Schistosomiasis japonicum diagnosed on liver biopsy in a patient with hepatitis B co-infection: a case report

Abstract

IntroductionChronic hepatitis B virus and schistosomiasis are independently associated with significant mortality and morbidity worldwide. Despite much geographic overlap between these conditions and no reason why co-infection should not exist, we present what is, to the best of our knowledge, the first published report of a proven histological diagnosis of hepatic Schistosomiasis japonicum and chronic hepatitis B co-infection. A single case of hepatitis B and hepatic Schistosomiasis mansoni diagnosed by liver biopsy has previously been reported in the literature.Case presentationA 38-year-old Chinese man with known chronic hepatitis B virus infection presented with malaise, nausea and headache. Blood tests revealed increased transaminases and serology in keeping with hepatitis B virus e-antigen seroconversion. A liver biopsy was performed because some investigations, particularly transient elastography, suggested cirrhosis. Two schistosome ova were seen on liver histology, identified as S. japonicum, probably acquired in China as a youth. His peripheral eosinophil count was normal, schistosomal serology and stool microscopy for ova, cysts and parasites were negative.ConclusionHepatic schistosomiasis co-infection should be considered in patients with hepatitis B virus infection who are from countries endemic for schistosomiasis. Screening for schistosomiasis using a peripheral eosinophil count, schistosomal serology and stool microscopy may be negative despite infection, therefore presumptive treatment could be considered. Transient elastography should not be used to assess liver fibrosis during acute flares of viral hepatitis because readings are falsely elevated. The impact of hepatic schistosomiasis on the sensitivity and specificity of transient elastography measurement for the assessment of hepatitis B is as yet unknown.

Liver ultrasound elastography for the evaluation of periportal fibrosis in schistosomiasis mansoni: A cross-sectional study

“…Nevertheless, there are only few studies evaluating elastography in schistosomotic patients, and schistosomiasis mansoni monoinfection has not been evaluated by pSWE so far. Accordingly, in studies evaluating coinfected patients with PPF and chronic hepatitis B [29] or C [25,26,30], the liver stiffness measurement using pSWE could be overestimated. Moreover, patients with schistosomiasis mansoni are usually excluded from elastography analyzes to assess the severity of liver fibrosis in patients with viral hepatitis [31,32].…”

Poliovirus and other enteroviruses in children infected with intestinal parasites in Nigeria

“…Studies have been conducted on HIV/HBV and parasites such as Taenia crassiceps [32], Strongyloides stercoralis [33], Cryptosporidium spp. [34], and Schistosoma japonicum [10]. The major cause of susceptibility has been attributed to impairment of cell-mediated immunity often initiated by the viral agent [9,32].…”

“…There have been several reports on intestinal parasites and viral co-infections with more emphasis on human immunodeficiency virus (HIV) and, to a lesser extent, hepatitis viruses (HBV and HCV) [8][9][10]. Although there have been no published reports on the co-infection patterns in poliovirus and intestinal parasites, the overlap in their geographical distributions is a strong indication of their possible coexistence.…”

Role of liver biopsy in management of liver diseases without hepatic nodules following end of the interferon era: experience of a tertiary referral center

“…The need of LB for recognition of hepatic schistosomiasis was reported in 4.72% of current study cases. Schistosomal non-cirrhotic portal hypertension was the most prevalent diagnostic need for LB with the characteristic hepatic granuloma [29]. Thanks to the governmental efforts, the prevalence of hepatic schistosomiasis had been dramatically ameliorated in Egypt [30].…”