Aspartate aminotransferase to platelet ratio index and blood platelet count are good markers for fibrosis evaluation in schistosomiasis mansoni

Lambertucci, José Roberto; Silva, Luciana Cristina dos Santos; Antunes, Carlos

doi:10.1590/s0037-86822007000500023

Cited by 18 publications

(22 citation statements)

References 4 publications

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“…Hepatosplenic patients with thrombocytopenia have diffi culty fi nding jobs because they are considered to be sick and cannot work, particularly when the job requires physical exercise 70,71 . Dentists do not treat their gingival problems or remove their teeth because they can bleed excessively.…”

Section: Thrombocytopeniamentioning

confidence: 99%

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Revisiting the concept of hepatosplenic schistosomiasis and its challenges using traditional and new tools

Lambertucci

2014

Rev. Soc. Bras. Med. Trop.

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Different aspects of hepatosplenic schistosomiasis are revisited here. Manson's schistosomiasis causes periportal fi brosis and portal hypertension in approximately 6% of infected subjects, usually with preservation of their hepatic function. The assessment of liver involvement is of major importance in determining the prognosis and risk of complications from schistosomiasis, such as upper digestive bleeding secondary to variceal rupture. For many years, the diagnosis of hepatosplenic schistosomiasis and liver fi brosis was made by abdominal palpation and the fi nding of liver and/or spleen enlargement. However, there is no consensus regarding the clinical parameters of the liver and spleen to be considered in this physical evaluation. For the last three decades, abdominal ultrasound (US) has become the best imaging technique to evaluate liver fi brosis caused by schistosomiasis mansoni. However, US is a subjective procedure and is therefore examiner-dependent. Magnetic resonance imaging (MRI) fi ndings have provided valuable information in addition to ultrasound and clinical examination. The combination of a comprehensive history and physical examination, basic laboratory tests (a stool examination for Schistosoma mansoni eggs and a blood cell count), biomarkers for liver fi brosis/portal hypertension and imaging methods seem to offer the best approach for evaluating patients with this disease. In situations where research is involved or in patients with severe disease, MRI may be considered.

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Section: Thrombocytopeniamentioning

confidence: 99%

“…Thrombocytopenia has been successfully assayed during fi eldwork for screening patients with hepatosplenic schistosomiasis in rural areas 70 .…”

Section: Thrombocytopeniamentioning

confidence: 99%

Revisiting the concept of hepatosplenic schistosomiasis and its challenges using traditional and new tools

Lambertucci

2014

Rev. Soc. Bras. Med. Trop.

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“…Although these results contrast with those of Burchard et al (1998), who found no correlation between serum concentrations of HA (or type-III procollagen or laminin) in cases of schistosomiasis mansoni and the results of ultrasound scans, most of the cases investigated in this earlier study only had mild fibrosis. In other studies of Brazilian cases of schistosomiasis mansoni, the severity of PPF (as assessed with ultrasound) has been found to correlate with 'aspartate aminotransferase to platelet ratio indexes' (APRI; Lambertucci et al, 2007) and with serum concentrations of immunoglobulin G (Correia et al, 2009).…”

Section: Discussionmentioning

confidence: 87%

Schistosomiasis mansoni: ultrasound-evaluated hepatic fibrosis and serum concentrations of hyaluronic acid

Silva

Domingues

Lopes

et al. 2011

Annals of Tropical Medicine & Parasitology

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Schistosomiasis mansoni is a fibrogenic liver disease that constitutes a major health problem in north-eastern Brazil. Although one common manifestation of the disease, periportal fibrosis (PPF), can be assessed by ultrasonography by well-trained physicians, the necessary equipment and personnel are not always readily available. Serum markers, including hyaluronic acid (HA), have been used as alternative means of measuring fibrosis. Recently serum concentrations of HA have been evaluated in 77 Brazilians (61 cases of schistosomiasis mansoni and 16 healthy controls) and compared against the ultrasound-evaluated PPF in the same subjects. The HA was measured using a non-competitive fluorescence-based assay, while the PPF was explored using a portable ultrasound scanner (SSD-500; Aloka, Tokyo) and graded, as patterns A-F, according to the World Health Organization's 'Niamey protocol'. In general, the serum concentrations of HA were found to be positively correlated with the severity of the PPF. The mean concentration of HA in the sera of the 16 controls was significantly lower than that recorded in the schistosomiasis cases who showed PPF of patterns D or E (P,0.001 for each). The cases who showed pattern-C PPF also had significantly less HA in their sera than the cases with PPF of patterns D or E (P,0.001 for each), and the cases with pattern-D fibrosis had significantly lower HA concentrations in their sera than the cases with PPF of pattern E (P,0.001).In an analysis based on a receiver-operating-characteristic (ROC) curve, an HA concentration of 20.2 mg/litre of serum was identified as a threshold that could be used to distinguish moderate cases of PPF (i.e. patterns C or D) from the more advanced cases (i.e. patterns E or F), with a sensitivity of 60% and specificity of 65%.In conclusion, it appears that serum concentrations of hyaluronic acid could be used as markers for periportal fibrosis in patients with schistosomiasis mansoni.Although the human morbidity and mortality caused by schistosomiasis mansoni have been reduced over the last 25 years by chemotherapy, the disease still represents a significant health hazard, particularly in north-eastern Brazil (Katz and Peixoto, 2000;Araú jo et al., 2007).It is believed that between 2% and 7% of humans infected with Schistosoma mansoni go on to develop hepato-splenic disease, which is associated with portal hypertension and digestive bleeding brought on by the rupture of oesophageal varices or hypertensive

