Rate of reversion of hepatosplenic schistosomiasis after specific therapy

Abstract

Seventy patients with hepatosplenic schistosomiasis were treated with oxamniquine. The patients lived iti an endemic area and were evaluated 6, 18 and 24 months after treatment, during which time transmission in the area was interrupted. After treatment, clinical improvement occurred in 49 (70%) of the patients, as seen by reduction in visceromegaly and reversion of liver nodules. Reversion of hepatosplenic disease occurred in 28 (40%) patients and in liver nodularity in 26 (47.3%)patients after 24 months. Reversion of hepatosplenic disease was seen in 12 (21%) patients and liver nodules disappeared in 4 (8.5%) as early as 6 months after treatment. In general, hepatosplenomegaly reverses earlier than liver nodularity. Itis notable that reversion of hepatosplenic disease occurred in many individuals with a history ofprevious treatment and also in some with advanced age. In four cases this clinical form of the disease had existed for 20 years. Therefore, there must exist factors other than age and duration of the condition which determine the reversibility of this clinical form. Ourresults reinforce the concept that, in patients with hepatosplenic disease without esophageal hemorrhages, specific treatment shouldpreceed surgical intervention even in those with a history of previous treatment. At least 18 months should be allowed for the ejfects of treatment to be manifest.

Comparative clinical and ultrasound study of egg-negative and egg-positive individuals from Schistosoma mansoni low morbidity endemic areas, and hospitalized patients with hepatosplenic disease

“…Whether mild periportal fibrosis is reinstalled when an individual is reinfected is still to be evaluated. It is also important to evaluate whether in patients with hepatosplenomegaly, the ultrasound confirms the same decrease in morbidity evidenced by clinical examination 6 .…”

Angiogenesis and schistosomiasis

“…Data from human and experimental studies have revealed that in such situations hepatic fibrosis regresses, accompanied by a reduction in the spleen size, a drop in portal pressure and a reduction of oesophageal varices (Bina & Prata 1983, Dietze & Prata 1986, Homeida et al 1988, Mohamed-Ali et al 1991, Richter 2003. In that way, it may be assumed that not only has hepatic fibrosis been degraded and reduced, but that a considerable degree of intra-hepatic vascular remodelling has also occurred.…”

Remodeling of hepatic vascular changes after specific chemotherapy of schistosomal periportal fibrosis

“…Clinical (Bina & Prata 1983, Dietze & Prata 1986, Homeida et al 1988, Mohamed-Ali et al 1991) and pathological (Andrade et al 1992) observations revealed that a proportion of patients with hepatosplenomegaly and portal hypertension due to Schistosoma mansoni infection, the so-called hepatosplenic schistosomiasis, could revert to normal, months or years after specific treatment. An instance of spontaneous regression of hepatosplenic schistosomiasis has even been observed in an isolated endemic area from the state of Minas Gerais, Brazil, probably due to the self-extinction of parasitism (Katz & Brener 1966).…”