Chronic Hepatic Schistosomiasis Research Articles

Treatment of Upper Gastrointestinal Bleeding by Percutaneous Transsplenic Varices Embolization in Chronic Hepatic Schistosomiasis Japonicum Patients.

To evaluate percutaneous transsplenic varices embolization (PTSVE) in the treatment of upper gastrointestinal bleeding (UGIB) in patients with chronic hepatic schistosomiasis japonicum (CHS), 29 CHS patients (20 males and 9 females) complicated with UGIB were selected as the investigation subjects. The patients were treated by PTSVE under the guidance of X-ray fluoroscopy. The success rate of PTSVE and the rate of complications were observed. In addition, the degrees of varices before and after PTSVE were evaluated by abdominal computed tomography (CT). Results showed that 26 CHS patients (89.6%) were successfully treated with PTSVE. Three cases (10.3%) failed, and two experienced intraperitoneal bleeding within 1 week after PTSVE. The abdominal CT showed a significant decrease of the varices stage in coronary (P < 0.001), esophageal (P = 0.006), and paraesophageal (P = 0.013) varices, but slightly increased perisplenic varices within 1 month of the intervention (P = 0.014). PTSVE may be a safe and effective procedure for the treatment of UGIB in CHS patients, particularly suitable for those with a widened hepatic fissure and exposed hepatic portal vein trunk and an enlarged spleen.

Paeoniflorin in experimental BALB/c mansoniasis: A novel anti-angiogenic therapy

Chronic hepatic schistosomiasis causes portal hypertension, fibrosis and lethal hepatosplenic complications. Previous studies focused mainly on schistosomicidal drugs and neglected the therapeutic approaches against the vascular complications after portal hypertension. Investigating a novel anti-angiogenic therapy is an urgent. The current study is to evaluate the performance of Paeoniflorin (PAE) as an anti-angiogenic therapy, being a powerful anti-fibrotic, compared to artemether (ART) and praziqantel (PZQ) in schistosomiasis mansoni BALB/c mice. Thirty two laboratory bred male BALB/c Swiss albino mice. The mice were classified into four groups (8 mice each), control infected (CI), PZQ (300 mg/kg/12 h), ART (0.1 ml/mg/d) and PAE (50 mg/kg/d) treated groups for one month. All mice groups were sacrificed 15 weeks post infection for assessment of the drugs' efficacy by parasitological, histopathological and immunohistochemical studies. Our results in PAE group showed marked reduction in the mean egg count/gram stool, worm burden, egg count/gram liver tissue, granuloma diameter and pro-angiogenic factors as vascular endothelial growth factor (VEGF), Proliferating cell nuclear antigen (PCNA), alpha-smooth muscle actin (α-SMA) and CD34; conversely, there was an augmentation of the tissue inhibitor metalloproteinases-2 (TIMP-2) as an anti-angiogenic expression that was exceeded ART and PZQ treated groups compared to CI group (p˂0.001). Conclusively, PAE has an anti-angiogenic impact with no vascular proliferative activity or recanalization, no micro-vessel density (MVD) changes, granuloma resolution and fibrosis regression. PAE is predicted to be a potential therapy for chronic hepatic diseases associated with fibrosis and angiogenesis, hopeful in protecting from advanced serious complications; cancer and metastasis.

Magnetic Resonance Spectroscopy for Evaluating Portal-Systemic Encephalopathy in Patients with Chronic Hepatic Schistosomiasis Japonicum

Portal-systemic encephalopathy (PSE) is classified as type B hepatic encephalopathy. Portal-systemic shunting rather than liver dysfunction is the main cause of PSE in chronic hepatic schistosomiasis japonicum (HSJ) patients. Owing to lack of detectable evidence of intrinsic liver disease, chronic HSJ patients with PSE are frequently clinically undetected or misdiagnosed, especially chronic HSJ patients with covert PSE (subclinical encephalopathy). In this study, we investigated whether magnetic resonance spectroscopy (MRS) could be a useful tool for diagnosing PSE in chronic HSJ patients. Magnetic resonance (MR) T1-weighted imaging, diffusion-weighted imaging, and MRS were performed in 41 chronic HSJ patients with suspected PSE and in 21 age-matched controls. The T1 signal intensity index (T1SI) and apparent diffusion coefficient (ADC) value were obtained in the Globus pallidus. Liver function was also investigated via serum ammonia and liver function tests. Higher T1SI and ADC values, increased lactate and glutamine levels, and decreased myo-inositol were found in the bilateral Globus pallidus in chronic HSJ patients with PSE. No significantly abnormal serum ammonia or liver function tests were observed in chronic HSJ patients with PSE. On the basis of these findings, we propose a diagnostic procedure for PSE in chronic HSJ patients. This study reveals that MRS can be useful for diagnosing PSE in chronic HSJ patients.

