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Pach S, Webb EL, Edielu A, Nagawa R, Anguajibi V, Mpooya S, Wu H, Colt S, Mawa P, Richter J, Friedman JF, Bustinduy AL. Baseline Liver Ultrasound Findings in Preschool Children From the Praziquantel in Preschoolers Trial in Lake Albert, Uganda. Pediatr Infect Dis J 2024; 43:14-20. [PMID: 37922490 PMCID: PMC10842963 DOI: 10.1097/inf.0000000000004119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
BACKGROUND Periportal fibrosis is a late-stage manifestation of chronic infection with Schistosoma mansoni . Praziquantel (PZQ), the only drug available for the treatment of schistosomiasis, has limited effect in treating established morbidity. Preschool-age children (PSAC) are not considered to be an at-risk population for severe morbidity. However, the prevalence of periportal fibrosis in PSAC in S. mansoni endemic settings is unknown. METHODS As part of a phase II clinical trial comparing different dosing regimens of PZQ in children age 12-47 months infected with S. mansoni in Uganda ("praziquantel in preschoolers" trial), we present baseline results assessing liver ultrasound (US) findings as per the WHO Niamey Protocol. RESULTS A total of 7/347 (2%) PSAC had Image Pattern C with pipe stems and echogenic rings suggestive of periportal fibrosis, 29/347 (8%) had Image Pattern B and 58 (17%) had evidence of periportal thickening There were higher adjusted odds of periportal thickening with older age [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.00-1.07], primary maternal education (OR: 1.04; 95% CI: 1.00-1.07) and being taken to the lake weekly (OR: 3.02; 95% CI: 1.19-7.63). A further 44/347 children (13%) had a rounded caudal liver edge which was associated with high S. mansoni infection intensity (adjusted OR: 3.31; 95% CI: 1.46-7.51). CONCLUSIONS Incipient schistosomiasis-related liver morbidity was detected in young children enrolled in the praziquantel in preschoolers trial. Adequate age-adjusted reference measurements for liver ultrasound findings in very small children are lacking but urgently needed. Schistosomiasis-related fibrosis may be delayed or averted with early and repeated PZQ treatment.
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Affiliation(s)
| | - Emily L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andrew Edielu
- From the Department of Clinical Research
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Roy Nagawa
- J.B International Medical Centre, Kampala, Uganda
| | | | | | - Hannah Wu
- Center for International Health Research, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Susannah Colt
- Center for International Health Research, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Patrice Mawa
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joachim Richter
- Global Health Center, Institute of International Health, Charite Universitätsmedizin, Corporate Member of Free and Humboldt University, Berlin, Germany
- Swiss Tropical and Public Health Institute, Basle, Switzerland
| | - Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
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Hashim A, Berzigotti A. Noninvasive Assessment of Schistosoma-Related Periportal Fibrosis. J Ultrasound Med 2021; 40:2273-2287. [PMID: 33448437 DOI: 10.1002/jum.15623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
Schistosomiasis affects nearly 250 million individuals in the world. Hepatosplenic schistosomiasis (HSS) results in periportal fibrosis (PPF) and portal hypertension (pHTN). Ultrasound has been extensively used for the diagnosis of Schistosoma-related PPF and a number of staging methods have been validated for this purpose such as Strickland classification and Niamey protocol. Nevertheless, the application of noninvasive techniques, particularly elastography modalities, has not been well explored. In this review, we describe the various noninvasive diagnostic tools for assessment of Schistosoma-related PPF including US parameters, serum biomarkers, and US-based elastography techniques. While elastography techniques have demonstrated value in the evaluation of HSS, the evidence remains limited with most studies recruiting a small number of patients. Longitudinal studies with larger sample size are required in order to devise robust criteria to accurately assess the performance of noninvasive techniques in the prediction of both regression and progression of the degree of PPF and identify their cost-effectiveness in community screening.
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Affiliation(s)
- Ahmed Hashim
- Hepatology Department, Royal Free Hospital, London, UK
| | - Annalisa Berzigotti
- University of Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
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dos Santos Ferreira D, Arora G, Gieseck RL, Rotile NJ, Waghorn PA, Tanabe KK, Wynn TA, Caravan P, Fuchs BC. Molecular Magnetic Resonance Imaging of Liver Fibrosis and Fibrogenesis Is Not Altered by Inflammation. Invest Radiol 2021; 56:244-251. [PMID: 33109919 PMCID: PMC7956154 DOI: 10.1097/rli.0000000000000737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
METHODS Three groups of mice that develop either mild type 2 inflammation and fibrosis (wild type), severe fibrosis with exacerbated type 2 inflammation (Il10-/-Il12b-/-Il13ra2-/-), or minimal fibrosis with marked type 1 inflammation (Il4ra∂/∂) after infection with S. mansoni were imaged using both probes for determination of signal enhancement. Schistosoma mansoni-infected wild-type mice developed chronic liver fibrosis. RESULTS The liver MR signal enhancement after either probe administration was significantly higher in S. mansoni-infected wild-type mice compared with naive animals. The S. mansoni-infected Il4ra∂/∂ mice presented with little liver signal enhancement after probe injection despite the presence of substantial inflammation. Schistosoma mansoni-infected Il10-/-Il12b-/-Il13ra2-/- mice presented with marked fibrosis, which correlated to increased signal enhancement after injection of either probe. CONCLUSIONS Both MR probes, EP-3533 and Gd-Hyd, were specific for fibrosis in this model of chronic liver disease regardless of the presence or severity of the underlying inflammation. These results, in addition to previous findings, show the potential application of both molecular MR probes for detection and quantification of fibrosis from various etiologies.
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Affiliation(s)
- Diego dos Santos Ferreira
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129 USA
| | - Gunisha Arora
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114 USA
| | - Richard L. Gieseck
- Laboratory of Parasitic Disease, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Ln, Bethesda, MD, 20892, United States
| | - Nicholas J. Rotile
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129 USA
| | - Philip A. Waghorn
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129 USA
| | - Kenneth K. Tanabe
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114 USA
| | - Thomas A. Wynn
- Laboratory of Parasitic Disease, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Ln, Bethesda, MD, 20892, United States
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129 USA
- The Institute for Innovation in Imaging (i), Department of Radiology, Massachusetts General Hospital, Boston, MA 02129 USA
| | - Bryan C. Fuchs
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114 USA
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Kamdem SD, Kuemkon EM, Kamguia LM, Tchanana GK, Konhawa F, Nche F, Oumarou A, Hamza M, Essomba RG, Kengne M, Ondigui BE, Assoumou MCO, Brombacher F, Nono JK. An ultrasound-based referential of body height-adjusted normal liver organometry in school children from Bokito in rural Cameroon. Sci Rep 2020; 10:2773. [PMID: 32066761 PMCID: PMC7026466 DOI: 10.1038/s41598-020-59613-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/22/2020] [Indexed: 11/16/2022] Open
Abstract
The grading system for ultrasonographic assessment of Schistosoma mansoni morbidity is crucial for evaluation of control programs. This requires prior definition of normal liver organometric ranges in the population from the endemic area. A cross-sectional study was conducted in a S. mansoni endemic area in rural Cameroon. 1002 Participants were screened and 234 of them, free from all common liver-affecting diseases in the area (schistosomiasis, malaria, hepatitis B and C) and with no ultrasonographic signs of liver disease were selected and their liver parameters measured by ultrasonography. All statistics were considered significant for p-values < 0.05. Normal dimensions of livers lobe sizes, portal vein wall thickness and portal vein diameters are reported. The liver organometric data are presented for the entire study population as a whole and separately for males and females as prediction plots, with observed values and fitted regression line with 95% confidence. Reference ranges for liver parameters (size, portal vein thickness and diameter) adjusted for body height established in the current study are novel for Cameroon. The prediction plots generated should improve the accuracy of the assessment of liver morbidity by ultrasonography in the region.
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Affiliation(s)
- Severin Donald Kamdem
- Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa
- Cape Town Component, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa
- Immunology of Infectious Diseases Unit, South African Medical Research Centre, Cape Town, South Africa
| | - Erve Martial Kuemkon
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Leonel Meyo Kamguia
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Gladys K Tchanana
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
- CIAB EXACT Medical Laboratory, Yaoundé, Cameroon
| | - Francis Konhawa
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Frungwa Nche
- Faculty of medicine and biomedical sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | - René Ghislain Essomba
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
- National Public Health Laboratory, Ministry of Public Health, Yaoundé, Cameroon
| | - Michel Kengne
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | | | | | - Frank Brombacher
- Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa
- Cape Town Component, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa
- Immunology of Infectious Diseases Unit, South African Medical Research Centre, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Justin Komguep Nono
- Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa.
- Cape Town Component, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa.
- Immunology of Infectious Diseases Unit, South African Medical Research Centre, Cape Town, South Africa.
- The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies, Ministry of Scientific Research and Innovation, Yaoundé, Cameroon.
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Tamarozzi F, Buonfrate D, Badona Monteiro G, Richter J, Gobbi FG, Bisoffi Z. Ultrasound and intestinal lesions in Schistosoma mansoni infection: A case-control pilot study outside endemic areas. PLoS One 2018; 13:e0209333. [PMID: 30562400 PMCID: PMC6298661 DOI: 10.1371/journal.pone.0209333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/04/2018] [Indexed: 11/18/2022] Open
Abstract
Background Infection with Schistosoma mansoni is a major cause of morbidity and mortality in endemic areas, and is increasingly diagnosed in migrants and travellers outside transmission areas. Markers for the assessment of morbidity and impact of control programs in endemic areas and for the clinical management of patients in the clinical setting are scant, especially for intestinal involvement. Ultrasonography is well established to evaluate hepatosplenic pathology; on the contrary, ultrasound evaluation of intestinal schistosomiasis is virtually unexplored. In this pilot study, we aimed to describe and evaluate the accuracy of unenhanced intestinal ultrasound for morbidity due to intestinal S. mansoni infection. Methodology/Principal findings We performed a blind case-control study of unenhanced intestinal ultrasound on 107 adults accessing the outpatient clinic of our Centre for Tropical Diseases between January-July 2018 as part of a screening for tropical diseases in migrants and travellers returning from endemic areas. Other clinical and laboratory data were obtained routine examination reports. We could not find any overtly pathological thickness of the gut wall in the sigma, proximal ascending colon, and terminal ileum, in patients with S. mansoni infection (n = 17), S. haematobium infection (n = 7), positive anti-Schistosoma serology (n = 31), and uninfected individuals (n = 52), with no difference among groups as assessed by ANOVA. No polyps or other intestinal abnormalities were visualized. There was no significant change in gut wall thickness one month after treatment with praziquantel in patients with S. mansoni infection (n = 11). Conclusions/Significance Our preliminary results suggest that intestinal ultrasound might not be a sensitive tool for detecting minor intestinal morbidity due to schistosomiasis. Further studies in a hospital setting comparing colonoscopy and ultrasonography may be envisaged; in endemic areas, further studies are needed to describe and assess the usefulness of intestinal ultrasound in patients stratified by infection intensity and compared with markers such as calprotectin and fecal occult blood.
