A laboratory test for the diagnosis of neuroschistosomiasis

To provide a general description of the studies on spinal cord schistosomiasis that our team has developed in Brazil, with an emphasis on how we have planned the investigations and managed the problems.

Schistosoma mansoni is endemic in extensive areas in Brazil. We review the subject and discuss the design, development and initial evaluation of a diagnostic cerebrospinal fluid enzyme-linked immunoassay test for spinal cord schistosomiasis.

Since the late 1980s, several clinical investigations have led to a better understanding of the natural history of this disorder and an improved characterization of its clinical presentations. Spinal cord schistosomiasis is a severe condition that typically presents as an acute/subacute low cord syndrome generally associated with the involvement of the cauda equina roots. Cerebrospinal fluid examination usually shows an inflammatory pattern, and MRI demonstrates findings of an inflammatory spinal cord lesion. Its diagnosis is largely based on clinical evidence. There is no definitive consensus on the treatment of neuroschistosomiasis, but most authors recommend the administration of praziquantel and a steroid. The outcome is variable and chiefly dependent on early treatment. The results of the cerebrospinal fluid enzyme-linked immunoassay test for schistosomal myeloradiculopathy allow the confirmation or exclusion of this disorder in a large proportion of suspected cases.

Although knowledge on schistosomiasis has improved during the last two decades, several aspects of this disorder are still unknown and deserve investigation. The enzyme-linked immunoassay test in cerebrospinal fluid showed promising results, but needs validation in a new sample of subjects.