Anicteric cholangiopathy in schistosomiasis patients

Brant, Paulo Eugênio; Kopke-Aguiar, Luciane; Shigueoka, David Carlos; Sales, Danilo Moulin; D'Ippólito, Giuseppe; Kouyoumdjian, Maria; Borges, Durval Rosa

doi:10.1016/j.actatropica.2008.06.001

Cited by 8 publications

(15 citation statements)

References 12 publications

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“…This supports the use of γ-GT as one of three biological markers proposed by Camacho-Lobato and Borges [9] to evaluate the progression of liver dysfunction in schistosomiasis, while Köpke-Aguiar et al [15] also found γ-GT to be a sensitive indicator along with the platelet count and INR to differentiate patients with or without portal hypertension. Moreover, elevated γ-GT along with ALP was also a feature in hepatosplenic patients with anicteric cholangiopathy, who have alterations in biliary ducts (ductopenia intermediary and small caliber branches) reflecting advanced fibrosis [16].…”

Section: Discussionmentioning

confidence: 96%

Hemostatic Dysfunction Is Increased in Patients with Hepatosplenic Schistosomiasis Mansoni and Advanced Periportal Fibrosis

et al. 2013

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BackgroundSchistosomiasis mansoni is an endemic parasitic disease and a public health problem in Northeast Brazil. In some patients, hepatic abnormalities lead to periportal fibrosis and result in the most severe clinical form, hepatosplenic schistosomiasis. This study aimed to evaluate whether abnormal blood coagulation and liver function tests in patients with hepatosplenic schistosomiasis (n = 55) correlate with the severity of their periportal fibrosis.Methodology/Principal FindingsBlood samples were used for liver function tests, hemogram and prothrombin time (International Normalized Ratio, INR). The blood coagulation factors (II, VII, VIII, IX and X), protein C and antithrombin IIa (ATIIa), plasminogen activator inhibitor 1 (PAI-1) and D-dimer were measured by photometry or enzyme linked immunosorbent assay. Hyperfibrinolysis was defined on the basis of PAI-1 levels and a D-dimer concentration greater than a standard cut-off of 483 ng/mL. Standard liver function tests were all abnormal in the patient group compared to healthy controls (n = 29), including raised serum transaminases (p<0.001) and lower levels of albumin (p = 0.0156). Platelet counts were 50% lower in patients, while for coagulation factors there was a 40% increase in the INR (p<0.001) and reduced levels of Factor VII and protein C in patients compared to the controls (both p<0.001). Additionally, patients with more advanced fibrosis (n = 38) had lower levels of protein C compared to those with only central fibrosis (p = 0.0124). The concentration of plasma PAI-1 in patients was one-third that of the control group (p<0.001), and D-dimer levels 2.2 times higher (p<0.001) with 13 of the 55 patients having levels above the cut-off.Conclusion/SignificanceThis study confirms that hemostatic abnormalities are associated with reduced liver function and increased liver fibrosis. Of note was the finding that a quarter of patients with hepatosplenic schistosomiasis and advanced periportal fibrosis have hyperfibrinolysis, as judged by excessive levels of D-dimer, which may predispose them to gastrointestinal bleeding.

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Section: Discussionmentioning

confidence: 96%

Hemostatic Dysfunction Is Increased in Patients with Hepatosplenic Schistosomiasis Mansoni and Advanced Periportal Fibrosis

et al. 2013

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“…Biliary involvement is secondary to intense periportal fibrosis with subsequent biliary obstruction, a paucity of second-and third-order biliary branches, and bile duct proliferation (47,48).…”

Section: Schistosomiasis-schistosoma Mansoni Andmentioning

confidence: 99%

“…Biliary findings tend to manifest at MR cholangiopancreatography before the detection of laboratory findings of cholestasis. The imaging findings include areas of focal narrowing, a paucity of second-and third-order biliary branches, and irregularities in the contours of biliary ducts (48).…”

Section: Schistosomiasis-schistosoma Mansoni Andmentioning

confidence: 99%

Biliary Infections: Spectrum of Imaging Findings and Management

Catalano¹,

Sahani²,

Forcione³

et al. 2009

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Infectious cholangitides encompass a wide spectrum of infectious processes affecting the biliary tree. They can have protean clinical and imaging appearances. Some manifest as an acute medical emergency with high mortality if not properly and emergently managed. Others are chronic processes that may predispose a patient to liver failure or cholangiocarcinoma. The clinical and imaging features and the subsequent therapy are dictated by the pathogens involved, the immune status of the host, and the degree and distribution of biliary obstruction. Bacteria cause most cases of infectious cholangitis in Western countries. In other parts of the world, parasites play an important role, either as causative agents or in predisposing the host to bacterial superinfection. Viral cholangitides primarily affect immunocompromised patients. The clinical and imaging features of cholangitis differ between immunocompetent and immunocompromised patients. Imaging plays a pivotal role in diagnosis of infectious cholangitis, helps identify predisposing causes, and demonstrates complications. Moreover, interventional radiology provides tools to treat acute life-threatening biliary infections, chronic entities, and complications.

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“…Histological abnormalities of the intrahepatic ducts were originally described in patients by Vianna et al4; almost all cases demonstrated periductal fibrosis with onion skinning. A schistosomiasis cholangiopathy with abnormal MRCP findings has also been described, and this infection should be included as a cause of ductopenia 5…”

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confidence: 99%

Small-duct sclerosing cholangitis associated with Schistosoma mansoni

McCrann

Boyer

2010

Hepatology

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A 17-year-old girl presented with a history of elevated alkaline phosphatase and gamma-glutamyl transpeptidase (cGT) levels for several years. She was asymptomatic and did not have jaundice, pruritus, abdominal pain, nausea, vomiting, weight loss, rashes, or diarrhea. Viral hepatitis serologies, autoimmune serologies, and thyroid studies were all normal.She had a past medical history of anxiety, which was treated with Celexa. Otherwise, she was healthy and had no major childhood illnesses or history of substance abuse. She had traveled extensively with her family during her childhood, notably to Northern and Eastern Africa and Southeast Asia. Her physical examination was unremarkable. An abdominal ultrasound examination was performed, and the findings were normal. Magnetic resonance cholangiopancreatography (MRCP) showed mild beading of the intrahepatic ducts consistent with the diagnosis of primary sclerosing cholangitis involving the small ducts. The patient was started on ursodiol (300 mg three times per day), and her alkaline phosphatase and cGT levels promptly normalized.Subsequently, colonoscopy was performed to rule out concomitant inflammatory bowel disease. The mucosa appeared normal on endoscopic examination, but random biopsy samples were taken to rule out quiescent colitis. The pathology specimens revealed schistosoma eggs, and stool studies were positive for Schistosoma mansoni. Percutaneous liver biopsy was then performed to evaluate hepatic involvement. There were Fig. 1. Portal triad demonstrating an intravenular granuloma surrounding a schistosoma egg. Onion-skinning fibrosis impinging on small interlobular ducts can also be noted. The over all histological examination showed minimal portal fibrosis with focal areas of periportal extensions.

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Anicteric cholangiopathy in schistosomiasis patients

Cited by 8 publications

References 12 publications

Hemostatic Dysfunction Is Increased in Patients with Hepatosplenic Schistosomiasis Mansoni and Advanced Periportal Fibrosis

Hemostatic Dysfunction Is Increased in Patients with Hepatosplenic Schistosomiasis Mansoni and Advanced Periportal Fibrosis

Biliary Infections: Spectrum of Imaging Findings and Management

Small-duct sclerosing cholangitis associated with Schistosoma mansoni

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