of hepatosplenic disease remain poorly understood. a process of chronic hepatitis is a common accompaniment of portal fibrosis in schistosomiasis. most of the times it is caused by concomitant viral infection. however, no especial interaction seems to exist between schistosomal hepatopathy and viral hepatitis.
Angiogenesis and schistosomal granuloma formation
Baptista, Ana Paula;Andrade, Zilton A;
Memórias do Instituto Oswaldo Cruz , 2005, DOI: 10.1590/S0074-02762005000200012
Abstract: an increasing amount of evidences points to angiogenesis as playing a paramount role in fibrosis development. however, granulomas in general, and periovular schistosomal granulomas in particular, are considered avascular structures, although they usually result in dense areas of focal fibrosis. in order to clarify this apparent paradox, the presence of blood vessels was systematically searched in hepatic schistosomal granulomas of mice, during different stages of the infection, and at different stages of granuloma evolution, by means of vascular injections of colored masses, demonstration of laminin in vascular basement membranes and by ultra structural analysis. vascular proliferation appeared evident at the early stages of granuloma formation, gradually decreasing thereafter, older granulomas becoming almost avascular structures, sometimes delimited at the periphery by a rich vascular network.
Oblique Corpectomy to Manage Cervical Myeloradiculopathy  [PDF]
Chibbaro Salvatore,Makiese Orphee,Bresson Damien,Reiss Alisha,Poczos Pavel,George Bernard
Neurology Research International , 2011, DOI: 10.1155/2011/734232
Abstract: Background. The authors describe a lateral approach to the cervical spine for the management of spondylotic myeloradiculopathy. The rationale for this approach and surgical technique are discussed, as well as the advantages, disadvantages, complications, and pitfalls based on the author's experience over the last two decades. Methods. Spondylotic myelo-radiculopathy may be treated via a lateral approach to the cervical spine when there is predominant anterior compression associated with either spine straightening or kyphosis, but without vertebral instability. Results. By using a lateral approach, the lateral aspect of the cervical spine and the vertebral artery are easily reached and visualized. Furthermore, the lateral part of the affected intervertebral disc(s), uncovertebral joint(s), vertebral body(ies), and posterior longitudinal ligament can be removed as needed to decompress nerve root(s) and/or the spinal cord. Conclusion. Multilevel cervical oblique corpectomy and/or lateral foraminotomy allow wide decompression of nervous structures, while maintaining optimal stability and physiological motion of the cervical spine. 1. Introduction Cervical spondylotic myelopathy (CSM) and cervical spondylotic radiculopathy (CSR) are classically approached by anterior single or multiple disc space decompression [1, 2], multilevel corpectomy [3], laminectomy [4–10], or laminoplasty [11–18]. More recently, techniques using lateral multiple oblique corpectomy (MOC) and/or foraminotomy [19–28] have been used with increasing frequency. In general, when three or more levels are affected, the preferred techniques remain either an anterior multilevel corpectomy or a posterior route such as laminectomy, open door laminoplasty, and posterior foraminotomy. However, the best management of such pathology (especially if 3 or more levels are involved) remains controversial. The authors consider the cervical spine lateral approach a valid and safe option to treat such pathologies as it provides very good clinical results and maintains long-term spinal stability. The goal of this paper is to further and critically present the idea and rationale of the cervical spine lateral approach with its advantages, disadvantages, complications, and pitfalls in a critical review of their last 2 decades experience. 2. Technique Indication Predominant anterior compression associated with either straightening or kyphosis of the cervical spine in the absence of instability is the general indication for the proposed technique. In cases of both anterior and posterior compression, the posterior
Schistosomal glomerular disease (a review)
Andrade, Zilton A.;Van Marck, E.;
Memórias do Instituto Oswaldo Cruz , 1984, DOI: 10.1590/S0074-02761984000400017
Abstract: in this review paper schistosomal glomerulopathy is defined as an immune-complex disease. the disease appears in 12-15 per cent of the individuals with hepatosplenic schistosomiasis. portal hypertension with collateral circulation helps the by pass of the hepatic clearance process and the parasite antigens can bind to antibodies in the circulation and be trapped in the renal glomerulus. chronic membranousproliferative glomerulonephritis is the most commom lesion present and the nephrotic syndrome is the usual form of clinical presentation. the disease can be experimentally produced, and schistosomal antigens and antibodies, as well as complement, can be demonstrated in the glomerular lesions. specific treatment of schistosomiasis does not seem to alter the clinical course of schistosomal nephropathy.
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