Comparison between clinical and ultrasonographic findings in cases of periportal fibrosis in an endemic area for schistosomiasis mansoni in Brazil

Abstract

INTRODUCTION: Abdominal palpation and ultrasound findings among patients from an endemic area for schistosomiasis in Brazil who had been followed up for 27 years were compared. METHODS: In 2004, 411 patients from Brejo do Espírito Santo, in the State of Bahia, were selected for the present investigation after giving their written informed consent. Based on clinical data, they were divided into three groups: 41 patients with evidence of liver fibrosis in 2004 (Group 1); 102 patients with evidence of liver fibrosis in the past (1976-1989) but not in 2004 (Group 2); and 268 patients without evidence of liver fibrosis at any time during the 27-year follow-up (Group 3). All of the patients underwent abdominal ultrasound in which the examiner did not know the result from the clinical examination. The data were stored in a database. RESULTS: The prevalence of periportal fibrosis on ultrasound was 82.9%, 56.9% and 13.4% in Groups 1, 2 and 3, respectively. In the presence of hard, nodular liver or prominent left lobe and a hard palpable spleen, ultrasound revealed periportal fibrosis in 70.9%. However, periportal fibrosis was diagnosed using ultrasound in 25.4% of the patients in the absence of clinical evidence of liver involvement. Thus, ultrasound diagnosed periportal fibrosis 3.1 times more frequently than clinical examination did. CONCLUSIONS: Although clinical examination is important in evaluating morbidity due to Manson's schistosomiasis in endemic areas, ultrasound is more accurate in diagnosing liver involvement and periportal fibrosis.

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

“…However, there is no consensus regarding the clinical parameters of the liver and spleen to be considered in this physical evaluation 10,14,15 .…”

Thrombocytopenia as a surrogate marker of hepatosplenic schistosomiasis in endemic areas for Schistosomiasis mansoni

“…Particular attention was given to the abdominal examination; specifi cally, the right hepatic lobe was examined along the anterior axillary line, and the left hepatic lobe was examined along a line passing through the xiphoid process. The spleen was palpated and measured under the left costal margin with the patient in the dorsal decubitus position during deep inspiration [13][14][15][16][17][18][19] .…”

Antigens of worms and eggs showed a differentiated detection of specific IgG according to the time of Schistosoma mansoni infection in mice

“…Schistosomiasis is the most important of the human helminthiases in terms of morbidity and mortality associated with subtle but persistent morbidities [1][2][3][4] . During schistosomiasis progression, schistosomes mature to adults in the hepatic circulation and then in pairs migrate to inhabit in the mesenteric veins, where they mate and lay a large number of eggs in the vessels of the intestinal wall 5 and other tissues, mainly in the liver.…”