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Affiliation(s)
- Francesca Tamarozzi
- Centre for Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
- * E-mail:
| | - Dora Buonfrate
- Centre for Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | | | - Joachim Richter
- Institute of Tropical Medicine and International Health, Universitäts-Medizin, Berlin, Germany
| | | | - Zeno Bisoffi
- Centre for Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
- Diagnostic and Public Health Department, Infectious Diseases and Tropical Medicine Section, University of Verona, Verona, Italy
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Carvalho Santos J, Dória Batista A, Maria Mola Vasconcelos C, Souza Lemos R, Romão de Souza Junior V, Dessein A, Dessein H, Maria Lucena Montenegro S, Pessoa Almeida Lopes E, Lúcia Coutinho Domingues A. Liver ultrasound elastography for the evaluation of periportal fibrosis in schistosomiasis mansoni: A cross-sectional study. PLoS Negl Trop Dis 2018; 12:e0006868. [PMID: 30444885 PMCID: PMC6267962 DOI: 10.1371/journal.pntd.0006868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/30/2018] [Accepted: 09/22/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND ARFI elastrography has been used as a noninvasive method to assess the severity of liver fibrosis in viral hepatitis, although with few studies in schistosomiasis mansoni. We aimed to evaluate the performance of point shear wave elastography (pSWE) for predicting significant periportal fibrosis (PPF) in schistosomotic patients and to determine its best cutoff point. METHODOLOGY/PRINCIPAL FINDINGS This cross-sectional study included 358 adult schistosomotic patients subjected to US and pSWE on the right lobe. Two hundred two patients (62.0%) were women, with a median age of 54 (ranging 18-92) years. The pSWE measurements were compared to the US patterns of PPF, as gold standard, according to the Niamey classification. The performance of pSWE was calculated as the area under the ROC curve (AUC). Patients were further classified into two groups: 86 patients with mild PPF and 272 patients with significant PPF. The median pSWE of the significant fibrosis group was higher (1.40 m/s) than that of mild fibrosis group (1.14 m/s, p<0.001). AUC was 0.719 with ≤1.11 m/s as the best cutoff value for excluding significant PPF. Sensitivity and negative predictive values were 80.5% and 40.5%, respectively. Whereas, for confirming significant PPF, the best cutoff value was >1.39 m/s, with specificity of 86.1% and positive predictive value of 92.0%. CONCLUSIONS/SIGNIFICANCE pSWE was able to differentiate significant from mild PPF, with better performance to predict significant PPF.
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Affiliation(s)
- Joelma Carvalho Santos
- Postgraduate Program in Tropical Medicine, Centro de Ciências da Saúde, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Andrea Dória Batista
- Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | - Roberto Souza Lemos
- Postgraduate Program in Tropical Medicine, Centro de Ciências da Saúde, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | - Alain Dessein
- Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Hélia Dessein
- Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | | | - Edmundo Pessoa Almeida Lopes
- Postgraduate Program in Tropical Medicine, Centro de Ciências da Saúde, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Ana Lúcia Coutinho Domingues
- Postgraduate Program in Tropical Medicine, Centro de Ciências da Saúde, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Gonçalves-Macedo L, Domingues ALC, Lopes EP, Luna CF, Mota VG, Becker MMDC, Markman-Filho B. Pulmonary shunts in severe hepatosplenic schistosomiasis: Diagnosis by contrast echocardiography and their relationship with abdominal ultrasound findings. PLoS Negl Trop Dis 2017; 11:e0005417. [PMID: 28369056 PMCID: PMC5391128 DOI: 10.1371/journal.pntd.0005417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 04/13/2017] [Accepted: 02/16/2017] [Indexed: 12/31/2022] Open
Abstract
Background Schistosomiasis is endemic to several parts of the world. Among the species that affect humans, Schistosoma mansoni is one of the most common causes of illness. In regions where schistosomiasis mansoni is endemic, reinfection is responsible for the emergence of hepatosplenic schistosomiasis (HSS) with portal hypertension in about 10% of infected individuals. Regardless of its etiology, portal hypertension may bring about the formation of arteriovenous fistulas and pulmonary vascular dilation, thus constituting a pulmonary shunt and its presence has been associated with the occurrence of neurological complications. The objective of this study was to identify pulmonary shunt using TTCE in patients with HSS and esophageal varices, and to compare the abdominal ultrasound and endoscopy findings among patients with and without pulmonary shunt. Methodology/Principal findings In this case series, a total of 461 patients with schistosomiasis mansoni were prospectively evaluated using abdominal ultrasound and endoscopy and 71 presented with HSS with esophageal varices. Fifty seven patients remained in the final analysis. The mean age of the patients was 55 ± 14 years, and 65% were female. Pulmonary shunts were observed in 19 (33.3%) patients. On comparing the groups with and without pulmonary shunt, no significant differences were observed in relation to the abdominal ultrasound and endoscopic findings. When comparing the two subgroups with pulmonary shunts (grade 1 vs grades 2 and 3), it was observed that the subgroup with shunt grades 2 and 3 presented with a significantly higher frequency of an enlarged splenic vein diameter (>0.9 cm), and an advanced pattern of periportal hepatic fibrosis (P = 0.041 and P = 0.005, respectively). None of the patients with pulmonary shunts had severe neurological complications. Conclusions/Significance Our findings suggest that in HSS with esophageal varices the pulmonary shunts may be present in higher grades and that in this condition it was associated with ultrasound findings compatible with advanced HSS. Among the species of Schistosoma that infect humans Schistosoma mansoni is one of the most common causes of illness. In the areas where schistosomiasis mansoni is endemic, around 10% of infected individuals develop hepatosplenic schistosomiasis (HSS) with portal hypertension. Portal hypertension may promotes an imbalance in the hepatic production of vasoactive substances, which may act on the lungs promoting the formation of arteriovenous fistulas and pulmonary vascular dilation, a condition that is called a pulmonary shunt. When the pulmonary shunt is of higher grades, small thrombus or septic emboli that would normally be filtered through the pulmonary capillaries reach the left heart and the systemic circulation, which can lead to neurological complications. We found pulmonary shunts in patients with HSS and esophageal varices and we also found that patients with higher grades of pulmonary shunts presented with a significantly higher frequency of advanced periportal fibrosis and an enlarged splenic vein diameter. No neurological complications were observed. Our findings suggest that pulmonary shunts may be present in patients with HSS and esophageal varices. The abdominal ultrasound findings compatible with advanced HSS could be used as screening to investigate pulmonary shunt.
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Affiliation(s)
- Liana Gonçalves-Macedo
- Graduate Program in Tropical Medicine, Universidade Federal de Pernambuco, Recife, Brazil
- * E-mail:
| | - Ana Lucia Coutinho Domingues
- Department of Clinical Medicine, Universidade Federal de Pernambuco, Recife, Brazil
- Center for Gastroenterology and Hepatology, Universidade Federal de Pernambuco, Recife, Brazil
| | - Edmundo Pessoa Lopes
- Department of Clinical Medicine, Universidade Federal de Pernambuco, Recife, Brazil
- Center for Gastroenterology and Hepatology, Universidade Federal de Pernambuco, Recife, Brazil
| | - Carlos Feitosa Luna
- Laboratory of Quantitative Health Methods, Fundação Oswaldo Cruz (Fiocruz), Recife, Brazil
| | - Vitor Gomes Mota
- Department of Clinical Medicine, Universidade Federal de Pernambuco, Recife, Brazil
- Center for Cardiology and Echocardiography, Universidade Federal de Pernambuco, Recife, Brazil
| | - Mônica Moraes de Chaves Becker
- Department of Clinical Medicine, Universidade Federal de Pernambuco, Recife, Brazil
- Center for Cardiology and Echocardiography, Universidade Federal de Pernambuco, Recife, Brazil
| | - Brivaldo Markman-Filho
- Department of Clinical Medicine, Universidade Federal de Pernambuco, Recife, Brazil
- Center for Cardiology and Echocardiography, Universidade Federal de Pernambuco, Recife, Brazil
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Tan TJ, Ng VW, Lim KR. "Right Iliac Fossa Pain": More Than Meets the Eye. Ann Acad Med Singap 2016; 45:527-529. [PMID: 27922149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Tien Jin Tan
- Department of Radiology, Changi General Hospital, Singapore
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10
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Carvalho DLM, Capua A, Leme PLS. Portal flow and hepatic function after splenectomy and esophagogastric devascularization. Int Surg 2008; 93:314-320. [PMID: 20085039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We studied 27 patients who had mansonic schistosomiasis and portal hypertension with previous episodes of digestive bleeding from esophageal varices. According to the routine of the Liver and Portal Hypertension Unit of the Faculty of Medical Sciences-Santa Casa de São Paulo, these patients underwent surgical treatment that consisted of azygoportal disconnection and splenectomy. The goal of this study was to analyze the developmental profile of portal flow and hepatic function using Doppler ultrasound and the Child-Turcotte-Pugh criteria, respectively, in the pre- and postoperatory stages, in a 3-year period. The results showed a significant 27% reduction of the portal blood flow in the recent postoperatory period and up to 37% in the first to the second year after surgery, remaining stable after this period. We observed that all patients presented with good hepatic functional reserve in the preoperatory period, with no hepatic alteration in the postoperatory period. We conclude that, despite the reduction of portal flow in response to surgery, there was no deterioration of hepatic function.
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Affiliation(s)
- Darcy L M Carvalho
- Surgery Department, Santa Casa São Paulo Faculty of Medical Sciences, São Paulo, Brazil.
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Lambertucci JR, dos Santos Silva LC, Andrade LM, de Queiroz LC, Carvalho VT, Voieta I, Antunes CM. Imaging techniques in the evaluation of morbidity in schistosomiasis mansoni. Acta Trop 2008; 108:209-17. [PMID: 18760990 DOI: 10.1016/j.actatropica.2008.07.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 07/11/2008] [Accepted: 07/16/2008] [Indexed: 11/17/2022]
Abstract
Over the last 20 years a great advance has been observed in many aspects of medicine, and the advent of novel imaging techniques is certainly amongst the most important. In schistosomiasis these new methods caused a revolution in the definition of the clinical forms of the disease and in the evaluation of its complications, such as, liver fibrosis, pulmonary hypertension and neuroschistosomiasis, as never before. Herein we present an overview of the image methods used to diagnose schistosomiasis mansoni nowadays.