Incidence of insulin resistance and diabetes in patients with portosystemic shunts without liver dysfunction.

ObjectiveTo investigate the incidence of insulin resistance (IR) and diabetes in patients with chronic hepatic schistosomiasis japonica (HSJ) and portosystemic shunts (PSS).MethodsPre- and post-contrasted computed tomography images obtained from patients with HSJ and control subjects were reviewed by two radiologists who identified and graded any shunting vessels. Anthropometric measurements, hepatic enzymes, lipid profile, blood levels of albumin, glucose, insulin and homeostasis model assessment (HOMA-2) index of all participants were also assessed.ResultsFifty-two patients with HSJ and 30 control subjects were involved in the study. The coronary, short gastric and perisplenic veins were the most common shunting vessels. There were no significant differences between patients and controls in terms of body mass index or liver function. The degree of shunting vessels, blood glucose, oral glucose tolerance test120/0, insulin, HOMA-2 index, glycosylated haemoglobin, cholesterol, high- and low-density lipoprotein, and C-reactive protein were significantly higher in the patients with IR. A positive correlation was found between the degree of the shunting vessels and the HOMA-2 index.ConclusionsPatients with chronic HSJ and PSS without liver dysfunction had a high incidence of IR and diabetes. The study showed that PSS and IR are related and therefore patients with PSS should be screened for IR and vice versa.

Profiling lifetime episodes of upper gastrointestinal bleeding among patients from rural Sub-Saharan Africa where schistosoma mansoni is endemic.

IntroductionSevere chronic hepatic schistosomiasis is a common cause of episodes upper gastrointestinal bleeding (UGIB) in sub-Saharan Africa (SSA). However, there is paucity of data on clinical epidemiology of episodes of UGIB from rural Africa despite on going public health interventions to control and eliminate schistosomiasis.MethodsThrough a cross sectional study we profiled lifetime episodes of upper gastrointestinal bleeding and associated factors at a rural primary health facility in sub-Saharan Africa were schistosomiasis is endemic. The main outcome was number of lifetime episodes of UGIB analyzed as count data.ResultsFrom 107 enrolled participants, 323 lifetime episodes of UGIB were reported. Fifty-seven percent experienced ≥ 2 lifetime episodes of UGIB. Ninety-four percent had severe chronic hepatic schistosomiasis and 80% esophageal varices. Alcohol use and viral hepatitis was infrequent. Eighty-eight percent were previously treated with praziquantel and 70% had a history of blood transfusion. No patient had ever had an endoscopy or treatment for prevention of recurrent variceal bleeding. Multivariable analysis identified a cluster of eight clinical factor variables (age ≥ 40, female sex, history of blood transfusion, abdominal collaterals, esophageal varices, pattern x periportal fibrosis, anemia, and thrombocytopenia) significantly associated (P-value < 0.05) with increased probability of experiencing two or more lifetime episodes of UGIB in our study.ConclusionUpper gastrointestinal bleeding is a common health problem in this part of rural SSA where schistosomiasis is endemic. The clinical profile described is unique and is important for improved case management, and for future research.

Schistosomiasis, an Unusual Cause of Variceal Bleeding in the United States

In Brief We present the case of a 38-year-old man from Africa who presented to our hospital with melena. After workup, he was found to have noncirrhotic portal hypertension from schistosomiasis. He required multiple banding procedures to control variceal bleeding. Worldwide, this disease is epidemic in Africa, Asia, and South America; but in the United States, only a few cases are seen in tertiary centers, mainly in immigrants from these nations. This case illustrates that complications of chronic hepatic schistosomiasis are treatable, and clinicians should have a broad differential when providing care to patients from outside the United States. This case report highlights that schistosomiasis is a rare cause of variceal bleeding and non-cirrhotic portal hypertension in the United States. Physicians should consider this disease as part of the differential for gastrointestinal bleeding, especially in immigrants from areas where this disease is highly prevalent.

