Visceral Leishmaniasis has been showing remarkable epidemiological changes
in recent decades, with marked expansion and an emergence of cases in urban areas of
the North, Southeast and Midwest regions of Brazil. The Kala-azar cases reported
here, despite being very characteristic, presented a great difficulty of diagnosis,
because the disease is not endemic in Volta Redonda. The child underwent two
hospitalizations in different hospitals, but got the correct diagnosis only after 11
months of symptom onset. In this report we discuss the main differential diagnoses
and call attention to the suspected symptoms of visceral leishmaniasis in patients
with prolonged fever, hepatosplenomegaly and pancytopenia, even in areas not
traditionally endemic for the disease.
OBJETIVO: Este estudo de campo objetivou identificar as alterações ultrassonográficas e hemodinâmicas indicativas da morbidade da esquistossomose mansônica em áreas endêmicas. MATERIAIS E MÉTODOS: Foram examinados pela ultrassonografia Doppler 554 pacientes esquistossomóticos em três áreas com níveis distintos de endemicidade: baixa endemicidade (n = 109); média endemicidade (n = 255) e alta endemicidade (n = 190). Para o estudo ultrassonográfico foi utilizado o protocolo da Organização Mundial da Saúde (Niamey Working Group, 2000). Pelo Doppler foram avaliados: vasos portais, artérias hepática e esplênica, veias hepáticas e vasos colaterais. RESULTADOS: Houve correlação significativa entre a frequência das alterações ultrassonográficas e o nível de endemicidade das áreas, exceto a hipertrofia do lobo esquerdo. As veias hepáticas apresentaram padrão de fluxo alterado em 23,7% dos casos, alteração esta relacionada à presença e à intensidade de espessamento periportal. A artéria hepática não apresentou alterações nos parâmetros avaliados. Os vasos colaterais foram identificados apenas na área de alta endemicidade. A artéria esplênica apresentou alterações (aumento do calibre, da velocidade e do índice de resistência) mais frequentes na área de alta endemicidade, com diferença significativa entre os grupos. CONCLUSÃO: A ultrassonografia Doppler mostrou-se ferramenta auxiliar importante no estudo da morbidade relacionada à esquistossomose mansônica, contribuindo para definição mais precisa do perfil da doença nas áreas endêmicas.
This study was undertaken in the municipality of Bananal, São Paulo, an endemic area for schistosomiasis with a prevalence under 10% and low parasite load among infected individuals. Our objective was to identify the clinical forms of schistosomiasis among 109 patients in whom the disease had been diagnosed through direct fecal analysis and who had been medicated with oxamniquine at the time of the Plan for the Intensification of Schistosomiasis Control Actions (1998-2000). These patients were submitted to an abdominal ultrasonography and fecal analysis by Kato-Katz method, four years, on average, after the end of the Plan. Five patients, whose abdominal ultrasound images were compatible with either peripheral or central periportal fibrosis and portal hypertension, were identified. None of the 109 patients presented Schistosoma mansoni eggs at fecal analysis. Ultrasonography is a sensitive, noninvasive diagnostic method that allows a better identification of the extent of liver involvement in schistosomiasis cases.
This study aimed to report the first case of a patient with hepatosplenic
schistosomiasis mansoni, refractory ascites and portal vein thrombosis treated
with a transjugular intrahepatic portosystemic shunt (TIPS), at the Instituto de
Radiologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao
Paulo, Brazil. After the procedure, the patient recovered favorably and
progressed with portal pressure reduction and no deterioration of the liver
function. Endovascular shunt modification is a conservative medical approach
that often helps in reducing symptoms significantly, making it a less invasive
and a safer alternative to liver transplantation for the treatment of
schistosomiasis with portal hypertension.
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