Abstract
ObjectiveTo use ultrasound to investigate the morbidity related to schistosomiasis in the Xakriabá indigenous population.Materials and MethodsThis was a field-based census study conducted in the territory of the Xakriabá people. A total of 166 individuals were invited, and 148 (≤ 77 years of age) agreed to participate. Most participants underwent abdominal ultrasound, physical examination, and stool examination. Mann-Whitney U and chi-square tests were used for comparisons. We determined risk by calculating odds ratio (OR) and performed logistic regression analysis.ResultsSchistosoma mansoni eggs were found in 31 (26.7%) of the 116 stool samples examined, 22 (70.9%) of the 31 being from individuals 4-16 years of age. The median count was 144 eggs/g of feces (interquartile range, 264). Of the 105 participants examined with ultrasound, 68 (64.8%) had hepatomegaly (left lobe), 6 (5.7%) had splenomegaly, and 4 (3.8%) had portal hypertension. Egg-positive stool samples were more common in those with an enlarged left lobe (OR = 3.4; 95% confidence interval (CI): 1.1-11.2; p = 0.043). Periportal fibrosis was found in 30 participants (28.6%), of whom 9 (30%) had pattern C, 10 (33.3%) had pattern D, and 11 (36.7%) had pattern Dc. Age was the only independent risk factor for fibrosis (p = 0.007). Fibrosis was up to nine-fold more common in alcohol drinkers than in nondrinkers (OR = 9.28; 95% CI: 2.60-33.06; p < 0.001). Among the 138 participants in whom the clinical form was classified, the chronic hepatic form was identified in 54 (39.1%), of whom 32 (59.2%) were under 30 years of age and one (1.8%) was hepatosplenic.ConclusionSchistosomiasis in the Xakriabá population is characterized by a high frequency of egg-positive stool samples, predominantly in children/adolescents, and by chronic hepatic form in the young, especially among alcohol drinkers.
Highlights
The territory of the Xakriabá people is the largest demarcated indigenous area in the state of Minas Gerais, Brazil, where conditions are favorable for the transmission of schistosomiasis, because the vector is present and there is poor sanitation[1]
Pattern B is characterized by diffuse echogenic foci; pattern C shows echogenic rings corresponding to the pipe-stem fibrosis seen in a perpendicular scan; and patterns D and E are characterized by progressive echogenic thickening and patches extending around the portal bifurcation and the main stem
There were no statistical associations between positivity for Schistosoma eggs and the clinical findings
Summary
The territory of the Xakriabá people is the largest demarcated indigenous area in the state of Minas Gerais, Brazil, where conditions are favorable for the transmission of schistosomiasis, because the vector is present and there is poor sanitation[1]. Abdominal ultrasound is noninvasive, practical and safe It is considered the best imaging technique to detect changes suggestive of chronic schistosomiasis in the field[5]. It is a dynamic and examiner-dependent method[6]. If some degree of periportal thickening is observed, the image is compared with standard imaging patterns of liver parenchyma. Pattern B is characterized by diffuse echogenic foci; pattern C shows echogenic rings corresponding to the pipe-stem fibrosis seen in a perpendicular scan; and patterns D and E are characterized by progressive echogenic thickening and patches extending around the portal bifurcation and the main stem. It should be borne in mind that the intensity of fibrosis on ultrasound may not correlate with disease severity[8]
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