Schistosomiasis associated pulmonary hypertension

Abstract

Schistosomiasis is one of the most prevalent infectious diseases, endemic in more than 70 countries, mainly within the developing world. More than 200 million people might be infected worldwide; about 20 million of those might develop severe disease. The hepatosplenic form of schistosomiasis is the most prevalent form of chronic disease, characterised by the presence of periportal fibrosis and portal hypertension. Pulmonary hypertension is a well-recognised complication of hepatosplenic schistosomiasis. Recent prevalent studies revealed that schistosomiasis patients may develop precapillary and postcapillary forms of pulmonary hypertension, reinforcing the role of invasive haemodynamic measurements for the proper diagnosis. These studies also demonstrated that schistosomiasis associated pulmonary arterial hypertension may represent the most prevalent form of pulmonary arterial hypertension (PAH). Many aspects regarding the appropriate management of Sch-PAH patients still remain to be elucidated, as the use of specific PAH therapy. Although the ongoing control programmes that started within the 1980s have clearly improved the schistosomiasis cenario worldwide, Sch-PAH will be seen for decades after proper control is reached, strengthening the current need for comprehensive studies aiming to clarify the multiple mechanisms involved in the pathophysiology of this particular subgroup of PAH.

Schistosomiasis and pulmonary hypertension

“…PAH'lı hastalarda gerektiğinde diüretikler, antikoagü-lanlar ve oksijen gibi konvansiyonel tedaviler kullanılmaktadır. Bununla birlikte hepatosplenik şistoso-miyazisli hastaların çoğunda portal hipertansiyon vardır ve özefagus varis kanaması olasılığı nedeniyle antikoagülan kullanımı risklidir (21). Yüksek doz kalsiyum kanal blokerleri portal hipertansiyon varlı-ğında yan etkileri nedeniyle önerilmez (12).…”

Pulmonary Hypertension Associated to Schistosomiasis and Marfan Syndrome

“…However, hepatoesplenic form, commonly related to PH, wasn't confirmed by abdominal ultrasonography. It has been demonstated that the presence of hepatic changes is not necessary for occurrence of pulmonary involvement, since it follows multiple mechanisms, still in research: mechanical impaction (embolism) of the parasite eggs in pulmonary arteries; inflammatory process and vascular remodeling; high pulmonary blood output due to arteriovenous shunts in presence of portal hypertension [2,5].…”

“…The lung is a mandatory checkpoint in parasite's lifecycle, which leads to acute and chronic local damage. Hepatoesplenic form, most prevalent form of the chronic illness, characterized by periportal fibrosis and portal hypertension, causes PH as a well-known complication [2,5]. In fact, the real prevalence of the association between schistosomiasis and PH is not well defined due to lack of data, with great variability among the publications.…”

“…In fact, the real prevalence of the association between schistosomiasis and PH is not well defined due to lack of data, with great variability among the publications. Therefore, studies showed up to 7.6% prevalence of PH associated to hepatosplenic form, with 4.6% as PAH and 3% as postcapillary PH [2,3,5]. Other studies showed that schistosomal PH may be the most frequent cause of PH worldwide, responsible for up to 30% of all the cases [1][2][3]5].…”

“…Therefore, studies showed up to 7.6% prevalence of PH associated to hepatosplenic form, with 4.6% as PAH and 3% as postcapillary PH [2,3,5]. Other studies showed that schistosomal PH may be the most frequent cause of PH worldwide, responsible for up to 30% of all the cases [1][2][3]5]. Schistosomal PH is categorized at group 1-PAH.…”