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Affiliation(s)
- José Roberto Lambertucci
- Serviço de Doenças Infecciosas e Parasitárias, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190, 30130-100 Belo Horizonte, Minas Gerais, Brazil.
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Daveson J, Macdonald G. A case of periportal fibrosis in a Sudanese refugee. Med J Aust 2008; 188:677-8. [PMID: 18513182 DOI: 10.5694/j.1326-5377.2008.tb01834.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 02/20/2008] [Indexed: 11/17/2022]
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Berhe N, Myrvang B, Gundersen SG. Reversibility of schistosomal periportal thickening/fibrosis after praziquantel therapy: a twenty-six month follow-up study in Ethiopia. Am J Trop Med Hyg 2008; 78:228-234. [PMID: 18256420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
To study outcome determinants of schistosomal periportal thickening/fibrosis (PPT/F), 199 subjects (mean age = 24.0 years, range = 7-68 years), 109 with mild (image pattern C) PPT/F, 69 with moderate (image pattern D) PPT/F, and 21 with severe (image patterns E and F) PPT/F were treated with praziquantel and evaluated every six months for a mean duration of 26 months. Subjects excreting Schistosoma mansoni eggs during any of the six-month evaluations were offered repeat treatment. Thirty-five had some improvement, and 69 had total resolution of PPT/F, of which 63.8% resolved within one year. Compared with subjects with moderate lesions, a significantly higher proportion of subjects with mild lesions had resolution/improvement of PPT/F (40.6% versus 69.7%, P < 0.001). Subjects with severe PPT/F showed no improvement. Resolution of PPT/F was significantly more frequent at a younger age, among seronegative for hepatitis B virus and among those with a lower frequency of post-treatment recurrence of S. mansoni infections.
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Affiliation(s)
- Nega Berhe
- Department of Infectious Diseases, Centre for Imported and Tropical Diseases, Ullevål University Hospital, Oslo, Norway.
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14
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Silva LCS, Pereira ACF, Queiroz LC, Andrade LM, Antunes CMF, Lambertucci JR. Disagreement between ultrasound and magnetic resonance imaging in the identification of schistosomal periportal fibrosis. Mem Inst Oswaldo Cruz 2006; 101 Suppl 1:279-82. [PMID: 17308782 DOI: 10.1590/s0074-02762006000900043] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 06/26/2006] [Indexed: 11/21/2022] Open
Abstract
Abdominal ultrasound (US) has been widely used in the evaluation of patients with schistosomiasis mansoni. It represents an important indirect method of diagnosis and classification of the disease, and it has also been used as a tool in the evaluation of therapeutic response and regression of fibrosis. We describe the case of a man in whom US showed solid evidence of schistosomal periportal fibrosis and magnetic resonance imaging revealed that periportal signal alteration corresponded to adipose tissue which entered the liver together with the portal vein.
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Affiliation(s)
- Luciana C S Silva
- Serviço de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Alfredo Balena 190, 30130-100 Belo Horizonte, MG, Brazil.
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15
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Marinho CC, Voieta I, Azeredo LM, Nishi MP, Batista TS, Pereira ACF, Serufo JC, Queiroz LCD, Ruiz-Guevara R, Antunes CM, Prata A, Lambertucci JR. Clinical versus ultrasound examination in the evaluation of hepatosplenic schistosomiasis mansoni in endemic areas. Mem Inst Oswaldo Cruz 2006; 101 Suppl 1:317-21. [PMID: 17308789 DOI: 10.1590/s0074-02762006000900050] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 06/26/2006] [Indexed: 11/22/2022] Open
Abstract
The best way to appraise the size of abdominal organs remains undefined. Herein we compare the size of liver and spleen in hepatosplenic schistosomiasis using clinical and ultrasound (US) examination, and the size of the organs measured by US with their visualization below the costal margin ("palpable by US"). For this study, 411 individuals from an endemic area for schistosomiasis mansoni in Brazil have been selected. We found that palpable spleens and left liver lobes are larger than non palpable ones. Also, 23% of normal spleens measured by US were palpable on clinical examination, and 22% of spleens increased in size on US were non palpable. A total of 21% of normal spleens were "palpable by US". We also found 54% of normal sized right liver lobes palpable on clinical examination, whilst 54% of the increased livers, measured by US, were non palpable. About 76% of normal right liver lobes were "palpable by US". We conclude that the association of clinical, ultrasound and magnetic resonance imaging (MRI) examinations, in the near future, should give the investigators the necessary tools to perform a more accurate clinical diagnosis of hepatosplenic schistosomiasis mansoni.
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Affiliation(s)
- Carolina Coimbra Marinho
- Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130-100 Belo Horizonte, MG, Brazil
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16
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Berhe N, Geitung JT, Medhin G, Gundersen SG. Large scale evaluation of WHO's ultrasonographic staging system of schistosomal periportal fibrosis in Ethiopia. Trop Med Int Health 2006; 11:1286-94. [PMID: 16903891 DOI: 10.1111/j.1365-3156.2006.01665.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To evaluate the recent WHO's ultrasonographic diagnostic staging system of schistosomal periportal thickening/fibrosis and to assess intra/inter-observer variation associated with its use. METHODS Local standard of portal branch wall thickness (PBWT) for height was established using 150 healthy subjects. Intra and inter-observer variation in image pattern identification and PBWT measurements were assessed in 94 and 35 subjects, respectively, with differing stages of periportal thickening fibrosis. WHO's diagnostic criteria were evaluated in 2,451 community members (1,277 males, 1,174 females; mean age 18.8 years) with an overall Schistosoma mansoni prevalence estimate of 65.9%. RESULTS There were no significant inter/intra-observer variations in image pattern identification and PBWT measurements. Based on Ethiopian PBWT-for-height standard, 128/2,451 (5.2%) had insipient, 46/2,451 (1.9%) had possible/probable and 112/2451 (4.6%) had definite/advanced periportal thickening/fibrosis. Comparable figures were obtained using the Senegalese PBWT-for-height standard and there was good agreement between Ethiopian and Senegalese healthy control-based diagnostic criteria in classifying the 286 subjects into stages of periportal thickening/fibrosis (kappa = 0.87, P < 0.001). CONCLUSIONS With further improvement, the WHO's ultrasonographic diagnostic criteria can be used in health institutions and community surveys. Image pattern based assessment is simple and more reproducible than PBWT based assessment of periportal thickening/fibrosis. The latter is, however, more useful in clarifying the status of an individual with doubtful image pattern, and in monitoring post-treatment outcome of periportal thickening/fibrosis. Considering the comparability of PBWT-for-height standards, setting one international standard of PBWT-for-height is more practical than developing local standards for each endemic area.
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Affiliation(s)
- Nega Berhe
- Institute of Pathobiology, Addis Ababa University, Ethiopia.
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17
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Vezozzo DCP, Farias AQ, Cerri GG, Da Silva LC, Carrilho FJ. Assessment of portal hemodynamics by Doppler ultrasound and of liver morphology in the hepatosplenic and hepatointestinal forms of schistosomiasis mansoni. Dig Dis Sci 2006; 51:1413-9. [PMID: 16868833 DOI: 10.1007/s10620-005-9020-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Accepted: 09/06/2005] [Indexed: 12/09/2022]
Abstract
The aim of this study was to compare portal and splenic blood flows and the liver morphology in hepatosplenic (HS) and hepatointestinal (HI) schistosomiasis. Doppler ultrasound measurements were performed in 48 adult patients with schistosomiasis, according to the criteria of the World Health Organization, and compared with those performed in 20 healthy controls. Portal flow was significantly higher (P < 0.0001) in both HS and HI (2481 +/- 1467 and 2159 +/- 1446 ml/min, respectively) than in normal individuals (842 +/- 322 ml/min). There was no difference in splenic blood flow (822 +/- 685 and 458 +/- 292 ml/min, respectively) between HS and HI, but these values were significantly higher than those of normal controls (243 +/- 94 ml/min). Portal and splenic overflow are found in both the HS and the HI forms of schistosomiasis.
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MESH Headings
- Adult
- Animals
- Blood Flow Velocity/physiology
- Feces/parasitology
- Female
- Humans
- Hypertension, Portal/diagnostic imaging
- Hypertension, Portal/etiology
- Hypertension, Portal/physiopathology
- Intestinal Diseases, Parasitic/complications
- Intestinal Diseases, Parasitic/diagnostic imaging
- Intestinal Diseases, Parasitic/physiopathology
- Liver Circulation/physiology
- Liver Diseases, Parasitic/complications
- Liver Diseases, Parasitic/diagnostic imaging
- Liver Diseases, Parasitic/physiopathology
- Male
- Schistosoma mansoni/isolation & purification
- Schistosomiasis mansoni/complications
- Schistosomiasis mansoni/diagnostic imaging
- Schistosomiasis mansoni/physiopathology
- Splenic Diseases/diagnostic imaging
- Splenic Diseases/parasitology
- Splenic Diseases/physiopathology
- Ultrasonography, Doppler
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18
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Affiliation(s)
- José Roberto Lambertucci
- Serviço de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena 190, 30130-100 Belo Horizonte, MG, Brazil.
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19
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Blanton RE, Salam EA, Ehsan A, King CH, Goddard KA. Schistosomal hepatic fibrosis and the interferon gamma receptor: a linkage analysis using single-nucleotide polymorphic markers. Eur J Hum Genet 2005; 13:660-8. [PMID: 15756299 DOI: 10.1038/sj.ejhg.5201388] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A minority of individuals infected with the parasite Schistosoma mansoni develops hepatic fibrosis. HLA studies in Egypt and a candidate gene search in a Sudanese population indicate that the host's genetics contribute to disease susceptibility. In an Egyptian community, 32.7% of individuals 11 years and older had significant fibrosis by WHO ultrasound criteria. Linkage to 10 candidate genes was tested using 89 affected sibling pairs from 40 pedigrees in this community. The candidates included genes that initiate fibrosis, participate in collagen synthesis, or control collagen degradation. Two to four single-nucleotide polymorphisms (SNPs) were genotyped per locus, and 188 individuals were genotyped at 48 markers. Model-free modified Haseman-Elston analysis identified linkage to a SNP in the interferon gamma receptor locus (P=0.000001). There was also weak evidence for linkage to the interleukin 13-4 region and tissue growth factor beta 1.
