Ultrasound and intestinal lesions in Schistosoma mansoni infection: A case-control pilot study outside endemic areas

Abstract

BackgroundInfection with Schistosoma mansoni is a major cause of morbidity and mortality in endemic areas, and is increasingly diagnosed in migrants and travellers outside transmission areas. Markers for the assessment of morbidity and impact of control programs in endemic areas and for the clinical management of patients in the clinical setting are scant, especially for intestinal involvement. Ultrasonography is well established to evaluate hepatosplenic pathology; on the contrary, ultrasound evaluation of intestinal schistosomiasis is virtually unexplored. In this pilot study, we aimed to describe and evaluate the accuracy of unenhanced intestinal ultrasound for morbidity due to intestinal S. mansoni infection.Methodology/Principal findingsWe performed a blind case-control study of unenhanced intestinal ultrasound on 107 adults accessing the outpatient clinic of our Centre for Tropical Diseases between January-July 2018 as part of a screening for tropical diseases in migrants and travellers returning from endemic areas. Other clinical and laboratory data were obtained routine examination reports. We could not find any overtly pathological thickness of the gut wall in the sigma, proximal ascending colon, and terminal ileum, in patients with S. mansoni infection (n = 17), S. haematobium infection (n = 7), positive anti-Schistosoma serology (n = 31), and uninfected individuals (n = 52), with no difference among groups as assessed by ANOVA. No polyps or other intestinal abnormalities were visualized. There was no significant change in gut wall thickness one month after treatment with praziquantel in patients with S. mansoni infection (n = 11).Conclusions/SignificanceOur preliminary results suggest that intestinal ultrasound might not be a sensitive tool for detecting minor intestinal morbidity due to schistosomiasis. Further studies in a hospital setting comparing colonoscopy and ultrasonography may be envisaged; in endemic areas, further studies are needed to describe and assess the usefulness of intestinal ultrasound in patients stratified by infection intensity and compared with markers such as calprotectin and fecal occult blood.

Evaluation of microscopy, serology, circulating anodic antigen (CAA), and eosinophil counts for the follow-up of migrants with chronic schistosomiasis: a prospective cohort study

“…This is a prospective cohort study aimed to evaluate the trend over time in laboratory parameters, namely microscopy, serology, eosinophil counts, and UCP-LF CAA, for the post-treatment follow-up of chronic schistosomiasis diagnosed either by the detection of eggs or with serology. Patients included in this study are part of a larger cohort involved in a case–control and longitudinal study (“master study”) aimed to evaluate the accuracy of ultrasound for intestinal morbidity due to S. mansoni infection [ 41 ] and for long-term follow-up of bladder lesions in urinary schistosomiasis (ongoing). The master study involves a convenience sample of variably symptomatic individuals from Schistosoma -endemic areas accessing the dedicated outpatient clinic at the Department of Infectious-Tropical Diseases and Microbiology (DITM) of the IRCCS Sacro Cuore Don Calabria hospital between January and December 2018.…”

O retrato epidemiológico das internações por esquistossomose no Brasil, entre 2017 e 2021

“…Nos últimos anos, o tema vem se tornando cada vez mais relevante e a comunidade científica internacional vem se esforçando para controlar a infecção por meio da administração do praziquantel, derivado pirazino-isoquinoleínico, do grupo dos tioxantônicos, que oferece larga margem de segurança e consequentemente redução da morbidade dessa patologia. Entretanto, os marcadores pré e pós intervenção são escassos, impedindo uma avaliação precisa desse tipo de medida (Tamarozzi et al, 2018).…”