Hepatic Schistosomiasis Research Articles

Bleeding esophageal varices associated with hepatic schistosomiasis in Egypt

Bleeding esophageal varices associated with hepatic schistosomiasis in Egypt

Schistosomiasis japonica of the liver: contrast-enhanced CT findings in 113 patients.

The purpose of this study was to determine the findings on contrast-enhanced CT scans in patients with hepatic schistosomiasis japonica and to determine their pathologic basis. Unenhanced and contrast-enhanced CT scans of 113 patients with histologically proved schistosomiasis were reviewed. Radiologic and pathologic findings were correlated after autopsy in 19 patients. Unenhanced CT scans showed septal calcification in the liver parenchyma in 53 patients (47%) and capsular calcification along the hepatic surface in 29 patients (26%). Twenty-seven patients (24%) had both types of calcification. Fifty-four patients (48%) showed one or more types of enhancement. Septal enhancement (i.e., linear enhancement of hepatic parenchyma looking like septa in the liver) was seen in 52 patients (46%). Forty-seven of the 53 patients who had septal calcification on unenhanced CT scans had septal enhancement on scans obtained after the administration of contrast material. The enhancement was found at sites of septal calcification in 44 patients and at noncalcified sites in 18 (15 had enhancement at both calcified and noncalcified sites). Five of 60 patients who did not have septal calcification on unenhanced CT scans had septal enhancement at noncalcified sites on scans obtained after the administration of contrast material. Amorphous enhancement (i.e., poorly defined and irregularly shaped enhancement) was seen in six patients (5%). Capsular enhancement (i.e., curvilinear enhancement along the hepatic surface) was seen in 12 patients (11%). Histologic studies showed broad fibrous septa at sites of septal enhancement. CT findings in patients with schistosomiasis japonica involving the liver include septal, amorphous, and capsular contrast enhancement. Septal enhancement occurs in broad fibrous septa. CT evidence of septal enhancement may suggest the diagnosis of hepatic schistosomiasis japonica, especially when no calcification is seen on unenhanced CT scans.

Grading of hepatic schistosomiasis by the use of ultrasonography.

Forty-three subjects with pure hepatic schistosomiasis having ultrasonographic assessment of periportal fibrosis were grouped according to the thickness of their portal tracts: grade I = 3-5 mm, grade II = greater than 5-7 mm, and grade III = greater than 7 mm. A history of hematemesis, blood transfusion, sclerotherapy, and lower limb edema correlated with the ultrasonographic grade of periportal fibrosis. With increasing grade, the average liver size was smaller and the average spleen size was larger, as determined by physical examination and by ultrasonography. Abnormalities in serum enzyme levels were more frequent in those with thicker portal tracts. Greater diameters of the portal and splenic veins and ultrasonographically detectable collateral blood vessels were associated with increasing thickness of portal tracts. The grade of endoscopically determined esophageal varices was highly correlated with the grade of periportal fibrosis. We concluded that this method of grading accurately reflects the hemodynamic changes and provides a good estimate of the clinical status of patients who have periportal fibrosis due to schistosomiasis mansoni. Where available, it should replace clinical grading based upon the liver and spleen size as detected by physical examination.

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.

Morphological features of collagen degradation in advanced hepatic schistosomiasis of man.

Optical and electron microscopical evidences of focal matrix degradation were frequently seen in liver sections taken from patients with periportal ("pipe-stem") fibrosis caused by schistosomiasis mansoni. Besides the presence of focal areas of rarefaction, fragmentation and dispersion of collagen fibers, the enlarged portal spaces also showed hyperplasia of elastic tissue and disarray of smooth muscle fibers following the destruction of portal vein branches. Ultrastructural changes represented by focal lytic and/or electron dense alterations of collagen fibrils were similar to those first seen in experimental material and designated as "chronic collagen degradation". Elastin and related microfibrils were also affected by focal condensation, fragmentation, distortion and dissolution. Schistosome eggs were scanty in the tissue sections examined. Matrix degradation represented involuting changes related to the progressive diminution of parasite aggression, which occurs spontaneously with age or after cure by chemotherapy. Changes of focal matrix degradation now being described represent the basic morphological counterpart of periportal fibrosis involution documented clinically, especially by ultrasonography, in patients with hepatosplenic schistosomiasis submitted to curative chemotherapy.