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Affiliation(s)
- Ronald E Blanton
- Center for Global Health and Diseases, Case Western Reserve University, Wolstein Research Building, Room 4133, 2103 Cornell Road, Cleveland, OH 44106-7286, USA.
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Kabatereine NB, Kemijumbi J, Ouma JH, Kariuki HC, Richter J, Kadzo H, Madsen H, Butterworth AE, Ørnbjerg N, Vennervald BJ. Epidemiology and morbidity of Schistosoma mansoni infection in a fishing community along Lake Albert in Uganda. Trans R Soc Trop Med Hyg 2005; 98:711-8. [PMID: 15485701 DOI: 10.1016/j.trstmh.2004.06.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2002] [Revised: 09/22/2003] [Accepted: 09/24/2003] [Indexed: 10/26/2022] Open
Abstract
Schistosoma mansoni infection, associated morbidity and symptoms were studied in Piida fishing community at Butiaba, along Lake Albert, Uganda, from November 1996 to January 1997. The study revealed that S. mansoni is highly endemic with an overall prevalence of 72%, a mean intensity of 419.4 eggs per gram (epg) faeces (geometric mean for positives only), with 37.8% of males and 33.0% of females excreting over 1000 epg. Prevalence and intensity peaked in the 10-14 year old age group and decreased with increasing age. Females were less heavily infected than males. Differences were also shown between tribes. Diarrhoea and abdominal pain were commonly reported in Piida. However, no clear-cut correlation between intensity of S. mansoni infection and these conditions could be demonstrated, indicating that retrospective questionnaires concerning S. mansoni related-symptomatology are of limited value. Organomegaly, as assessed by ultrasonography, was frequent and hepatomegaly was associated with heavy S. mansoni infection. No correlation was demonstrated between splenomegaly and infection. This study emphasizes that schistosomiasis mansoni is a major public health problem in Piida fishing community and presumably also in many similar fishing communities. These observations call for immediate intervention and can help in planning long-term strategies for sustainable morbidity control.
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Affiliation(s)
- N B Kabatereine
- Vector Control Division, Ministry of Health, P.O Box 1661, Kampala, Uganda
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21
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Magalhães TVB, Gazzinelli G, Alvarez MCB, Lima e Silva FC, Fraga LAO, Silveira AMS, Gazzinelli A, Bethony J, LoVerde P, Caldas IR, Correa-Oliveira R, Prata A. Comparative clinical and ultrasound study of egg-negative and egg-positive individuals from Schistosoma mansoni low morbidity endemic areas, and hospitalized patients with hepatosplenic disease. Rev Soc Bras Med Trop 2005; 38:33-7. [PMID: 15717092 DOI: 10.1590/s0037-86822005000100007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Two hundred and twenty three subjects from a Schistosoma mansoni low morbidity endemic area and nine hospitalized hepatosplenic patients were submitted to stool test and clinical examination and abdomen ultrasound assessments. According to stool examination and ultrasound results, they were grouped as follows: G1 -- 63 Schistosoma mansoni egg-negative individuals; G2 -- 141 egg-positive patients and without evidence of periportal fibrosis; G3 -- 19 egg-positive patients with periportal echogenicity (3-6 mm); and G4 -- 9 hepatosplenic patients with periportal echogenicity (> 6 mm). Hepatomegaly detected by physical examination of the abdomen evaluated in the midclavicular line was verified in G1, G2 and G3, respectively, in 11.1, 12.1 and 26.3%. In G1, G2 and G3, periportal thickening occurred only in schistosomal patients (8.5%). Mild pathological alterations in patients that cannot yet be detected by clinical examination were detectable in the liver by ultrasound and can be due to fibrosis. The degree of mild periportal fibrosis was diminished in 57.9% of patients 12 months after treatment of schistosomiasis with oxamniquine. At ultrasonography, the mean liver left lobe measurement of G3 was larger than that of G1, and that of G4 larger than that of G1 and G2. The mean size of the spleen of G4 was significantly larger than that of the other three groups, and that of G3 larger than that of G1 and G2.
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22
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Talaat RM, El-Bassiouny A, Osman A, Yossif M, Charmy R, Al-Sherbiny M. Circulating adhesion molecules in patients with different clinical forms of S. mansoni infection. Egypt J Immunol 2005; 12:143-154. [PMID: 17977219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Elucidating the mechanisms that regulate the severity of schistosomiasis has been a major research objective over the past several years. In this study, morbidity of S. mansoni infection was assessed using an ultrasonographic staging system of periportal fibrosis of the liver. Sera of S. mansoni infected patients with different clinical forms of the disease were assayed for the presence of intercellular adhesion molecule-1 (ICAM-1), soluble endothelial cell adhesion molecule-1 (sE-selectin), leukocyte adhesion molecule-1 (sL-selectin) and granule membrane protein-140 (P-selectin). Association between serum levels of adhesion molecules and ultrasonographic data was evaluated. Fifty-one subjects with pure hepatic schistosomiasis having ultrasonographic assessment of periportal fibrosis (PPF) were grouped according to the thickness of their portal tracts: simple intestinal =<3mm, grade I=3-5mm, grade II=>5-7mm and grade III=>7mm. Greater diameter of portal vein and larger spleen size were associated with increasing the thickness of portal tract. All groups had elevated levels of slCAM-1 compared with normal controls. Patients in grade III had significantly higher levels of serum slCAM-1 than those in other grades of infection. The sE- and sL-selectin were comparable in the sera of all patient groups. sP-selectin was significantly elevated in the sera of grade II patients compared with other patients of various clinical groups. Positive correlation was recorded between slCAM-1 level and degree of PPF, but not with other adhesion molecules. These data suggested that, the main criteria of diagnosis of S. mansoni infection using ultrasonography include periportal fibrosis, hypertrophy of left hepatic lobe, widening of the portal veins and splenomegaly. slCAM-1 may participate in the pathology associated with schistosomiasis infection. It could be employed as a potential morbidity marker in schistosomiasis mansoni infection.
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Affiliation(s)
- Roba M Talaat
- Genetic Engineering and Biotechnology Research Institute, Minofiya University, Egypt
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23
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Alfidja AT, Badiane M, Mbaye A, Dial Y, Richter J, Ba Diop S. [Sonographic evaluation of periportal fibrosis in children living in a Schistosoma mansoni endemic region]. ACTA ACUST UNITED AC 2004; 85:763-7. [PMID: 15243377 DOI: 10.1016/s0221-0363(04)97679-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess with ultrasound periportal fibrosis due to chronic Schistosoma mansoni infection in children living in an endemic region. Materials and methods. A total of 441 children underwent two stool examinations and abdominal sonography. Liver echotexture was assessed by two observers and compared to pre-defined image patterns and a fibrosis score was assigned ranging from 0 to 8. Ultrasound features were correlated to age, sex, and parasitologic findings. RESULTS Prevalence of Schistosoma mansoni infestation was 63%. Two cases of advanced fibrosis (E pattern or fibrosis score of 6) were observed. Fibrosis correlated with age. No correlation existed between fibrosis and intensity of egg-output. A correlation between the two examinors was noted in 84% of examinations with a kappa coefficient of 0.7. CONCLUSION Although severe periportal fibrosis is a rare finding in this endemic region, follow-up sonography must be performed because it is the only non invasive and reliable tool for detection of periportal fibrosis.
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Affiliation(s)
- A T Alfidja
- Service de Radiologie Générale CHU de Fann, BP 5035 Dakar, Sénégal.
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24
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Lambertucci JR, Silva LCDS, Andrade LM, de Queiroz LC, Pinto-Silva RA. Magnetic resonance imaging and ultrasound in hepatosplenic schistosomiasis mansoni. Rev Soc Bras Med Trop 2004; 37:333-7. [PMID: 15334268 DOI: 10.1590/s0037-86822004000400009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report the findings of abdominal ultrasound and magnetic resonance imaging observed in a patient with advanced schistosomiasis mansoni. A 25-year-old man with hepatosplenic schistosomiasis and variceal bleeding confirmed by upper endoscopy was submitted to abdominal ultrasound and magnetic resonance imaging. During surgery for portal hypertension, a liver biopsy was taken and the diagnosis of Symmers' fibrosis was confirmed. magnetic resonance imaging scans gave more precise information about the gallbladder, periportal thickening and abdominal venous system than did the ultrasound.
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Affiliation(s)
- José Roberto Lambertucci
- Serviço de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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de Jesus AR, Magalhães A, Miranda DG, Miranda RG, Araújo MI, de Jesus AA, Silva A, Santana LB, Pearce E, Carvalho EM. Association of type 2 cytokines with hepatic fibrosis in human Schistosoma mansoni infection. Infect Immun 2004; 72:3391-7. [PMID: 15155645 PMCID: PMC415716 DOI: 10.1128/iai.72.6.3391-3397.2004] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to evaluate the role of cytokines in hepatic fibrosis in the prehepatosplenic and early hepatosplenic stages of schistosomiasis mansoni. Hepatic fibrosis was classified by ultrasonography of 94 patients. Immunological evaluation was performed by the measurement of secreted cytokines (interleukin-5 [IL-5], IL-10, IL-13, gamma interferon, tumor necrosis factor alpha, and transforming growth factor beta) in peripheral blood mononuclear cells (PBMC) stimulated by Schistosoma mansoni antigens. Significantly, higher levels of IL-5, IL-10, and IL-13 were found in supernatants of soluble egg antigen-stimulated PBMC from subjects with degree III hepatic fibrosis compared to patients with degree I or II fibrosis. Significant increases in IL-5 and IL-13 levels were also observed in some of the subjects who remained untreated for 1 year following initial assessment and developed more serious fibrosis during this period. The data suggest a role for type 2 cytokines in hepatic fibrosis in human schistosomiasis mansoni.
