Treatment of Schistosomiasis with Schistosomal Myeloradiculopathy and Spinal Cord Involvement
Spinal cord involvement in schistosomiasis — schistosomal myeloradiculopathy — is a serious neurological complication requiring prompt, structured management. The protocol below addresses this specific presentation, supported by CSF and neuroimaging findings.
Clinical Scenario
This protocol applies to patients with schistosomal myeloradiculopathy with confirmed spinal cord involvement, where MRI or CT demonstrates neuroschistosomiasis. Supporting CSF findings include:
- Eosinophilia
- Raised protein level
Treatment Approach
Management combines corticosteroid-based anti-inflammatory therapy with antiparasitic treatment. The full protocol specifies the sequencing, duration, and consideration of an additional antiparasitic agent — all available in the complete regimen.
Clinical Goal
Full recovery from neurological symptoms
References
- All S. spp. may infect the CNS; spinal cord involvement is most frequently caused by S. haematobium and S. mansoni
- CSF: ‐ Eosinophilia (40% of cases) ‐ Raised protein level (90% of cases) ‐ Raised mononuclear cell count
- Methylprednisolone 15 mg/kg/day (max. 1 g) for 5 days followed by Prednisolone 1 mg/kg/day for up to 6 months (+ tapering after 4 weeks)
- Praziquantel 60 mg/kg/day p.o. in 2‐3 doses on days 30, 60 and 90
- consider empirically adding Ivermectin 200 µg/kg p.o. single dose
- Stopping steroid treatment before 6 months of treatment should only be considered if the patient has fully recovered from the neurological symptoms