Nódulo pulmonar esquistossomótico simulando neoplasia: relato de caso

Schistosoma haematobium infection with pulmonary involvement in a traveller returning from Congo: A case report and systematic review of literature on nodular pulmonary schistosomiasis

BACKGROUND

Schistosomiasis is highly prevalent in sub-Saharan Africa and diagnosis is difficult for travel medicine practitioners, because it can affect different organs with atypical manifestations. S. haematobium is mostly associated with urinary involvement and rarely with pulmonary lesions. This review aims to summarise the pulmonary forms associated with schistosomiasis, especially with S. haematobium.

METHOD

Based on a case report of both pulmonary and urogenital schistosomiasis, we performed a systematic literature review of schistosomiasis occurring in migrants and travellers, with a specific focus on pulmonary schistosomiasis.

RESULTS

Pulmonary schistosomiasis can present two different clinical patterns. On the one hand, there is an acute pattern, which more frequently affects non-immune young travellers within three to eight weeks of their return and, on the other hand, there is a chronic pattern, which has been evolving in recent years and which mostly affects people living in endemic areas or migrating from these countries. Nodular pulmonary lesions are described in both patterns. Genus identification should not focus only on known patterns, and identification of S. haematobium should not be associated exclusively with urinary schistosomiasis.

CONCLUSIONS

Pulmonary schistosomiasis, even when resulting from S. haematobium, is a rare but existing infection that appears to be spreading with increasing travel and global migration. Physicians need to be more aware of non-specific symptoms that may reveal an atypical presentation of a tropical disease, in order to avoid the chronic complications which can result from parasitic diseases.

New Insights on Acute and Chronic Schistosomiasis: Do We Need a Redefinition?

A precise timeframe to differentiate acute schistosomiasis (AS) and chronic schistosomiasis (CS) is not well defined. Based on recent published literature, lung nodular lesions in AS and CS seem to have the same pathophysiology, that is, eggs laid in situ by adult worms, during an ectopic migration. Moreover, the occurrence of lung nodules due to clusters of eggs and the systemic immunoallergic reaction of AS (Katayama syndrome) may be two separate clinical entities, which may overlap during the early phase of infection. Consequently, the classical distinction between AS and CS loses much of its conceptual validity. If adult worms play a more important role in the early phase of the disease the clinical management of AS should probably be revised.

Radiographic and HRCT imaging findings of chronic pulmonary schistosomiasis: review of 10 consecutive cases

Objective:

To describe the chest radiography (CR) and the high resolution CT (HRCT) imaging findings of chronic pulmonary schistosomiasis (CPS)

Methods and materials:

This retrospective study included 10 patients suffering from CPS, studied between September 2013 and October 2016 by using CR and HRCT. Images were reviewed by two experienced radiologists in consensus, blinded to clinical data. A p value < 0.05 was considered significant

Results:

All the patients enrolled showed some abnormalities at HRCT, including lung consolidations, solid nodules, nodules with peri-nodular halo, ground-glass opacities, enlarged hilar lymph-nodes. Only seven patients showed findings at CR ( p = 0.001). At CT, none of the patients had significant pleural, vascular (pulmonary arteries) or cardiac findings. Post-therapy studies (mean interval 35 days) demonstrated the absence of residual disease in all patients.

Conclusion:

The imaging findings of CPS varied widely in our study population. HRCT may show signs which are occult on plain radiograph. All lesions disappeared after appropriate therapy at imaging follow-up studie.

Imaging of Parasitic Diseases of the Thorax

A broad spectrum of parasitic infections frequently affects the lungs, mediastinum, and thoracic wall, manifesting with abnormal imaging findings that often make diagnosis challenging. Although most of these infections result in nonspecific abnormalities, familiarity with their imaging features and the diagnostic pathways help the radiologist to formulate an adequate differential diagnosis and to guide diagnosticians in reaching a definitive diagnosis.