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Affiliation(s)
- Amélia Ribeiro de Jesus
- Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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26
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Vennervald BJ, Kenty L, Butterworth AE, Kariuki CH, Kadzo H, Ireri E, Amaganga C, Kimani G, Mwatha J, Otedo A, Booth M, Ouma JH, Dunne DW. Detailed clinical and ultrasound examination of children and adolescents in a Schistosoma mansoni endemic area in Kenya: hepatosplenic disease in the absence of portal fibrosis. Trop Med Int Health 2004; 9:461-70. [PMID: 15078264 DOI: 10.1111/j.1365-3156.2004.01215.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hepatosplenic schistosomiasis involving organomegaly, portal fibrosis and portal hypertension has been observed in autopsy studies. Here, we have tested the hypothesis that hepatosplenic disease including organomegaly and markers of increased portal pressure can occur in school aged children in the absence of fibrosis. A case-only study of 96 children aged 7-20 years defined by ultrasound detectable hepatomegaly was undertaken in Makueni district, Kenya. A novel method of clinical examination that involved a consensus scoring by three or four examiners was used to classify children as presenting with severe or moderate hepatosplenic disease after palpation of livers and spleens. Ultrasound examination of livers and spleens was based on the Niamey protocol. Clinical measurements included spleen enlargement along the mid-clavicular and mid-axillary lines, liver enlargement along the mid-sternal (MSL) and mid-clavicular lines, as well as organ consistency. The clinical examination indicated that 9% and 60% of the children had severe or moderate hepatosplenomegaly, respectively. Amongst egg-positive children, all clinical measurements, except MSL liver enlargement, correlated with egg count, as did portal vein diameter, spleen length and liver length measured by ultrasound. Peri-portal fibrosis was not observed in any child, whereas 28% of the children were classified as having increased portal pressure according to World Health Organization criteria. There was no effect of malaria parasitaemia or hepatitis seropositvity on any of the observed parameters. These results indicate that hepatosplenic disease in school-aged children attributable to S. mansoni infection, involving hepatosplenomegaly and increased portal vein diameter, can occur in the absence of peri-portal fibrosis.
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Chevillard C, Moukoko CE, Elwali NEMA, Bream JH, Kouriba B, Argiro L, Rahoud S, Mergani A, Henri S, Gaudart J, Mohamed-Ali Q, Young HA, Dessein AJ. IFN-gamma polymorphisms (IFN-gamma +2109 and IFN-gamma +3810) are associated with severe hepatic fibrosis in human hepatic schistosomiasis (Schistosoma mansoni). J Immunol 2004; 171:5596-601. [PMID: 14607968 DOI: 10.4049/jimmunol.171.10.5596] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Schistosome infection is a major public health concern affecting millions of people living in tropical regions of Africa, Asia, and South America. Schistosomes cause mild clinical symptoms in most subjects, whereas a small proportion of individuals presents severe clinical disease (as periportal fibrosis (PPF)) that may lead to death. Severe PPF results from an abnormal deposition of extracellular matrix proteins in the periportal spaces due to a chronic inflammation triggered by eggs and schistosome Ags. Extracellular matrix protein production is regulated by a number of cytokines, including IFN-gamma. We have now screened putative polymorphic sites within this gene in a population living in an endemic area for Schistosoma mansoni. Two polymorphisms located in the third intron of the IFN-gamma gene are associated with PPF. The IFN-gamma +2109 A/G polymorphism is associated with a higher risk for developing PPF, whereas the IFN-gamma +3810 G/A polymorphism is associated with less PPF. The polymorphisms result in changes in nuclear protein interactions with the intronic regions of the gene, suggesting that they may modify IFN-gamma mRNA expression. These results are consistent with the results of previous studies. Indeed, PPF is controlled by a major locus located on chromosome 6q22-q23, closely linked to the gene encoding the alpha-chain of the IFN-gamma receptor, and low IFN-gamma producers have been shown to have an increased risk of severe PPF. Together, these observations support the view that IFN-gamma expression and subsequent signal transduction play a critical role in the control of PPF in human hepatic schistosome infection (S. mansoni).
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Affiliation(s)
- Christophe Chevillard
- Immunologie et Génétique des Maladies Parasitaires, Laboratoire de Parasitologie-Mycologie, Faculté de Médecine, Institut National de la Santé et de la Recherche Médicale Unité 399, Marseille, France.
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Hornstrup MK, Havelund T. [Picture of the months: schistosomiasis]. Ugeskr Laeger 2003; 165:931. [PMID: 12661521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Ruiz R, Candia P, Garassini M, Tombazzi C, Certad G, Bruces AC, Noya O, Alarcon de Noya B. Schistosomiasis mansoni in low transmission areas: abdominal ultrasound. Mem Inst Oswaldo Cruz 2003; 97 Suppl 1:153-9. [PMID: 12426611 DOI: 10.1590/s0074-02762002000900029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In endemic areas with low prevalence and low intensity of infection, the diagnosis of hepatic pathology due to the Schistosoma mansoni infection is very difficult. In order to establish the hepatic morbidity, a double-blind study was achieved in Venezuelan endemic areas, with one group of patients with schistosomiasis and the other one of non-infected people, that were evaluated clinically and by abdominal ultrasound using the Cairo classification. Schistosomiasis diagnosis was established based on parasitologic and serological tests. The increase of the hepatic size at midclavicular and midsternal lines (in hepatometry) and the hard liver consistency were the clinical parameters able to differentiate infected persons from non infected ones, as well as the presence of left lobe hepatomegaly detected by abdominal ultrasound. The periportal thickening, especially the mild form, was frequent in all age groups in both infected and uninfected patients. There was not correlation between the intensity of infection and ultrasound under the current circumstances. Our data suggest that in Venezuela, a low endemic area of transmission of schistosomiasis, the hepatic morbidity is mild and uncommon. The Cairo classification seems to overestimate the prevalence of periportal pathology. The specificity of the method must be improved, especially for the recognition of precocious pathology. Other causes of hepatopathies must be investigated.
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Affiliation(s)
- R Ruiz
- Sección de Biohelmintiasis, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
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King CH, Magak P, Salam EA, Ouma JH, Kariuki HC, Blanton RE. Measuring morbidity in schistosomiasis mansoni: relationship between image pattern, portal vein diameter and portal branch thickness in large-scale surveys using new WHO coding guidelines for ultrasound in schistosomiasis. Trop Med Int Health 2003; 8:109-17. [PMID: 12581434 DOI: 10.1046/j.1365-3156.2003.00994.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE World Health Organization consensus meetings on 'Ultrasound in Schistosomiasis' in 1996 and 1997 anticipated further challenges in the global implementation of a standardized protocol for morbidity assessment in schistosomiasis mansoni. We evaluated the performance of the qualitative and quantitative components of the new Niamey criteria. METHOD Use of the Niamey protocol among 3954 subjects in two linked, cross-sectional ultrasound surveys of Schistosoma mansoni-endemic populations in Egypt and Kenya. RESULTS There were significant differences between Egyptian and Kenyan sites in prevalence and age distribution of S. mansoni-related hepatic fibrosis (36%vs. 3%, P < 0.001). Protocol image pattern scoring could be performed quickly and was stable to interobserver variation. However, there were unintended but systematic differences between study sites in the measurement of portal vein diameter (PVD) and wall thickness. By Niamey criteria, a high prevalence of portal dilation was scored for normal Egyptian subjects, which reduced the predictive value of image pattern for portal hypertension. Using alternative height-indexing of PVD, image pattern plus PVD findings predicted 15% of Egyptians and 2.5% of Kenyans were at risk for variceal bleeding, whereas locally derived PVD norms estimated 25% of Egyptians and 12% of Kenyans to be at possible risk. CONCLUSION Niamey scoring criteria performed acceptably as a relative grading system for disease in schistosomiasis mansoni, but failed to account fully for site-to-site variation in test performance and morbidity prevalence. Consequently, standardized image pattern scoring appears to provide the most useful tool for detection and comparison of S. mansoni-associated morbidity in large-scale surveys.
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Affiliation(s)
- Charles H King
- Division of Geographic Medicine, Case Western Reserve University and University Hospitals of Cleveland, OH 44103-4983, USA.
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31
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Ramarokoto CE, Morel B. [Use of ultrasonography in Schistosoma mansoni infections: from the past to the present and future perspectives]. Arch Inst Pasteur Madagascar 2002; 63:38-42. [PMID: 12463014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Before the sonographic era, clinics or parasitology even autopsy have been the only sources of basic principles on the morbidity due to Schistosoma mansoni. The exploration of inner organs and their pathologies became easier. The organ's size as well as their echogenicity permit grading. Up till now, any classification is not appropriate. Attempts of standardization haven't yet succeeded, thus any comparison among different endemic regions is not possible. A simple method based on qualitative observation of the periportal fibrosis is proposed to help sonographist for the diagnosis of presumption in front of evocative image and to be a guideline for later investigation.
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Affiliation(s)
- C E Ramarokoto
- Institut Pasteur de Madagascar, BP 1274, 101 Antananarivo, Madagascar
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Raobelison A, Rabarijaona L, Ramarokoto CE, Ravoniarimbinina P, Ravaoalimalala VE, Esterre P, Boisier P. [Ultrasonographic evaluation of Schistosoma mansoni morbidity: comparison of Cairo/WHO and Managil-Hannover classifications]. Arch Inst Pasteur Madagascar 2002; 63:43-5. [PMID: 12463015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
A ultrasonographical survey of morbidity in schistosomiasis mansoni was carried out in two villages of an endemic area of Madagascar. Using the Managil-Hannover classification, the overall prevalence of morbidity in the first village was of 49.4% and of 39.4% in the second one, while modified Cairo/WHO classification found 9.1% and 1.9% respectively. Thus, results given by the two classifications for a same individual are often discordant. This discrepancy is essentially observed in the lower stage of morbidity while advanced cases are generally well-staged by either of these two methods. These differences in the sonographical assessment of morbidity related to hepatosplenic schistosomiasis make it necessary to continue investigations in order to establish a classification that will have the agreement of everybody.
