Hepatosplenic alterations determined by ultrasonography in a population recently infected with Schistosoma mansoni in Richard-Toll, Senegal

Abstract

Three years after intestinal schistosomiasis had been reported for the first time in the delta of the Senegal River Basin, an ultrasonographic study was conducted on 358 subjects of the community of Richard-Toll with a proven Schistosoma mansoni infection and compared with the findings from 352 uninfected subjects of a nearby town. Periportal thickening was found in 119 subjects (33%) in only one of whom it was greater than 10 mm; liver parenchyma lesions were found in 40 subjects (11%), at about the same rate in all age groups. No correlation was found between hepatomegaly and schistosomiasis. Frequency of thickening of the omentum was significantly higher in Richard-Toll than in the control group. 11% of the Richard-Toll subjects had portal vein diameters significantly larger than the values in the control group; of those, 6% had no periportal fibrosis sign in the liver. Significantly more splenomegaly was found in the infected group, though malaria as an aetiological agent cannot be ruled out. Based on periportal alterations and parenchyma lesions only, 141 (39%) subjects in the Richard-Toll group had alterations, corresponding to the World Health Organization proposed criteria for stage I; one subject had alterations corresponding to stage II. As S. mansoni infection is still new in this area, the patho-anatomical pattern is likely to change significantly in the future.

Clinical investigation of a population recently infected with Schistosoma mansoni (Richard‐Toll, Senegal)

“…In Richard-Toll, neither the ultrasound study (Rouquet et al 1993), nor the present study denionstrated hepatomegaly associated with schistosomiasis.…”

“…Treatment with praziquantel may be used to prevent hepatic complications as suggested by Andrade and Bina (1985). We found an important amount of periportal thickening ( 3 3 %) and parenchymal lesions ( I I %) in these subjects before treatment, only 3 years after the first case had been detected (Rouquet et al 1993). This could be due to an initial reversible inflammatory reaction rather than to chronic fibrosis (Gigase 1982).…”

“…During clinical examination in 1992, I year after treatment, 5/279 subjects ( 2 % ) had a palpable liver. Before treatment, 30% of the infected subjects had splenomegaly detected by ultrasound, compared to only 9% in the control group (Rouquet et al 1993). During clinical examination in 1992, I year after treatment, only 71279 patients (3%) were found to have a palpable spleen.…”

“…Four hundred and seventeen subjects ( 7 0 % ) responded to the invitation, of whom 358 had technically satisfactory ultrasound examinations performed (Rouquet et al 1993). A control group of 352 subjects was selected from Saint-Louis, a town free of schistosomiasis.…”

“…At that time, this dose was used to treat the thousands of patients who presented spontaneously at the clinic of the health centre because of the very limited amount of praziquantel available (Kongs et al 1993). …”