Hyperplasia of elastic tissue in hepatic schistosomal fibrosis

Elastic tissue hyperplasia, revealed by means of histological, immunocytochemical and ultra-structural methods, appeared as a prominent change in surgical liver biopsies taken from 61 patients with schistosomal periportal and septal fibrosis. Such hyperplasia was absent in experimental murine schistosomiasis, including mice with "pipe-stem" fibrosis. Displaced connective tissue cells in periportal areas, such as smooth muscle cells, more frequently observed in human material, could be the site of excessive elastin synthesis, and could explain the differences observed in human and experimental materials. Elastic tissue, sometimes represented by its microfibrillar components, also appeared to be more condensed in areas of matrix (collagen) degradation, suggesting a participation of this tissue in the remodelling of the extracellular matrix. By its rectratile properties elastic tissue hyperplasia in hepatic schistosomiasis can cause vascular narrowing and thus play a role in the pathogenesis of portal hypertension.

The Use of Reduction of Splenomegaly as a Parameter for Therapeutic Response in Hepatic Schistosomiasis

DOI: http://dx.doi.org/10.5915/23-2-15068 The effectiveness of praziquantel in the treatment of hepatic schistosomiasis was studied in 30 patients with bilharzial splenomegaly. Reduction in splenomegaly was used as a parameter of therapeutic success. Twenty one out of 30 patients improved when treated by repeated doses of praziquantel. The number of administered doses necessary to achieve clinical improvement was directly related to the pretreatment size of the spleen. The patients were divided into three groups according to the size of the spleen; up to 5 cm below the costal margin in the mid-clavicular line (Group 1), between 5-10 cm in Group 2, and more than 10 cm in Group 3. The rate of improvement was 100% in Group I, 75% in Group 2, and 25% in Group 3.

Hyperdynamic circulation in a chronic murine schistosomiasis model of portal hypertension

Chronic murine schistosomiasis is a natural disease model of portal hypertension closely mimicking the clinical and histological features of human hepatic schistosomiasis. We studied the splanchnic and systemic hemodynamics in the murine model of schistosomiasis by radioactive microsphere technique. Mice infected with 60 cercariae of Schistosoma mansoni (n = 8) were studied hemodynamically 11 wk after the infection and were compared with age-matched healthy controls (n = 11). Mean portal venous inflow in the infected mice (3.82 +/- 0.32 ml/min) was 61% higher than in the healthy animals (2.37 +/- 0.25 ml/min; p less than 0.01). A twofold increase in hepatic arterial flow was also seen in mice with schistosomiasis (0.47 +/- 0.14 ml/min) as compared with controls (0.16 +/- 0.03 ml/min; p less than 0.05), whereas splanchnic arteriolar resistance (60.91 +/- 7.64 vs. 101.21 +/- 11.06 mm Hg.min.ml-1.gm; p less than 0.05) and peripheral vascular resistance (112.05 +/- 14.05 vs 254.53 +/- 29.86 mm Hg.min.ml-1.gm; p less than 0.01) were reduced. There was a significant increase in cardiac index (752 +/- 99 vs. 453 +/- 55 ml.min-1.kg body weight-1; p less than 0.05) and reduction in mean arterial pressure (81.37 +/- 3.09 vs. 101.45 +/- 5.85 mm Hg; p less than 0.05) in the infected animals compared with controls. These observations clearly demonstrate the existence of a hyperdynamic circulatory state in this model of portal hypertension.

Hyperdynamic circulation in a chronic murine schistosomiasis model of portal hypertension

Chronic murine schistosomiasis is a natural disease model of portal hypertension closely mimicking the clinical and histological features of human hepatic schistosomiasis. We studied the splanchnic and systemic hemodynamics in the murine model of schistosomiasis by radioactive microsphere technique. Mice infected with 60 cercariae of Schistosoma mansoni (n = 8) were studied hemodynamically 11 wk after the infection and were compared with age-matched healthy controls (n = 11). Mean portal venous inflow in the infected mice (3.82 ± 0.32 ml/min) was 61% higher than in the healthy animals (2.37 ± 0.25 ml/min; p < 0.01). A twofold increase in hepatic arterial flow was also seen in mice with schistosomiasis (0.47 ± 0.14 ml/min) as compared with controls (0.16 ± 0.03 ml/min; p < 0.05), whereas splanchnic arteriolar resistance (60.91 ± 7.64 vs. 101.21 ± 11.06 mm Hg · min · ml−1. gm; p < 0.05) and peripheral vascular resistance (112.05 ± 14.05 vs 254.53 ± 29.86 mm Hg · min ml−1 · gm; p < 0.01) were reduced. There was a significant increase in cardiac index (752 ± 99 vs. 453 ± 55 ml · min−1 · kg body weight−1; p < 0.05) and reduction in mean arterial pressure (81.37 ± 3.09 vs. 101.45 ± 5.85 mm Hg; p < 0.05) in the infected animals compared with controls. These observations clearly demonstrate the existence of a hyperdynamic circulatory state in this model of portal hypertension. (HEPATOLOGY 1991;13:581–584.)