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Affiliation(s)
- A Raobelison
- Unité de Parasitologie, Institut Pasteur de Madagascar, BP 1274, 101 Antananarivo, Madagascar
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Widman A, Oliveira IRSD, Speranzini MBL, Cerri GG, Saad WAO, Gama-Rodrigues J. [Late morphologic and hemodynamic changes in the splenic territory of patients with mansoni's hepatosplenic schistosomiasis after distal splenorenal shunt. (Ultrasonography-Doppler study)]. Arq Gastroenterol 2002; 39:217-21. [PMID: 12870080 DOI: 10.1590/s0004-28032002000400003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The distal splenorenal anastomosis (Warren's operation) has been indicated for the treatment of high digestive bleeding caused by esophagic varices because it would ideally reduce the venous pressure in the cardiotuberositary territory without changing the mesenteric-portal venous flow. However, the changes it produce in the splenic territory have not been fully understood. AIM To appraise the late morphologic and hemodynamic changes in the splenic territory produced by the distal splenorenal anastomosis in patients with portal hypertension due to mansoni's hepatosplenic schistosomiasis complicated by esophagic bleeding. METHOD Ultrasonography-Doppler study of the splenic region of 52 patients with portal hypertension due to mansoni's schistosomiasis and previous bleeding by esophagic varices. They were divided in two groups: 40 non operated upon and 12 with a distal splenorerenal anastomosis. The following parameters and indices were compared between the two groups: a) morphometric parameters (splenic artery and vein's diameter, splenic diameters (longitudinal, transversal and antero-posterior); b) velocimetric parameters of the splenic vessels (systolic peak velocity in the splenic artery, mean flow velocity in the splenic vein; c) biometric index of the spleen (longitudinal x transversal); volumetric index of the spleen (longitudinal x transversal x antero-posterior x 0,523); hemodynamic indices of the splenic artery's impedance: pulsatility and resistivity. RESULTS The patients with distal splenorenal anastomosis showed: a) reduction in splenic indices: volumetric (non operated 903,83 +/- 452, 77 cm / distal splenorenal anastomosis 482,32 +/- 208,02 cm (46,64%)) and biometric (non operated 138,14 +/- 51,89 cm /distal splenorenal anastomosis 94,83 +/- 39,83 cm (33,35%)); b) no change: splenic artery's diameter (non operated 0,57 +/- 0,16 cm/distal splenorenal anastomosis 0,57 +/- 0,23 cm); velocity in the splenic artery non operated 107 +/- 42,02 cm/seg/distal splenorenal anastomosis 89,81 +/- 41,20 cm/seg), resistivity (non operated 0,58 +/- 0,008/distal splenorenal anastomosis 0,56 +/- 0,06) and pulsatility (non operated 0,91 +/- 0,19/distal splenorenal anastomosis 0,86 +/- 0,15, splenic vein (non operated 1,10 +/- 0,30 cm/distal splenorenal anastomosis 1,19 +/- 0,29 cm); c) increase: mean flow velocity in the splenic vein (non operated 20,54 +/- 8,45 cm/seg/distal splenorenal anastomosis 27,83 +/- 9,29 cm/seg). CONCLUSIONS The comparison of the ultrasonography Doppler results of the two groups of patient (non operated and distal splenorenal anastomosis) showed that in patients with distal splenorenal anastomosis there was a decrease of the volume of spleen; increase in the mean flow velocity in the splenic vein; no changes in the morphologic and hemodinamyc parameters of the splenic artery neither in its velocimetric indices.
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Affiliation(s)
- Azzo Widman
- Grupo de Cirurgia do Fígado e Hepertensão Portal da Divisão de Clínicas Cirúrgica II do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, RS, Brasil
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Blanton RE, Salam EA, Kariuki HC, Magak P, Silva LK, Muchiri EM, Thiongo F, Abdel-Meghid IE, Butterworth AE, Reis MG, Ouma JH. Population-based differences in Schistosoma mansoni- and hepatitis C-induced disease. J Infect Dis 2002; 185:1644-9. [PMID: 12023771 DOI: 10.1086/340574] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2001] [Revised: 01/22/2002] [Indexed: 11/03/2022] Open
Abstract
Two populations with differing histories of Schistosoma mansoni and hepatitis C infection were compared directly for severity of disease and extent of comorbidity. Demographic, parasitologic, and ultrasound surveys were conducted on 2038 Egyptians and on 2120 Kenyans. Hepatitis B and C serologies and transaminase levels were obtained from a subset at each site. Despite significantly lower prevalence and intensity of infection, Egyptians had a higher prevalence of severe schistosomal fibrosis than Kenyans (36.8% vs. 4.6%). Hepatitis C infection was 3 times more prevalent among Egyptians, and evidence of hepatocellular damage was significantly greater among Egyptians. There was no interaction between S. mansoni infection or disease and the prevalence or severity of hepatitis C. For both infections, the intensity or prevalence of infection was a poor predictor of morbidity. The prevalence of disease in the Egyptian population from different pathogens suggests a generalized susceptibility to inflammatory liver disease.
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Affiliation(s)
- Ronald E Blanton
- Division of Geographic Medicine, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106-4983, USA.
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Lambertucci JR, Cota GF, Pinto-Silva RA, Serufo JC, Gerspacher-Lara R, Costa Drummond S, Antunes CM, Nobre V, Rayes A. Hepatosplenic schistosomiasis in field-based studies: a combined clinical and sonographic definition. Mem Inst Oswaldo Cruz 2002; 96 Suppl:147-50. [PMID: 11586441 DOI: 10.1590/s0074-02762001000900022] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A combined clinical and sonographic classification of hepatosplenic schistosomiasis mansoni to be used in field-based studies is proposed herein. Seven hundred forty one individuals out of 892 (83%), living in an area endemic for schistosomiasis in Brazil, have been submitted to clinical and ultrasound examinations. Based on two stool examinations the overall prevalence for schistosomiasis in this area was 73%. Abdominal palpation was performed with patients in dorsal decubit, during deep breath, by two experienced physicians and a portable ultrasound was used for the evaluation of liver fibrosis, portal collaterals and spleen size. Four groups of individuals were identified using data obtained by abdominal palpation and ultrasound examination: (1) palpable spleen and intense periportal thickening in 9 individuals (1.2%); (2) spleen not palpable and intense periportal thickening in 15 (2%); (3) palpable spleen with light to moderate periportal thickening in 32 (4.3%), and (4) palpable spleen with a normal liver on ultrasound in 30 (4%). The definition of hepatosplenic schistosomiasis in field-based studies as the finding of Schistosoma mansoni eggs in the stools in an individual with splenomegaly is not acceptable anymore. Abdominal ultrasound should be combined with clinical examination to accurately identify hepatosplenics in endemic areas for schistosomiasis.
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Affiliation(s)
- J R Lambertucci
- Serviço de Doenças Infecciosas e Parasitárias, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, 30130-100, Brasil.
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37
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Amaral ACDC, de Aguiar LAK, Souza MRDA, de Toledo CF, Borges DR. [Serum gamma-glutamyltransferase alteration in hepatic schistosomiasis doesn't correlate with parasitic load and precedes ultrasound alterations]. Arq Gastroenterol 2002; 39:27-31. [PMID: 12184162 DOI: 10.1590/s0004-28032002000100006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Liver disorders are the major manifestations of schistosomiasis mansoni. Factors that account for increased concentrations of cholestasis-indicating enzymes in the hepatosplenic form of the disease are unknown. OBJECTIVE To assess the correlation between increased gamma-glutamyltransferase serum levels and both the parasitic load and ultrasound alterations in patients with schistosomiasis. PATIENTS AND METHODS Twenty-five patients with the chronic form of schistosomiasis were assessed for the presence or absence of increased enzymatic levels, for the parasitic load (low x medium/high) and for ultrasound parameters. Furthermore, analysis of prothrombin time and a platelet count were performed. RESULTS Of the 25 patients, 13 showed increased gamma-glutamyltransferase plasma levels. No significant correlation was found between increased gamma-glutamyltransferase levels and the parasitic load, or between increased enzyme levels and ultrasound alterations. Nor did the prothrombin index or the platelet count differ between the two groups (normal gamma-glutamyltransferase levels and increased gamma-glutamyltransferase levels). CONCLUSION The parasitic load explains no rise in gamma-glutamyltransferase plasma levels in patients with the chronic form of schistosomiasis, and conventional ultrasound is not a sensitive method to detect the alteration suggested by the increased enzyme level in those patients.
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Affiliation(s)
- Ana Cristina de Castro Amaral
- Setor de Esquistossomose, Disciplina de Gastroenterologia, Departamento de Medicina, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP-EPM
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Widman A, de Oliveira IR, Speranzini MB, Cerri GG, Saad WA, Gama-Rodrigues J. [Patent paraumbilical vein: hemodynamic importance in Mansoni's hepatosplenic portal hypertension (Study with ultrasonography Doppler]. Arq Gastroenterol 2001; 38:221-6. [PMID: 12068531 DOI: 10.1590/s0004-28032001000400003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The hemodynamical effect of the collateral portosystemic circulation upon the portal system has not yet been fully understood. The US-Doppler made possible the non-invasive study of the portal system by evaluating the parameters: flow direction, diameter and flow velocity in it's vessels. AIMS To study the paraumbilical vein as a collateral portosystemic pathway and identify patterns for appraising its hemodynamic importance to the portal system. METHOD US-Doppler study of the portal system of 24 patients with Mansoni's hepatosplenic schistosomic portal hypertension, previous esophagic variceal bleeding and patent paraumbilical vein with hepatofugal flow. The diameter and the mean flow velocity were measured in the paraumbilical vein and so were the mean flow velocity in the portal vein, right and left portal branches. The Pearson test (linear correlation) was applied to the portal vein's mean flow velocity and the paraumbilical vein's diameter and mean flow velocity. The patients were divided in four groups: D1-paraumbilical vein with diameter < 0.68 cm (n = 14), D2-paraumbilical vein with diameter > or = 0.68 cm (n = 10), V1-paraumbilical vein with mean flow velocity < 18.41 cm/seg (n = 13) and V2-paraumbilical vein with mean flow velocity > or = 18.41 cm/seg (n = 11). The mean flow velocity in the portal vein, right and left portal branches of the four groups were compared. RESULTS The paraumbilical vein diameter was 0.68 +/- 0.33 cm (range: 0.15-1.30 cm) and the mean flow velocity was 18.41 +/- 11.51 cm/seg (range: 5.73-38.20 cm/seg). The linear correlation between the portal vein's mean flow velocity/paraumbilical vein diameter and the paraumbilical vein's mean flow velocity showed r = 0.504 and r = 0.735, respectively. In the group D2 there was an increase in the mean flow velocity in the portal vein (17.80 +/- 3.42/22.30 +/- 7.67 cm/seg) and in the left portal branch (16.00 +/- 4.73/22.40 +/- 7.90 cm/seg). In the group V2 there was an increase in the mean flow velocity in the portal vein (16.31 +/- 3.49/21.96 +/- 5.89 cm/seg) and in the left portal branch (14.22 +/- 4.41/21.94 +/- 7.20 cm/seg). There was no change in the right portal branch (13.67 +/- 5.74/15.43 +/- 3.43 cm/seg). CONCLUSIONS In portal hypertension due to hepatosplenic schistosomiasis, the patent paraumbilical vein, with hepatofugal flow, diameter > or = 0.68 cm and mean flow velocity > or = 18.41 cm/seg causes an increase of the mean flow velocity in the portal vein and left portal branch. The best US-Doppler parameter to appraise the paraumbilical vein influence upon the portal system is the mean flow velocity. The correlation between the increase in portal vein's mean flow velocity is stronger with the paraumbilical vein's mean flow velocity than with its diameter. The increase in the portal vein's and left portal branch's mean flow velocity may be understood as the paraumbilical vein's hemodynamic influence upon the portal system. An active portosystemic collateral pathway increases the mean flow velocity in the vein's segment proximal to its point of origin.
