Characteristic Sonographic Pattern of Schistosomal Hepatic Fibrosis

Mf, Abdel-Wahab; Esmat, G.; Milad, M; Abd-Elrazek, Sherif; Gt, Strickland

doi:10.4269/ajtmh.1989.40.72

Cited by 87 publications

(12 citation statements)

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“…However, it should be noted that ultrasonography may not have the same sensitivity as histology in assessment of milder degrees of peri‐portal fibrosis and so far ultrasonography has only been directly compared with histology in studies of advanced Symmers’ fibrosis in humans (Homeida et al . 1988a,b; Abdel‐Wahab et al . 1989).…”

Section: Discussionmentioning

confidence: 99%

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Detailed clinical and ultrasound examination of children and adolescents in a Schistosoma mansoni endemic area in Kenya: hepatosplenic disease in the absence of portal fibrosis

Vennervald

Kenty

Butterworth

et al. 2004

Tropical Med Int Health

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SummaryHepatosplenic schistosomiasis involving organomegaly, portal fibrosis and portal hypertension has been observed in autopsy studies. Here, we have tested the hypothesis that hepatosplenic disease including organomegaly and markers of increased portal pressure can occur in school aged children in the absence of fibrosis. A case-only study of 96 children aged 7-20 years defined by ultrasound detectable hepatomegaly was undertaken in Makueni district, Kenya. A novel method of clinical examination that involved a consensus scoring by three or four examiners was used to classify children as presenting with severe or moderate hepatosplenic disease after palpation of livers and spleens. Ultrasound examination of livers and spleens was based on the Niamey protocol. Clinical measurements included spleen enlargement along the mid-clavicular and mid-axillary lines, liver enlargement along the mid-sternal (MSL) and mid-clavicular lines, as well as organ consistency. The clinical examination indicated that 9% and 60% of the children had severe or moderate hepatosplenomegaly, respectively. Amongst eggpositive children, all clinical measurements, except MSL liver enlargement, correlated with egg count, as did portal vein diameter, spleen length and liver length measured by ultrasound. Peri-portal fibrosis was not observed in any child, whereas 28% of the children were classified as having increased portal pressure according to World Health Organization criteria. There was no effect of malaria parasitaemia or hepatitis seropositvity on any of the observed parameters. These results indicate that hepatosplenic disease in school-aged children attributable to S. mansoni infection, involving hepatosplenomegaly and increased portal vein diameter, can occur in the absence of peri-portal fibrosis.

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Section: Discussionmentioning

confidence: 99%

“…At this stage the liver is often normal or diminished in size (Fataar et al . 1984; Abdel‐Wahab et al . 1989).…”

Section: Introductionmentioning

confidence: 99%

Detailed clinical and ultrasound examination of children and adolescents in a Schistosoma mansoni endemic area in Kenya: hepatosplenic disease in the absence of portal fibrosis

Vennervald

Kenty

Butterworth

et al. 2004

Tropical Med Int Health

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“…Two studies have confirmed the relationship between ultrasound findings and liver biopsy in advanced schistosomiasis mansoni (Homeida et al . 1988a; Abdel‐Wahab et al . 1989).…”

Section: Discussionmentioning

confidence: 99%

“…Using ultrasound examination, advanced degrees of S. mansoni ‐related liver fibrosis are easily distinguished from normal liver architecture (Homeida et al . 1988b; Abdel‐Wahab et al . 1989; Doehring‐Schwerdtfeger et al .…”

Section: Introductionmentioning

confidence: 99%

Measuring morbidity in schistosomiasis mansoni: relationship between image pattern, portal vein diameter and portal branch thickness in large‐scale surveys using new WHO coding guidelines for ultrasound in schistosomiasis

