Insights into diagnostics and management of spinal neuroschistosomiasis: A scoping review of 230 cases of a neglected disease.

Abstract

Background: Schistosomiasis is a neglected tropical disease caused by parasitic worms from the genus Schistosoma. Spinal neuroschistosomiasis (SN) is a rare but serious complication that can result in significant morbidity and mortality, with only a few hundred cases documented in the literature.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-ScR) statement, extension for scoping reviews, a systematic search of PubMed, Scopus, and Web of Science using relevant keywords, from inception until November 7th, 2024, was carried out followed by screening and extraction of only detailed cases.

Results: Of 657 reports, 108 reports of 230 detailed cases were finally included. The included patients had a mean (standard deviation) age of 25.22 (14.65) years with most of them being males (79.6%). The majority of our patients (85.7%) got infected in endemic areas. As for clinical presentations, myelitis was the most common syndrome (48.3%) followed by myeloradicular syndrome (33.5%). The dorsal cord was the most frequently affected region, documented in 56.5% of cases. Imaging studies revealed pathological findings in 57.7% with magnetic resonance imaging (MRI) and 34.4% with computed tomography (CT). Cerebrospinal fluid (CSF) findings included elevated protein (47.4%), pleocytosis (26.5%), and eosinophilia (29.6%). Anti-parasitic use was reported in most cases (79.6%) while steroids were attempted in 70.5% of cases. A complete recovery was achieved in 18% of cases. Death was the outcome in 4% of the included patients.

Conclusions: Due to delayed diagnosis and rarity, SN causes significant morbidity and mortality with diagnostic challenges and heterogeneity.