Revisiting the concept of hepatosplenic schistosomiasis and its challenges using traditional and new tools

Abstract

Different aspects of hepatosplenic schistosomiasis are revisited here. Manson's schistosomiasis causes periportal fi brosis and portal hypertension in approximately 6% of infected subjects, usually with preservation of their hepatic function. The assessment of liver involvement is of major importance in determining the prognosis and risk of complications from schistosomiasis, such as upper digestive bleeding secondary to variceal rupture. For many years, the diagnosis of hepatosplenic schistosomiasis and liver fi brosis was made by abdominal palpation and the fi nding of liver and/or spleen enlargement. However, there is no consensus regarding the clinical parameters of the liver and spleen to be considered in this physical evaluation. For the last three decades, abdominal ultrasound (US) has become the best imaging technique to evaluate liver fi brosis caused by schistosomiasis mansoni. However, US is a subjective procedure and is therefore examiner-dependent. Magnetic resonance imaging (MRI) fi ndings have provided valuable information in addition to ultrasound and clinical examination. The combination of a comprehensive history and physical examination, basic laboratory tests (a stool examination for Schistosoma mansoni eggs and a blood cell count), biomarkers for liver fi brosis/portal hypertension and imaging methods seem to offer the best approach for evaluating patients with this disease. In situations where research is involved or in patients with severe disease, MRI may be considered.

Morbidity Associated with Schistosomiasis Before and After Treatment in Young Children in Rusinga Island, Western Kenya

“…The major tool for assessing S. mansoni infection-associated morbidity in older patients is ultrasound [22][23][24][25][26][27][28] using the WHOrecommended Niamey scoring system. 29,30 It includes assessment of expected morbidities such as splenomegaly and left lobe hepatomegaly, as well as successively more pronounced liver ultrasound changes scored as image patterns (IP) A (normal), B ("starry sky," abnormal linear opacities of unclear significance), and C through F (progressive hepatic fibrosis).…”

Thrombocytopenia as a marker of liver steatosis in a low-endemic area for schistosomiasis mansoni

“…It has a total area of 418 km 2 , with a population density of 19 people/km 2 and human development index (HDI) of 0.783.…”

“…Pathologically dense bands of fibrosis around the portal tract are typical of Schistosoma mansoni. 2 Schistosomal periportal fibrosis is usually assessed using imaging methods, and abdominal ultrasonography (US) has become the imaging technique of choice. 3 However, the identification of other non-invasive, inexpensive, and simple routine laboratory tests for use as surrogate markers is of interest.…”

Scientific progress versus ecological influence on Schistosoma mansoni transmission

“…Medicina Tropical / Journal of the Brazilian Society of Tropical Medicine, we are delighted by the broad review and personal experience of Professor José Roberto Lambertucci regarding hepatosplenic schistosomiasis 1 . He is one of the leading clinical experts in schistosomiasis and among those responsible for the high quality of research that has helped explain several clinical aspects of the disease.…”