The value of immunological approaches to the diagnosis of schistosomal myelopathy.

Myelopathy due to schistosome infection is a rare, yet probably frequently unrecognized, form of schistosomiasis. This condition is clinically difficult to diagnose, and without specific biopsy evidence final confirmation relies largely on circumstantial evidence. We describe here immunological attempts to diagnose schistosomal myelopathy. ELISA performed on the cerebrospinal fluid (CSF) was the most successful, detecting 12/12 cases tested prior to or within one month of treatment. This is based on a "normal" value established on neurological patients without myelopathy. Only 13/149 non-schistosomal myelopathy patients from an endemic area gave positive results in this test. Oligoclonal bands were detected in the CSF of 5/9 schistosomal myelopathy patients and 11/18 cases of myelopathy of other known causes, but in 0/7 cases of myelopathy where the cause was not established. Western blotting was unable to distinguish between myelopathy due to schistosomiasis and other causes. It is recommended that the ELISA be performed on CSF and the results be compared with a "normal" level for neurological patients. In our laboratory this system gives a high sensitivity and a negative result can be confidently used to exclude schistosomal myelopathy.