Abstract:A esquistossomose mansoni é a única esquistossomíase existente nas Américas, sendo um dos maio res problemas de saúde pública para o Brasil. Existem, segundo estimativas, 200 milhões de esquistossomó-ticos no mundo e cerca de 12 milhões no Brasil14 29.Ao estudar o problema da esquistossomose no Brasil podemos considerar que, desde os seus primór dios, o ingresso e a expansão da doença foram devidos ao modelo econômico implantado; especialmente o modelo agrícola voltado para exportação, provendo o mundo de arti… Show more
“…After persistent infection and an evolving pathological process, hepatic enlargement is clinically recognized in the second or third decades 9,10 .…”
Section: Clinical Definition Of Hepatosplenicmentioning
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.
“…After persistent infection and an evolving pathological process, hepatic enlargement is clinically recognized in the second or third decades 9,10 .…”
Section: Clinical Definition Of Hepatosplenicmentioning
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.
“…The disease causes 200 thousand deaths in sub-Saharan Africa each year. In Brazil, 42 million individuals live in endemic areas and 6 million are infected with Schistosoma mansoni 1,2 . Renal involvement in schistosomiasis is an important cause of end-stage renal disease and increases the socioeconomic impact of schistosomiasis [3][4][5] .…”
Introduction:The current prevalence of glomerulonephritis in patients with hepatosplenic schistosomiasis mansoni in Brazil was evaluated. Methods: Sixty three patients (mean age 45.5±11 years) attending the outpatient infectious disease clinic of a University Hospital in Belo Horizonte, Brazil, from 2007 to 2009, were consecutively examined and enrolled in the present investigation. Diagnosis of hepatosplenic schistosomiasis was based on epidemiological, clinical and parasitological data and imaging techniques. Eight patients, who presented >30mg/day albuminuria, were submitted to percutaneous ultrasound guided renal biopsy. Kidney tissue fragments were examined under light, direct immunofluorescence and electron microscopy. Results: All patients showed mesangial enlargement. In five, mesangial hypercellularity was observed and four presented duplication of the glomerular basement membrane. Areas of glomerular sclerosis were diagnosed in four. Deposits of immunoglobulin M and C3 were present in six samples; deposits of IgG in four, IgA in three and C1q in two samples. In all patients, immunoglobulin A was reported in the lumen of renal tubules. Deposits of kappa and lambda were observed in six samples. Electron microscopy revealed dense deposits in the glomerular tissue of three patients. Arterial hypertension, small esophageal varices, slight increases in serum creatinine and decreases in serum albumin were associated with glomerular disease. Conclusions: Renal disease associated with hepatosplenic schistosomiasis was verified in 12.7% of patients and type I membranoproliferative glomerulonephritis was observed in 50% of them. Schistosomal glomerulopathy still is an important problem in patients with hepatosplenic schistosomiasis in Brazil.
“…It is estimated that between 200 and 300 million people are infected by S. mansoni worldwide 62 . In Brazil, it is estimated that between 10 and 12 million people have schistosomiasis mansoni 25 . Spread of the disease from rural to periurban regions has been recently described 3 .…”
SUMMARYNeuroschistosomiasis (NS) is the second most common form of presentation of infection by the trematode, Schistosoma mansoni. Granulomatous inflammatory reaction occurs as a result of schistosome eggs being transmitted to spinal cord or brain via the vascular system, or by inadvertent adult worm migration to these organs. The two main clinical syndromes are spinal cord neuroschistosomiasis (acute or subacute myelopathy) and localized cerebral or cerebellar neuroschistosomiasis (focal CNS impairment, seizures, increased intracranial pressure). Presumptive diagnosis of NS requires confirming the presence of S. mansoni infection by stool microscopy or rectal biopsy for trematode eggs, and serologic testing of blood and spinal fluid. The localized lesions are identified by signs and symptoms, and confirmed by imaging techniques (contrast myelography, CT and MRI). Algorithms are presented to allow a stepwise approach to diagnosis.
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