Evidence of intra-hepatic vascular proliferation remodeling early after cure in experimental schistosomiasis mansoni: An immunohistochemical descriptive study

Experimental studies have demonstrated the occurrence of angiogenesis, blood vessels formation from pre-existing vessels, in the initial phase of bilharzial granuloma formation and during fibrosis progression in chronic hepatic schistosomiasis. Paradoxically, a recent work demonstrated an occurrence of angiogenesis during fibrosis regression months after curative treatment. Studies regarding the in situ kinetics of blood vessels in the phase of granuloma resolution and liver tissue healing early after treatment are lacking. The current work compared the kinetics of blood vessels by immunohistochemical staining using CD34, vascular endothelial growth factor (VEGF) and actin in the livers of normal control mice, Schistosoma mansoni infected mice and mice 2weeks after curative treatment. The present study demonstrated a process of angiogenesis remodeling in the liver in the curative phase of hepatic schistosomiasis during the stage of granuloma resolution. Such finding raises the evidence of the importance and potential beneficial effect of vascular proliferation in the process of healing and restoration of liver tissue functions. Thus, blocking of angiogenesis may not represent the appropriate therapeutic target for the early treatment of schistosomal liver fibrosis.

Repeated infections with Schistosoma mansoni and liver fibrosis in undernourished mice

The mouse model of schistosomal periportal fibrosis (Symmers’ “pipestem” fibrosis), that develops in 30–50% of the infected animals, is not reproduced in undernourished mice. Host nutritional status is likely to be a variable that may influence the outcome and progression of infection, since it interferes with the dynamics of connective tissue changes occurring in chronic hepatic schistosomiasis. Re-infections increase the occurrence of periportal liver fibrosis in well-nourished animals, but it is not known how undernourished mice would behave being repeatedly re-infected. So, 21-day-old male albino Swiss mice were individually exposed to 30 cercariae (percutaneous route) of the BH strain of Schistosoma mansoni, 4 weeks after being on a low-protein diet. Control animals were fed on a commercial balanced chow for mice. The nutritional status was evaluated by body weight gain and measurement of food intake. Mice were divided into four groups: A1 (undernourished, single infected), A2 (well-nourished, single infected), B1 (undernourished, re-infected), B2 (well-nourished, re-infected). The primary infection was performed 4 weeks after ingesting the respective diet. Re-infections started 45 days later, with exposure to 15 cercariae, at 15 day intervals. Mice were sacrificed 18 weeks after the primary exposure. The livers were submitted to morphological (gross and microscopic pathology), morphometric (percentage of fibrosis; granuloma size; volume and numerical densities) by using semi-automatic morphometry, and biochemical (quantification of collagen as hydroxyproline) studies. Worm burdens and hepatic egg counting were also recorded. Values for body weight gains were always lower in undernourished mice, the effects of re-infection being minimal on this regard. Liver and spleen weights were higher in well-nourished mice (either single infected or re-infected) and mainly related to the type of ingested diet. A greater number of re-infected well-nourished mice developed periportal fibrosis, but undernourished re-infected animals did not reproduce this lesion. The percentage of fibrosis and hepatic collagen content were higher in well-nourished mice, but differences between single infected and re-infected groups were not statistically significant.

Hepatobiliary and pancreatic: Commentary

Journal of Gastroenterology and HepatologyVolume 17, Issue 10 p. 1129-1129 Free Access Hepatobiliary and pancreatic: Commentary First published: 22 September 2009 https://doi.org/10.1046/j.1440-1746.2002.t01-1-02866.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat INTERPRETATION OFFIGURE 1(SEE PAGE 1118) On the ultrasound study, the liver parenchyma shows hyperechoic bands of variable thickness (→, Fig. 1). The band near the posterior surface is very thick. These findings are typical of Schistosomiasis japonica and represent fibrosed portal tracts.1, 2 The liver biopsy showed portal inflammation and fibrosis with deposited ova (Fig. 2). Figure 2Open in figure viewerPowerPoint Liver biopsy. Ova are partially calcified. Diagnosis: chronic hepatic schistosomiasis japonica The hepatic effects of Schistosoma japonicum and S. mansoni differ both pathologically and radiologically. Schistosoma japonicum lays approximately 20 times as many ova as S. mansoni. These ova are laid in large aggregates and evoke an inflammatory response with portal fibrosis. However, lobular architecture is maintained and liver function tests are usually normal. The ultrasound pattern of portal fibrosis may be linear bands as in this case, but another common appearance is a network pattern variously described as ‘fish-scale’, crisscross or mosaic. This appearance is illustrated in Figure 3 (different case) and is because of branching fibrotic septa. Fibrosis is often more prominent near the liver capsule. Rarely, patients with advanced S. japonica have calcified fibrosis on a plain abdominal radiograph.3 In S. mansoni, portal fibrosis is more localized and may have a ‘pipestem’ appearance on cross-section. This ‘pipestem’ fibrosis is very uncommon in S. japonicum. Figure 3Open in figure viewerPowerPoint Another case of Schistosomiasis japonica showing crisscrossing bands. References 1 Okuda K. Hepatic schistosomiasis. In: Okuda K, Mitchell D, Itai Y, Ariyama J, eds. Hepatobiliary Diseases—Pathophysiology and Imaging. Oxford: Blackwell Science, 2001; 560– 9. Web of Science®Google Scholar 2 Cheung H, Lay YM, Loke TKL et al. The imaging diagnosis of hepatic schistosomiasis japonicum sequelae. Clin. Radiol. 1996; 51: 51– 5.CrossrefCASPubMedWeb of Science®Google Scholar 3 Okuda K, Jinnouchi S, Arakawa M et al. Generalized calcification of the liver in advanced schistosomiasis japonica: a case report. Acta Hepatol. Gastroenterol. 1975; 22: 98– 102. CASPubMedWeb of Science®Google Scholar Volume17, Issue10October 2002Pages 1129-1129 FiguresReferencesRelatedInformation