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Affiliation(s)
- A Widman
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo, FMUSP, São Paulo, SP
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Boisier P. [Ultrasonoic diagnosis of morbidity related to schistosomiasis due to Schistosoma mansoni and Schistosoma haematobium: epidemiological and individual value]. Med Trop (Mars) 2001; 60:395-401. [PMID: 11436599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
By allowing study of large population samples, ultrasonography has revolutionized assessment of schistosomiasis-related morbidity. Previous clinical or parasitological parameters provided poor documentation of the public health impact of schistosomiasis. Thanks to a WHO-coordinated drive to standardize examination protocols and severity scores, comparison of data from different regions is now much easier. The latest "Niamey" methodology has eliminated the major shortcomings of earlier methods. Detection of periportal fibrosis is the cardinal diagnostic feature for Schistosoma mansoni. Ultrasonographic evidence has been validated by correlation with hepatic biopsy findings from hospitalized patients with severe disease. The specificity of ultrasonography is poor in low- or moderate-grade disease for which different methodologies give discordant results. Ultrasonography is highly sensitive for assessment of morbidity related to Schistosoma haematobium infection, which is associated with typical bladder lesions. Lesions involving the upper urinary tract are also well visualized but do not constitute a specific finding. The best applications for which ultrasonographic investigation of schistomsomiasis is now considered as mandatory are community-based studies and post-therapeutic follow-up of populations. In contrast ultrasonography is not well suited to individual diagnosis. In endemic areas, ultrasonography may be used for individual diagnosis if more effective methods are unavailable. However the poor specificity of some images is a major limitation for use in zones of low transmission.
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Affiliation(s)
- P Boisier
- Service de Médecine des Collectivités, Hôpital d'instruction des Armées Robert-Picqué, 33998 Bordeaux Armées.
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De Jesus AR, Miranda DG, Miranda RG, Araújo I, Magalhães A, Bacellar M, Carvalho EM. Morbidity associated with Schistosoma mansoni infection determined by ultrasound in an endemic area of Brazil, Caatinga do Moura. Am J Trop Med Hyg 2001; 63:1-4. [PMID: 11357987 DOI: 10.4269/ajtmh.2000.63.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Morbidity in schistosomiasis is caused by a granulomatous response to Schistosoma mansoni eggs deposited in peripheral portal veins. Ultrasonography has been useful to assess the impact of control programs on the prevalence of hepatic fibrosis. In the present study, ultrasonographic criteria proposed by the World Health Organization were used to classify the degree of hepatic fibrosis in 164 schistosomiasis patients from an endemic area of Brazil. The majority of subjects (89%) had degree I or II hepatic fibrosis. Periportal tract thickness, portal vein diameter, splenic vein diameter, and spleen size were positively correlated (P < 0.01). Ultrasonography was repeated on 21 patients one year later and hepatic fibrosis had progressed in 17. Ultrasonography was performed after treatment on 39 subjects and periportal fibrosis had regressed in 27.
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Affiliation(s)
- A R De Jesus
- Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Brazil
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Abstract
AIM Schistosomiasis (Bilharzia, Bilharziasis) is one of the most prevalent tropical diseases, with an increasing number of cases being imported into Europe. Sonography is among the most valuable diagnostic tools for schistosomiasis-related organ lesions. This review outlines typical findings and their pathophysiological context. METHOD AND RESULTS Bilharziasis of the urinary tract, usually due to Schistosoma (S.) haematobium, leads to diffuse or localized wall thickening of the bladder and the distal ureter with typical sonographic features. Upper urinary tract obstruction and--rarely--bladder carcinoma may complicate the course and can also be detected sonographically. The other species (S. mansoni, S. japonicum, S. mekongi, S. intercalatum) primarily cause (entero-) colitis; the value of sonography in this condition is yet undefined. In later stages, fibrotic liver involvement with portal hypertension may develop (hepatosplenic schistosomiasis), leading to typical ultrasound features which are nearly pathognomonic under endemic conditions: severe periportal echogenicity with S. mansoni, and a peculiar "network pattern" of echogenic septa with S. japonicum. Sonographic indicators of portal hypertension may be identified and graded. CONCLUSION In endemic areas in the tropics, sonography with simple portable machines offers a unique opportunity to investigate morbidity on the community level non-invasively in large field surveys; it has thus become an important tool of clinical and epidemiological research.
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Kariuki HC, Mbugua G, Magak P, Bailey JA, Muchiri EM, Thiongo FW, King CH, Butterworth AE, Ouma JH, Blanton RE. Prevalence and familial aggregation of schistosomal liver morbidity in Kenya: evaluation by new ultrasound criteria. J Infect Dis 2001; 183:960-6. [PMID: 11237814 DOI: 10.1086/319247] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2000] [Revised: 12/01/2000] [Indexed: 11/04/2022] Open
Abstract
Severe periportal fibrosis is not an inevitable consequence of infection with Schistosoma mansoni. Genetic predisposition may be a deciding factor in the development of disease. To assess the contribution of genetic factors in the severity of hepatic fibrosis, the degree of familial aggregation was determined in a Kenyan population. Schistosomal fibrosis was identified with hepatic ultrasound and newly proposed World Health Organization criteria, which include both qualitative and quantitative observations. These 2 aspects of the criteria correlated well with one another. The peak prevalence of ultrasound proven fibrosis trailed 5-10 years behind peak prevalence of infection and declined sharply after age 50 years. This pattern was consistent with either resolution of severe fibrosis over 10-20 years or early death of those severely affected. Genetic predisposition appears to be a weak factor in the development of severe disease in this population, since no household or familial aggregation could be identified.
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Affiliation(s)
- H C Kariuki
- Division of Vector Borne Diseases and Office of Radiologic Services, Kenya Ministry of Health, Nairobi, Kenya
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43
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Affiliation(s)
- J H Ouma
- Division of Vector Borne Diseases, Ministry of Health, Nairobi, Kenya.
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Widman A, de Oliveira IR, Speranzini MB, Cerri GG, Saad WA, Gama-Rodrigues J. [Hepatosplenic schistosomiasis portal hypertension: effect of esophagogastric devascularization with splenectomy on the diameter and mean flow velocity in the portal system (ultra-sonographic Doppler]. Arq Gastroenterol 2001; 38:19-23. [PMID: 11582960 DOI: 10.1590/s0004-28032001000100005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Esophagogastric devascularization with splenectomy has been used for the treatment of upper digestive bleeding due to esophagic varices in hepatoportal mansoni's schistosomic portal hypertension. Nevertheless, early portal thrombosis has hampered this surgical technique (13.3% and 53.2%), compromising the good results on the hemorrhagic side. Supposing that portal circulatory changes, due to the surgical treatment, may play an important role in this kind of complication, our objective was to identify the hemodynamic facilitating factors. Portal hemodynamic aspects, identified by ultra-sonographic Doppler study, from two groups of patients: non-operated upon and splenectomized with esophagogastric devascularization in late post-operatory phase (in excess of 6 moths), with portal hypertension due to mansoni hepatoesplenic portal hypertension and in similar clinical conditions, were compared. METHOD Fifty eight ambulatorial patients were studied, all had portal hypertension caused by mansoni's hepatosplenic schistosomiasis and previous bouts of digestive bleeding. They were divided in two groups: A--29 followed clinically/endoscopically, and group B--29 previously submitted to esophagogastric devascularization with splenectomy. In all was measured the diameter and mean flow velocity in the portal vein and its right and left branches by ultra-sonographic Doppler study. The results were submitted to statistical analysis for inter- and intra-group comparison. RESULTS Group A (non-operated): the portal vein diameter was greater than the right and left branches (10.6 +/- 2.9, 8.0 +/- 1.8, 9.1 +/- 2.6 cm), the mean flow velocities in the portal vein and its branches were similar (15.62 +/- 6.17, 14.92 +/- 5.33, 16.12 +/- 4.18 cm/seg). Group B (operated): the diameter and mean flow velocity in all vessels were reduced (8.8 +/- 1.7, 5.2 +/- 1.2, 7.5 +/- 2.2 cm/12.53 +/- 2.60, 8.86 +/- 1.75, 9.69 +/- 3.75 cm/seg). CONCLUSIONS After esophagogastric devascularization with splenectomy, there was a reduction of the diameter and mean flow velocity in the portal vein, its right and left branches.
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Affiliation(s)
- A Widman
- Departamentos de Gastroenterologia e Radiologia, Faculdade de Medicina, Universidade de São Paulo-FMUSP
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45
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Abstract
Ultrasonography (US) is suitable for diagnosing schistosomiasis-related organic pathology and is particularly useful to assess its evolution after therapy and/or interruption of exposure to the Schistosoma parasites. Evolution of pathology after treatment: Regression of hepatic abnormalities in Schistosma mansoni-infected children and adolescents has been observed already from 7 months post-therapy on. This does, however, not occur in all cases: individual differences are great ranging from spontaneous regression of pathology without treatment to persistence of pathology lasting for years after therapy even without re-infection. Intensity and duration of exposure, different parasite strains, patients' age and genetic background all influence the evolution of pathology. In communities at continuous exposure to S. mansoni infection, repeated re-treatment is required to control hepatosplenic morbidity. In Schistosoma japonicum infection, changes around the portal tree may regress, but characteristic diffuse abnormalities described as 'network pattern' abnormalities do not resolve. In Schistosoma haematobium infection bladder abnormalities and urinary tract obstruction frequently resolve after treatment. Clinically relevant pathology may resurge from 1 year after therapy on if exposure continues. Subjects with more advanced pathology before therapy, appear to be at higher risk of pathology re-appearance. Evolution of pathology after interruption of exposure to schistosomiasis: Knowledge on the evolution of pathology induced by S. mansoni is limited to some reports in emigrants and to the experience of ultrasonographists working in areas, where transmission has been partially interrupted. Due to the longevity of the parasite, infection may last for many years. Even after elimination of the parasites severe pathology may persist for long. In S. haematobium infection spontaneous healing after interruption of re-exposure may occur, but cases have been reported where urogenital lesions led to complications many years after exposure. Contrary to hepatosplenic and urinary pathology, knowlegde on the evolution of other organic abnormalities is very limited: studies on the evolution of biliary abnormalities or intestinal pathology have not been published. Genital pathology may be induced by all Schistosoma spp. Post-therapy evolution of genital schistosomiasis is largely ignored. In some European travellers partial regression of prostatic fibrosis has been described. Schistosomal adnexitis leading to infertility and/or ectopic pregnancy has been reported occurring many years after interruption of exposure. Ultrasonography (US) has never been used to study the influence of schistosomiasis on pregnancy. Concluding, current knowlegde on the evolution of pathology after treatment and/or interruption of exposure is still fragmentary. Frequently, fibrosis reverses after therapy, but advanced pathology may persist for long. Therefore, the possibility of severe clinical complications has to be taken into account, even if the infection is inactive since many years. In interventions aimed at controlling schistosomiasis-related morbidity, evolution of pathology must be monitored by US in representative patient cohorts. Further systematic US-studies are needed not only on the evolution of hepatosplenic and urinary pathology but also on that of intestinal, biliary and genital pathology induced by schistosomiasis, as well as on the influence of schistosomiasis on the outcome of pregnancy.