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“…Recentemente, em pacientes com EM, foi descrita correlação entre a fibrose periportal e a contagem de plaquetas, assim como com o índice APRI, que utiliza o nível sérico de AST dividido pelo número de plaquetas, para avaliação da fibrose (12) .…”

Section: Discussionunclassified

Níveis séricos de globulinas e a intensidade da fibrose hepática em pacientes com esquistossomose mansônica

Correia¹,

Domingues²,

Lopes³

et al. 2009

Arq. Gastroenterol.

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RESUMO -Contexto -Tem sido descrita correlação entre os níveis séricos de globulinas e o grau de fibrose hepática nas hepatites crônicas, mas não se encontram relatos na esquistossomose mansônica. Objetivo -Avaliar os níveis séricos de globulinas e de IgG, e a intensidade da fibrose periportal mensurada pela ultrassonografia em pacientes com esquistossomose mansônica. INTRODUÇÃONa esquistossomose mansônica (EM), em sua forma hepatoesplênica (EHE), a hipertensão portal ocorre tanto em função da fibrose periportal (Symmers) como pelo hiperfluxo proveniente da veia esplênica em consequência da grande esplenomegalia (13,17,25) . Descreve-se correlação entre a intensidade da fibrose periportal e os níveis de pressão na veia porta (18) .A biopsia hepática, a ultrassonografia (US) e, mais recentemente, marcadores biológicos e a elastografia transhepática (FibroScan ® ) vêm sendo utilizados para mensurar a fibrose que se desenvolve nas doenças crônicas do fígado (8,15,20,22) . Na EM, a biopsia hepática em cunha, realizada a céu aberto, é o método mais acurado para a mensuração da fibrose periportal, mas implica na realização de laparotomia. Já a biopsia por agulha nem sempre representa o verdadeiro quadro histopatológico, visto que a fibrose, apesar de ser difusa, varia de intensidade no parênquima hepático (6) .A US, através da identificação do aumento do lobo hepático esquerdo e redução do direito, do espessamento periportal, além da comprovação da grande esplenomegalia, constitui importante ferramenta na propedêutica da EM (4,7,19) . Em 1990, convenção da OMS realizada no Cairo classificou em três graus a fibrose periportal na EM, e outra convenção em 1996, em Niamey, propôs nova classificação baseada em seis padrões de A a F, que auxiliam na avaliação da morbidade (27,28) . As duas classificações apresentam grande precisão, mas requerem equipamentos sofisticados e examinadores qualificados, inferindo a necessidade de que métodos mais simples sejam implementados.Sabe-se que as células hepáticas estreladas, também chamadas células de Ito, são as principais mediadoras da fibrose hepática e quando ativadas, se transformam em células proliferativas e contráteis, constituindo a essência da resposta fibrótica à agressão hepática (3,9) . Estas células são ativadas pelo fator de necrose tumoral alfa (TNF-α), pelo fator de crescimento derivado das

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Aspartate aminotransferase to platelet ratio index and blood platelet count are good markers for fibrosis evaluation in schistosomiasis mansoni

Cited by 18 publications

References 4 publications

Revisiting the concept of hepatosplenic schistosomiasis and its challenges using traditional and new tools

Revisiting the concept of hepatosplenic schistosomiasis and its challenges using traditional and new tools

Schistosomiasis mansoni: ultrasound-evaluated hepatic fibrosis and serum concentrations of hyaluronic acid

Níveis séricos de globulinas e a intensidade da fibrose hepática em pacientes com esquistossomose mansônica

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