Septa in the liver of patients with chronic hepatic schistosomiasis japonica: MR appearance.

Chronic hepatic schistosomiasis japonica is a disorder characterized by broad fibrous septa in the liver. The ability to recognize these septa on MR images might enable distinction of this lesion from other cirrhotic disorders. The purpose of this study was to analyze the MR appearance of these septa. MR images of 18 patients who had typical calcifications of hepatic septa on CT scans were reviewed. The diagnosis was proved by biopsy in six patients. In the remaining 12, stool examinations were positive for schistosomiasis. T1-weighted MR images and T2-weighted and intermediate (long repetition time and short echo time) MR images acquired with the use of gradient-moment nulling were obtained in all 18 patients. In eight of 18 patients, additional T2-weighted and intermediate images were obtained without gradient-moment nulling. Fifteen patients had contrast-enhanced T1-weighted images. The presence of abnormal MR signal and its intensity at sites corresponding to the septa seen on CT scans were studied. MR images showed the septa as linear abnormalities frequently seen in the subdiaphragmatic portion of the right lobe of the liver. On T1-weighted images, septa had low signal intensity and were identified in nine of 18 patients. On T2-weighted images obtained with gradient-moment nulling, septa had high signal intensity and were seen in 13 of 18 patients. On T2-weighted images obtained without gradient-moment nulling, the septa had primarily low signal intensity and were seen in five of eight patients. On intermediate MR images obtained with gradient-moment nulling, the septa had primarily high signal intensity and were seen in nine of 18 patients. On intermediate images obtained without gradient-moment nulling, the septa had primarily low signal intensity and were seen in four of eight patients. In nine of 15 patients, septa were visualized as high-signal-intensity lesions on contrast-enhanced T1-weighted images. In 14 of 18 patients, the septa were detected in one or more sequences. Our experience suggests that MR imaging in patients with chronic schistosomiasis of the liver depicts the morphologic features of hepatic septa. MR signal characteristics of septa are not unique, but use of gradient-moment nulling alters the signal intensity of septa, similar to that of blood vessels, on intermediate and T2-weighted images.

Serum laminin in hepatic schistosomiasis

Serum laminin levels were measured in patients with chronic hepatic schistosomiasis. A significant increase in the mean serum laminin level was observed in 14 patients with hepatosplenic schistosomiasis (2·57 ± 0·83 units/ml [standard deviation]) compared to the level in 10 patients with the hepatointestinal form of the disease (1·38 ± 0·45 units/ml) and in the control group of 10 (1·15 ± 0·31 units/ml). In the hepatosplenic patients there was a significant direct relation between serum laminin and percutaneous splenic pulp pressure ( r = 0·68). However, this relation was not observed with either liver function tests or levels of N-terminal propeptides of type III procollagen. These findings are compatible with an increased production of laminin in hepatosplenic schistosomiasis, which may be related to the observed enlarged liver and spleen basement membranes in such disease.

Radioimmunoassay of serum conjugated cholic acid in hepatic murine schistosomiasis

Cholylglycine levels were measured by radioimmunoassay in sera from 10 control CFI female mice and 22 CFI female mice experimentally infected with Schistosoma mansoni. Cholylglycine was significantly elevated in sera of all but one of the chronically infected animals. Serum aspartate transaminase was within normal limits in all the infected animals; while five infected mice had elevated serum alkaline phosphatase and all these five also had high levels of serum Cholylglycine. Marked hepatic histopathological changes were demonstrated in all the infected animals. The data suggest that serum Cholylglycine is a highly sensitive index for hepatic dysfunction in chronic hepatic schistosomiasis mansoni.