King

Magak

Salam

et al. 2003

Tropical Med Int Health

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Summaryobjective World Health Organization consensus meetings on 'Ultrasound in Schistosomiasis' in 1996 and 1997 anticipated further challenges in the global implementation of a standardized protocol for morbidity assessment in schistosomiasis mansoni. We evaluated the performance of the qualitative and quantitative components of the new Niamey criteria.method Use of the Niamey protocol among 3954 subjects in two linked, cross-sectional ultrasound surveys of Schistosoma mansoni-endemic populations in Egypt and Kenya.results There were significant differences between Egyptian and Kenyan sites in prevalence and age distribution of S. mansoni-related hepatic fibrosis (36% vs. 3%, P < 0.001). Protocol image pattern scoring could be performed quickly and was stable to interobserver variation. However, there were unintended but systematic differences between study sites in the measurement of portal vein diameter (PVD) and wall thickness. By Niamey criteria, a high prevalence of portal dilation was scored for normal Egyptian subjects, which reduced the predictive value of image pattern for portal hypertension. Using alternative height-indexing of PVD, image pattern plus PVD findings predicted 15% of Egyptians and 2.5% of Kenyans were at risk for variceal bleeding, whereas locally derived PVD norms estimated 25% of Egyptians and 12% of Kenyans to be at possible risk.conclusion Niamey scoring criteria performed acceptably as a relative grading system for disease in schistosomiasis mansoni, but failed to account fully for site-to-site variation in test performance and morbidity prevalence. Consequently, standardized image pattern scoring appears to provide the most useful tool for detection and comparison of S. mansoni-associated morbidity in large-scale surveys.keywords Schistosoma mansoni, schistosomiasis, portal vein, Egypt, Kenya, risk factors, diagnostic imaging/ultrasonography, mass screening/ standards, predictive value of tests correspondence Dr

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“…In brief, liver size, peripheral portal branches (PPBs), the degree of PPF, the thickness of the PPB wall, spleen size and splenic vein diameter (SVD) were assessed. Livers and spleens were measured as described previously (Abdel‐Wahab et al , 1989; Homeida et al , 1996). The portal vein diameter (PVD) was measured at its entrance to the porta hepatis at the lower end of the caudate lobe in subjects who had fasted ∼8–10 h. The thickness of secondary PPB was observed for all subjects with FI–FIII grade of fibrosis.…”

Section: Methodsmentioning

confidence: 99%

Factors controlling the effect of praziquantel on liver fibrosis inSchistosoma mansoni-infected patients

Rahoud¹,

Mergani²,

Khamis³

et al. 2010

FEMS Immunology &Amp; Medical Microbiology

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An association study of a cohort of 177 Sudanese patients infected with Schistosoma mansoni [82 (46%) males and 95 (54%) females] was conducted to evaluate the factors controlling the regression of liver fibrosis 39 months after treatment with praziquantel using ultrasound evaluation. Periportal fibrosis (PPF) was regressed in 63 (35.6%) patients, while the disease progressed to higher grades in 24 (13.6%) patients. The grade of PPF did not change in 90 (50.8%) patients. The mean values of portal vein diameter, splenic vein diameter and index liver size in subjects in whom PPF regressed after treatment were significantly lower than in subjects in whom the disease was progressed (P<0.0001, P=0.031 and P=0.003, respectively). The progression of hepatic fibrosis in males (15, 8.5%) was greater than that in females (9, 5.1%). Patients with regression or progression phenotypes tend to cluster in certain families. Our study indicated that regression, progression and stabilization of PPF after praziquantel therapy is controlled by gender, age, grade of fibrosis and possibly inherited factors.

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Characteristic Sonographic Pattern of Schistosomal Hepatic Fibrosis

Cited by 87 publications

References 0 publications

Detailed clinical and ultrasound examination of children and adolescents in a Schistosoma mansoni endemic area in Kenya: hepatosplenic disease in the absence of portal fibrosis

Detailed clinical and ultrasound examination of children and adolescents in a Schistosoma mansoni endemic area in Kenya: hepatosplenic disease in the absence of portal fibrosis

Measuring morbidity in schistosomiasis mansoni: relationship between image pattern, portal vein diameter and portal branch thickness in large‐scale surveys using new WHO coding guidelines for ultrasound in schistosomiasis

Factors controlling the effect of praziquantel on liver fibrosis inSchistosoma mansoni-infected patients

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