Ray John M Salud

Abstract

This presentation details a compelling case of neuroschistosomiasis in an adolescent, emphasizing the importance of including this neglected tropical disease in differential diagnoses for unexplained neurological symptoms. The case focuses on a 16-year-old Filipino male from Northern Samar, residing in Pasig City, who presented with a 6-month history of progressive seizures and headaches. His initial seizure was a generalized tonic- clonic event. Crucially, the patient had a significant exposure history: regular swimming in a river and consumption of snails, both known risk factors for schistosomiasis. Initial clinical management addressed symptomatic treatment, and other potential causes of seizures were ruled out. However, given the persistence of his symptoms and the notable exposure history, neuroschistosomiasis was strongly suspected. Further diagnostic workup, including the Circumoval Precipitin Test (COPT) and Kato Katz Test, was performed. The diagnosis was supported by Cranial MRI findings suggestive of the condition, and was ultimately confirmed by a positive COPT. The patient was treated with Dexamethasone and a 5-day course of Praziquantel Therapy. Following treatment, the patient showed rapid improvement, with no further recurrence of seizures, headaches, or vomiting noted during the hospital stay. He was subsequently discharged with a follow-up advisory for a repeat Cranial MRI after two weeks. This case serves as a vital reminder that schistosomiasis remains endemic in certain regions of the Philippines, and a high index of suspicion is critical for early, effective management.

Audience Takeaways:

The Importance of Considering Neuroschistosomiasis

The primary takeaway is the critical need for a high index of suspicion for neuroschistosomiasis, particularly in the differential diagnosis of pediatric patients who present with unexplained neurological symptoms like seizures and headaches. This is especially true for patients residing in or with a history of exposure in areas where schistosomiasis is endemic, like certain regions of the Philippines.

Recognizing Key Risk Factors and Exposure History

The audience will understand the significant risk factors for schistosomiasis, which include regular swimming in freshwater rivers and consumption of snails. A thorough patient history, focusing on these exposures, is essential for guiding the diagnostic process.

Early Diagnosis and Management Prevent Sequelae

The case demonstrates that early recognition and appropriate management—specifically treatment with agents like Dexamethasone and Praziquantel—are effective and can prevent the long-term neurological sequelae associated with this parasitic infection. The rapid cessation of symptoms (seizures, headaches, vomiting) after initiating therapy underscores the importance of timely intervention.

Diagnostic Confirmation

The presentation highlights the role of specific diagnostic tools, such as Cranial MRI and the Circumoval Precipitin Test (COPT), in confirming the diagnosis of neuroschistosomiasis. The audience will recognize that a combination of clinical suspicion, exposure history, and targeted testing leads to definitive diagnosis