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Affiliation(s)
- J Richter
- Abteilung für Gastroenterologie, Hepatologie und Infektiologie, Tropenmedizinische Ambulanz, Heinrich-Heine Universität Duesseldorf, Duesseldorf, Germany.
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46
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Bonnard P, Lanuit R, Dompnier JP, Remoue F, Diop A, Ly A, Capron A, Riveau G. [Predictive ultrasonographic criteria for portal hypertension due to Schistosoma mansoni in a recently established endemiz zone]. Med Trop (Mars) 2000; 60:42-6. [PMID: 10989786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The first cases of Schistosoma mansoni infection were reported in the Senegal River Basin ten years ago. Today endemicity is so high that prevalence rates exceed 90 p. 100 in some areas. Schistosomiasis sometimes goes undiagnosed until the occurrence of portal hypertension with rupture of esophageal varices. Endoscopy is the gold standard for detection of esophageal varices but it is impractical in remote areas. Ultrasonography has been proposed as a non-invasive alternative. The purpose of this study is to describe the results of simultaneous endoscopic and ultrasonographic assessment in 101 subjects from the Richard-Toll area of the Senegal River Basin. Findings showed that severe forms of schistosomiasis complicated by portal hypertension were already present in the region less 10 years after description of the first case. This study also proposes a diagnostic score for portal hypertension based on ultrasonographic findings. The features included in this score are thickening of portal vessel walls, portal vessel diameter, and collapsed appearance of the splenic vein during inspiration. In our hands this score allowed reliable prediction of the development of esophageal varices. Ultrasonography is a good tool for identifying severe forms of schistosomiasis. It should be useful for routine screening in recently established endemic zones.
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Affiliation(s)
- P Bonnard
- Programme ESPOIR, Hôpital de Saint-Louis
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47
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Garba A, Kinde-Gazard D, Makoutodé M, Boyer N, Ernould JC, Chippaux JP, Massougbodji A. [Preliminary evaluation of morbidity due to S. haematobium and S. mansoni in the area of the future Adjarala Dam in Benin]. Sante 2000; 10:323-8. [PMID: 11125338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The aim of this study was to provide a preliminary assessment of morbidity due to schistosomiasis in the area of the future Adjarala Dam in Benin. We included 412 schoolchildren from five villages in the study. The mean age of the children was 9.4 +/- 2.3 years and the sex ratio (F/M) was 0.94. These children underwent parasitological examination. The children provided urine samples, which were examined by eye, filtered and tested for blood and protein. Stool samples were examined using Kato's technique and an ultrasound scan of the urinary tract was performed. We carried out a survey of snails at the possible transmission sites of all the villages, with a view to identifying the intermediate hosts. We detected S. mansoni and S. haematobium in the area. Urinary schistosomiasis was mesoendemic (prevalence of 19.7%) whereas schistosomiasis due to S. mansoni was hypoendemic (prevalence of 3. 9%). Ultrasound scans showed that 28% of the children had bladder lesions and that 2.5% were carriers of hydronephrosis. We compared the diagnostic performances of the various indirect indicators of morbidity. We found that a history of hematuria was the most sensitive indicator (88%) but that the sensitivity of this indicator differed significantly according to the sex of the child. Hematuria >= 1+ was the most effective indicator. Snail surveys showed that Biomphalaria pfeifferi and Bulinus globosus were present in the area.
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Affiliation(s)
- A Garba
- Centre de recherche sur les méningites et les schistosomoses (CERMES), Niamey, Niger.
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48
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Hussein MH, El-Sayed MK, Talaat M, El-Badawy A, Miller FD. Epidemiology 1, 2, 3: study and sample design. Am J Trop Med Hyg 2000; 62:8-13. [PMID: 10813493 DOI: 10.4269/ajtmh.2000.62.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Bad sample designs and selection bias have plagued studies on schistosomiasis, and as a result some believe that schistosomiasis is too focal, making it difficult to draw reliable samples. The Epidemiology 1, 2, 3 (EPI 1, 2, 3) sample design, although complex, demonstrates that sampling theory is readily applicable to epidemiologic studies of schistosomiasis. The EPI 1, 2, 3 sampling scheme was designed to achieve the smallest feasible standard errors given EPI 1, 2, 3 objectives and certain logistical constraints. The sample design is a multi-stage selection of villages (ezbas, which were stratified by size) and households within each of 9 purposely selected Egyptian governorates. Villages and households were systemically selected from census frames. The sampling of ezbas was especially difficult because of the lack of complete sampling frames and their wide variation in population size. Ultimately, ezbas were stratified by size and then randomly selected from each stratum. Sample sizes for villages and ezbas and individuals within ezbas were calculated based on EPI 1 and 2 objectives, respectively. No re-selection was made for non-respondents. A 20% subsample of the full sample was drawn for clinical and ultrasonographic examinations. The sample selected from individual governorates closely parallel the age structure of the 1986 census of the respective rural populations. Details of the study design and related methods are given below.
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Affiliation(s)
- M H Hussein
- Department of Community Medicine, Faculty of Medicine, Cairo University, Egypt
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Abdel-Wahab MF, Esmat G, Medhat E, Narooz S, Ramzy I, El-Boraey Y, Strickland GT. The epidemiology of schistosomiasis in Egypt: Menofia Governorate. Am J Trop Med Hyg 2000; 62:28-34. [PMID: 10813497 DOI: 10.4269/ajtmh.2000.62.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Health questionnaires and parasitologic examinations of urine and stool were performed upon a stratified random sample of 10,899 individuals from 1,537 households in 27 rural communities in Menofia Governorate in Egypt in 1992 to investigate the prevalence of, risk factors for, and changing pattern of infection with Schistosoma sp. in the governorate. A subset, every fifth household, or 1,480 subjects, had physical and ultrasound examinations to investigate prevalence of and risk factors for morbidity. The prevalence of S. mansoni ranged from 0.3% to 72.9% and averaged 28.5%. The geometric mean egg count was 81.3 eggs/gram of stool. Age-stratified prevalence and intensity of infection was 30-40% and 60-80 eggs/gram of stool from the age of 10 onward; males had higher infection rates and ova counts than females in all age groups > 10 years old. Schistosoma haematobium was rare, being consequential in only 1 community. Risk factors for S. mansoni infection were male gender; age > 10 years; living in smaller communities; exposures to canal water; history of or treatment for schistosomiasis or blood in the stool; detection of splenomegaly by either physical or ultrasound; and ultrasound-detected periportal fibrosis (PPF). The more severe grades of PPF were rarely (21 of 1,450 examinations) detected. Risk factors for morbidity, i.e., ultrasound-detected PPF, were similar to those for infection. Schistosoma mansoni has almost totally replaced S. haematobium in Menofia. The prevalence of S. mansoni in rural communities remains high and average intensities of infection are moderate. The association of morbidity with schistosomal infection was variable and is obviously markedly influenced by both the frequent use of antischistosomal chemotherapy in communities in Menofia and by the prevalence of complications from chronic viral hepatitis in the population: hepatomegaly did not correlate with infection; PPF and splenomegaly, however, were related to S. mansoni infection in both individuals and communities.
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Affiliation(s)
- M F Abdel-Wahab
- Department of Tropical Medicine, Faculty of Medicine, Cairo University, Egypt
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Hammam HM, Zarzour AH, Moftah FM, Abdel-Aty MA, Hany AH, El-Kady AY, Nasr AM, Abd-El-Samie A, Qayed MH, Mikhail NN, Talaat M, Hussein MH. The epidemiology of schistosomiasis in Egypt: Qena governorate. Am J Trop Med Hyg 2000; 62:80-7. [PMID: 10813504 DOI: 10.4269/ajtmh.2000.62.80] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Qena is the southernmost governorate of Egypt included in the Epidemiology 1, 2, 3 national study. A probability sample selected 17,822 individuals from 2,950 households in 34 ezbas and 10 villages from a total rural target population of 1,731,252 (based on the most recent 1986 census of the population by the Egyptian Central Agency for Public Mobilization And Statistics). Parasitologic examination of urine and stool were made for Schistosoma haematobium and S. mansoni, respectively, and physical and ultrasound examinations were made on a 20% subsample. The overall estimated prevalence of S. haematobium was 4.8 +/- 0.7% (+/-SE) and geometric mean egg count (GMEC) was 7.0 ova per 10 ml of urine. Considerable variation in prevalence was observed between the villages and ezbas, ranging from 0.0% to 20%, with the smaller ezbas having a slightly higher overall prevalence. The age- and sex-specific patterns of S. haematobium showed typical peak prevalence in early adolescence, with males having a higher prevalence than females. A history of hematuria was associated with current infection (odds ratio = 3.6, 95% confidence interval = 2.32-5.63). Hepatomegaly and splenomegaly determined by physical examination present in 7.9% and 3.0%, respectively. Ultrasonography-determined hepatomegaly of the left liver lobe was found in 10.1%. Ultrasonography-detected hepatomegaly in both the left and right lobes increased in prevalence from approximately 5% in children to 15-20% in adults. The prevalence of ultrasonography-detected splenomegaly increased slightly with age. Grade III periportal fibrosis was detected in only 2 individuals in the sample. Bladder wall lesions and obstructive uropathy were also very infrequent. Other associations with these measures are given. Most villages and ezbas had an S. mansoni prevalence of less than 1%. The exception was Nag'a El-Sheikh Hamad, where the prevalence was 10.3 +/- 0.5% (GMEC = 57.4 +/- 2.6). Two other communities also had a prevalence >1% (Ezbet Sarhan and Kom Heitin).
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Affiliation(s)
- H M Hammam
- Department of Community Medicine, Faculty of Medicine, Assiut University, Egypt
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