Cerebral vasculitis associated with Schistosoma mansoni infection

BMC Infectious Diseases

Yves Hansmann³  Daniel Christmann³  Nicolas Lefebvre³  Ermanno Candolfi⁴  Ahmed Abou-Bacar⁴  Christian Marescaux²  Valérie Wolff²  Guillaume Camuset¹ 

[1] Unité des Maladies Infectieuses, Centre Hospitalier Universitaire La Réunion, Site Sud, BP 350, 97448, Saint-Pierre, Ile de la Réunion, France;Département de Neurologie, Centre Hospitalier Universitaire, Strasbourg, France;Service des Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire, Strasbourg, France;Institut de Parasitologie, Université de Strasbourg, Strasbourg, France

关键词: Praziquantel;    Corticosteroid;    Schistosoma mansoni;    Cerebral vasculitis;    Stroke;   

Others  :  1159681
DOI  :  10.1186/1471-2334-12-220

 received in 2012-02-09, accepted in 2012-09-12,  发布年份 2012

【 摘 要 】

Background

Cerebral involvement in schistosomiasis is not rare, but it is underdiagnosed because of the lack of clinical suspicion and the frequency of asymptomatic forms. Neurologic complications are generally supported by granuloma formation around ectopic eggs which have migrated to the brain. Moreover, vascular lesions and cerebral arteritis have been well documented in histopathological studies. Nevertheless, cerebral vasculitis in later stages of the Schistosoma mansoni infection have not yet been described in living subjects.

Case presentation

A 28-year-old french woman had a stroke linked with cerebral vasculitis, 6 monthes after returning from Burkina-Faso. At the same time, a S. mansoni disseminated infection was diagnosed. She suffered from a new stroke after undertaking praziquantel therapy, which lead us to associate the S. mansoni infection and cerebral vasculitis.

Conclusion

This is the first report of such association, since cerebral vasculitis has never been described in later stages of the S. mansoni infection. Although the causal link between the two pathologies could not be proved, we suggest that S. mansoni is able to cause severe vascular damage in cerebral vessels. Schistosomiasis must be investigated in the event of a brain infarct in young people, particularly in patients originating or returning from an endemic area.

【 授权许可】

   
2012 Camuset et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Carod-Artal FJ: Neurological complications of Schistosoma infection. Trans R Soc Trop Med Hyg 2008, 102:107-116.
• [2]Ferrari TC, Moreira PR, Cunha AS: Clinical characterization of neuroschistosomiasis due to Schistosoma mansoni and its treatment. Acta Trop 2008, 108:89-97.
• [3]Scrimgeour EM, Gajdusek DC: Involvement of the central nervous system in Schistosoma mansoni and S. Haematobium infection: a review. Brain 1985, 4:1023-1028.
• [4]Artal FJ, Mesquita HM, Gepp RA, Antunes JS, Kahl RH: Brain involvement in a Schistosoma mansoni myelopathy patient. J Neurol Neurosurg psychiatry 2006, 77:512.
• [5]Pitella JE: Vascular Changes in Cerebral Schistosomiasis mansoni: A Histopathological Study of Fifteen cases. Am J Trop Med Hyg 1985, 34:898-902.
• [6]Kane C, Most H: Schistosomiasis of the central nervous system. Arch Neurol Psychiatr 1948, 59:141-183.
• [7]Jauréguiberry S, Ansart S, Perez L, Danis M, Bricaire F, Caumes E: Acute neuroschistosomiasis: two cases associated with cerebral vasculitis. Am J Trop Med Hyg 2007, 76:964-966.
• [8]Liu LX: Spinal and cerebral schistosomiasis. Semin Neurol 1993, 13:189-200.
• [9]Wang P, Wu MC, Chen SJ: Research development of the pathogenesis pathways for neuroschistosomiasis. Neurosci Bull 2010, 2:168-174.
• [10]File S: Interaction of schistosome eggs with vascular endothelium. J Parasitol 1995, 81:234-238.
• [11]Lejoly-Boisseau H, Appriou M, Seigneur M, Pruvost A, Tribouley-Duret J: Schistosoma mansoni: In Vitro Adhesion of Parasite Eggs to the Vascular Endothelium. Subsequent Inhibition by a Monoclonal Antibody Directed to a Carbohydrate Epitope. Exp Parasitol: 1999, 91:20-29.
• [12]Pitella JE: Neuroschistosomiasis. Brain Pathol 1997, 7:649-662.
• [13]The Johns Hopkins Vasculitis Center: Central Nervous System Vasculitis. http://www.hopkinsvasculitis.org webcite