[Meningomyeloradiculitis caused by Schistosoma mansoni. Research protocol and report of 21 cases]

Twenty one cases of schistosomal meningomyeloradiculopathy due to Schistosoma mansoni are reported. This result was attained after a 4- year research period based on a "Clinical and Laboratory Investigation Protocol" applied on 212 patients in Itabuna, a city of Southeast region of Bahia state in the Northeast of Brazil. This region is a non endemic one for schistosomiasis. The Protocol consisted in leading to investigation every patient that presented a clinical triad characterized by: lumbar pain, paresthesias in the inferior limbs, miction difficulties. Diagnostic criteria were based on clinical neurologic signs, presence of Schistosoma mansoni eggs on feces or rectum biopsy, positive immunofluorescence reaction for schistosomiasis in the cerebrospinal fluid (CSF), the inflammatory CSF characteristics, and an exhaustive research for differential diagnosis. The diagnosis has been essentially based on clinical and laboratory data, not having for any of the cases an histopathological study. The treatment was performed the earliest as possible, and corticosteroids associated to oxaminiquine were used for all cases. The patients were studied as to sex, age, profession, city of origin, initial symptoms, laboratory tests related to schistosomiasis, the onset type of neurologic clinical symptoms and several CSF aspects. Treatment beginning was related with time of disease. Clinical evolution and sequelae were analysed. Abdominal contractions were observed in 10 cases several hours before the clinical picture had been clearly presented. Clinical diagnosis is justified since it is performed under severe clinical and laboratory evidences, as well as an accurate search for differential diagnosis. The authors think that the schistosomal meningomyeloradiculopathy is a well defined nosological entity by its neurological picture, as also from the pathological point of view. Finally, the authors suggest to neurological services of the country the planning and application of similar or even more detailed Protocol in order to obtain an early diagnosis and treatment for the disease, preventing so irreversible damages and sequelae very harmful for the patients in their social life.