RESUMO
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.
Assuntos
Hepatopatias Parasitárias/diagnóstico , Esquistossomose mansoni/diagnóstico , Esplenopatias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Hepatopatias Parasitárias/diagnóstico por imagem , Hepatopatias Parasitárias/epidemiologia , Masculino , Pessoa de Meia-Idade , Palpação , Prevalência , Esquistossomose mansoni/diagnóstico por imagem , Esquistossomose mansoni/epidemiologia , Esplenopatias/diagnóstico por imagem , Esplenopatias/epidemiologia , UltrassonografiaRESUMO
The literature on the assessment of morbidity due to Schistosoma mansoni infection is updated. Imaging techniques such as ultrasonography, echodoppler cardiography, computerized tomography (CT scan) and magnetic resonance imaging (MRI) introduced a new perspective, and expanded our knowledge on morbidity. Three well-defined syndromes caused by schistosomiasis mansoni have been described: the stage of invasion, acute schistosomiasis (Katayama fever), and chronic schistosomiasis. Complications of the acute and chronic syndromes have also been reported: pulmonary hypertension, neuroschistosomiasis, association with Salmonella, association with Staphylococci, viral hepatitis B, glomerulonephritis. In most individuals with hepatosplenic schistosomiasis the spleen is increased in size. Hepatosplenic schistosomiasis can, however, occur without splenomegaly. The definition of hepatosplenic schistosomiasis in endemic areas as the finding of S. mansoni eggs in the stools in an individual with hepatosplenomegaly is not satisfactory anymore. Many aspects of morbidity are expected to change after schistosomiasis control. Some are expected to change quickly (worm burden, Salmonella bacteremia, hepatosplenic schistosomiasis in children) whereas others shall remain for years (pulmonary hypertension, glomerulonephritis, neuroschistosomiasis). Intestinal schistosomiasis in individuals with low worm burdens is very difficult to diagnose and therefore laborious to control.
Assuntos
Controle de Doenças Transmissíveis , Esquistossomose mansoni/epidemiologia , Brasil/epidemiologia , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/parasitologia , Glomerulonefrite/complicações , Hepatite B/complicações , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Enteropatias/diagnóstico , Enteropatias/parasitologia , Hepatopatias/diagnóstico , Hepatopatias/parasitologia , Imageamento por Ressonância Magnética , Morbidade , Infecções por Salmonella/complicações , Esquistossomose mansoni/complicações , Esquistossomose mansoni/diagnóstico , Esplenopatias/diagnóstico , Esplenopatias/parasitologia , Infecções Estafilocócicas/complicações , Tomografia , UltrassonografiaRESUMO
Two young men with Salmonella bacteraemia, active schistosomiasis and the acquired immunodeficiency syndrome are reported. The clinical presentation comprised nonspecific signs and symptoms, such as fatigue, malaise, weight loss, diarrhoea, prolonged fever, and hepatosplenomegaly. In one patient, liver biopsy showed poorly formed granulomata around Schistosoma mansoni eggs and hepatitis. Treatment of schistosomiasis alone induced consistent clinical improvement with eventual cure of both Salmonella and S. mansoni infections. Recognition of the Salmonella-S. mansoni association in patients with AIDS is important because treatment of schistosomiasis makes a difference, improving the prognosis of this otherwise, recurrent, potentially fatal bacteraemia.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções por Salmonella/complicações , Esquistossomose mansoni/complicações , Adulto , Humanos , Masculino , Oxamniquine/uso terapêutico , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/tratamento farmacológico , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/tratamento farmacológico , Esquistossomicidas/uso terapêuticoRESUMO
We report a case of tropical pyomyositis in a boy who presented with a severe febrile illness associated with diffuse erythema, and swelling in many areas of the body which revealed on operation extensive necrotic areas of various muscles that required repeated débridement. The patient gave a history of contact with dogs, and an ELISA test for Toxocara canis was positive. He also presented eosinophilia and high serum IgE levels. Staphylococcus aureus was the sole bacteria isolated from the muscles affected. We suggest that tropical pyomyositis may be caused by the presence of migrating larvae of this or other parasites in the muscles. The immunologic and structural alterations caused by the larvae, in the presence of concomitant bacteremia, would favour seeding of the bacteria and the development of pyomyositis.
Assuntos
Larva Migrans Visceral/complicações , Miosite/complicações , Infecções Estafilocócicas/complicações , Toxocara canis , Adolescente , Animais , Seguimentos , Humanos , Larva Migrans Visceral/diagnóstico , Larva Migrans Visceral/tratamento farmacológico , Masculino , Miosite/diagnóstico , Miosite/tratamento farmacológico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/isolamento & purificaçãoRESUMO
In hospital-based series viral hepatitis B has been frequently described in association with schistosomiasis whilst in field-based studies the association has not been confirmed. The association between schistosomiasis and Salmonella bacteraemia has been well documented. More recently, acute schistosomiasis has been shown to be a facilitating factor in the genesis of pyogenic liver abscesses caused by Staphylococcus aureus. New evidences indicate an interaction between the acquired immunodeficiency syndrome (AIDS) and schistosomiasis. In this paper, data on the association of schistosomiasis with other infections are updated.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Hepatite B/complicações , Abscesso Hepático/complicações , Infecções por Salmonella/complicações , Esquistossomose/complicações , Infecções Estafilocócicas/complicações , Animais , HumanosRESUMO
This study was undertaken to determine the accuracy of splenic palpation for the diagnosis of splenomegaly, and to determine whether the frequency of individuals with a palpable spleen in an endemic area can be considered as an index of morbidity of schistosomiasis. For the clinical diagnosis of splenomegaly, two criteria have been tested: (A) presence of a palpable spleen and (B) presence of a palpable spleen whose border could be felt more than 4 cm below the costal margin. In an area of high prevalence of the disease (66.3%) 285 individuals aged 18 years or more have been submitted to abdominal ultrasonography and physical examination. Splenomegaly was defined as a splenic length greater than 120 mm by ultrasound and the sensitivity, specificity, positive and negative predictive values of criterion A were 72.2%, 90.5%, 35.1% and 97.8%. The values for criterion B were 27.8%, 98%, 50% and 95%, respectively. In an non endemic area, 517 individuals were submitted to the same protocol and 22 individuals had a palpable spleen, but no patient fulfilled criterion B for splenomegaly, and only one met the ultrasonographic criterion for splenomegaly. The authors concluded that abdominal palpation is a poor method for the diagnosis of splenomegaly.
Assuntos
Palpação/métodos , Esquistossomose mansoni/epidemiologia , Esplenomegalia/diagnóstico , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Doenças Endêmicas , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Morbidade , Valor Preditivo dos Testes , Prevalência , Esquistossomose mansoni/complicações , Sensibilidade e Especificidade , Esplenomegalia/epidemiologia , Esplenomegalia/etiologiaRESUMO
Data on the association of schistosomiasis and hepatitis B in field-based studies are scarce. Two areas have been selected for this study: i) Queixadinha, endemic for schistosomiasis, with a population of 693 individuals, and ii) Capão, a control non-endemic area, with 515 inhabitants. Sera of all individuals in both areas were tested for hepatitis B infection, yearly, from 1994 to 1997. In the first area hepatitis B was found in 32.1% of children up to one year old and reached a peak of 68.7% in the age range of 15 to 19 years. In the control area the prevalence of hepatitis B was under 5% up to 19 years of age and the highest prevalence was observed in adults over 45. HBsAg was detected in 9.4% of the individuals living in the endemic area for schistosomiasis and in 1.4% of the controls (OR = 4.98; 95% CI = 3.7-6.7). The index of chronicity of HBsAg was not statistically different in the studied areas (8.1% x 7.3%; OR = 1.09; 95% CI = 0.42-3.03), nor was it different for people with and without schistosomiasis in Queixadinha (8.7% x 7.0%). We conclude that the Schistosoma mansoni infection has not altered the course of hepatitis B in the studied area.
Assuntos
Antígenos de Superfície da Hepatite B/sangue , Hepatite B Crônica/complicações , Esquistossomose mansoni/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Biomarcadores , Brasil/epidemiologia , Portador Sadio/sangue , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Doenças Endêmicas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural , Esquistossomose mansoni/epidemiologiaRESUMO
The cases of five patients with unusual manifestation of acute schistosomiasis mansoni are described in this paper. One patient developed skin lesions, three displayed diverse lung involvement, and one presented pyrogenic liver abscesses caused by Staphylococcus aureus.
Assuntos
Humanos , Esquistossomose mansoni/complicações , Dermatite/parasitologia , Fígado/patologia , Pneumonia/parasitologiaRESUMO
The cases of five patients with unusual manifestations of acute schistosomiasis mansoni are described in this paper. One patient developed skin lesions, three displayed diverse lung involvement, and one presented pyogenic liver abscesses caused by Staphylococcus aureus.
Assuntos
Esquistossomose mansoni , Doença Aguda , Adolescente , Adulto , Animais , Dermatite/complicações , Humanos , Abscesso Hepático/complicações , Pneumopatias/complicações , Pessoa de Meia-Idade , Pneumonia/complicações , Esquistossomose mansoni/complicações , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/fisiopatologia , Dermatopatias Parasitárias/complicações , Infecções Estafilocócicas/complicaçõesRESUMO
In an endemic area for schistosomiasis in the northeast of the state of Minas Gerais in Brazil 516 individuals have been submitted to clinical and laboratory examination, ultrasonography of the abdomen and dopplerecocardiography in order to define the morbidity of schistosomiasis before and after treatment. A high prevalence of schistosomiasis (66.3%) and of severe disease (9.5% with palpable spleens) were recorded. Ultrasonography classified liver periportal fibrosis as light (19.4%), moderate (27.6%) and intense (6.8%), and 46.0% presented no periportal fibrosis. Twenty one out of the 53 individuals (39.6%) with palpable spleens did not present liver fibrosis on ultrasound. Periportal lymph nodes were described in 33.8% of the population and anti-KLH antibodies were found in the serum of 40.7%. Urinary alterations compatible with the glomerulopathy of schistosomiasis were observed in 4.5% of the population, and 11.7% of the individuals examined by dopplerecocardiography had pulmonary hypertension. Twelve months after treatment for schistosomiasis the prevalence of the disease dropped from 66.3% to 25.0%. In Queixadinha, a profile of the morbidity of schistosomiasis has just been established.