Effect of praziquantel on the distribution of interstitial collagen types I and III and basement membrane collagen types IV and V in murine hepatic schistosomiasis

The effect of specific chemotherapy (praziquantel) on liver function tests and on the distribution of collagen types I, III, IV and V was studied by indirect immunofluorescence in Swiss albino mice infected with Schistosoma mansoni. Treatment was started at 7 and 12 weeks after infection. Groups of treated and non-treated mice were killed 14 and 20 weeks after infection. Reduction in the amount of collagen and improvement of liver function were observed, especially when treatment was initiated early (7 weeks after infection), while collagen type III almost disappeared during the period of observation (13 weeks after treatment). The results indicate the importance of early specific treatment for schistosomiasis.

Selective shunt in schistosomiasis in Egypt

A joint study of the selective shunt in schistosomiasis was conducted in Egypt by the Mansoura University and Emory liver research teams. One hundred seventy patients with biopsy-proven hepatic schistosomiasis and a history of variceal bleeding were included in the study. The findings indicate that this procedure is safe and effective in the treatment of this patient population.

Bioquímica da esquistossomose mansônica: envolvimento dos siderossomos nos processos inflamatórios hepáticos

The inflammatory processes that develop during the advanced stages of hepatic schistosomiasis mansoni have been related in this study to: (a) accumulation of siderosomes; (b) capacity of the ferrous/ferric ions to unleash the formation of free radicals; (c) peroxidation of membrane lipids and; (d) reduction of stability of the membranes of several components of the hepatic lysosomal compartment. The lysosomes isolated from the livers of infected mice by 100 cercariae, with 80 and 100 days of infection, were respectively 2.5 and almost 4 times weaker than the control ones isolated from livers of non-infected mice. The presence of a great quantity of siderosomes has been demonstrated by transmission electronic microscopy and X-ray spectrometry microanalysis.

Laparoscopic Appearance of the Liver in Schistosoma mansoni Infection

In an area endemic for Schistosoma mansoni infection laparoscopy was performed in 45 patients with liver disease. Hepatic schistosomiasis was diagnosed by histology in 20 cases. The only complication encountered was unusual bleeding from the biopsy site in one patient. Liver lobe size was variable. Mild uniform irregularity of the liver surface was seen in most of the patients. Other changes noted were macronodularity, lumpy surface, tiny white tubercles, white patchy discoloration, and thick and thin adhesions. Characteristic features of the liver surface in Schistosoma mansoni infection as seen on laparoscopy are thus described.

Endometrial Cancer and Hepatic Schistosomiasis

Chronic liver disease when associated with impaired breakdown of sex steroids may result in hyperestrogenism, which, if unopposed by progesterone, represents a corpus carcinoma risk indicator. Liver schistosomiasis is endemic in third world countries, including Egypt, and is associated with hepatic dysfunction. We have evaluated the possible influence of liver schistosomiasis on the development of corpus carcinoma in 109 Egyptian women with and without hepatic involvement by schistosomiasis. A strong association between schistosomiasis and corpus carcinoma was found. The relative risk of developing carcinoma in patients with liver schistosomiasis was 8.5 and was independent of other known endometrial carcinoma risk factors. Hepatic schistosomiasis represents a significant risk indicator of corpus carcinoma and may contribute to its high prevalence in Egypt. Periodic outpatient endometrial evaluation in patients with liver schistosomiasis may be useful to detect early endometrial carcinoma or its precursor, intraepithelial neoplasia (atypical hyperplasia). (J GYNECOL SURG 5:285, 1989)

Liver involvement in human schistosomiasis mansoni. Assessment by immunological and biochemical markers.

In 20 patients with hepatic or hepatosplenic schistosomiasis and 82 individuals infected with S. mansoni, but without liver enlargement, serum parameters reflecting the fibrotic process and hemodynamic alterations as well as immunomodulation were examined. Included as controls were 35 age- and sex-matched healthy individuals from the study region in Northeast Brazil. Peripheral blood cholylglycine levels in patients with hepatomegaly, reflecting the spillover of portal blood into the systemic circulation, were elevated 12-fold over values of patients without liver involvement. Procollagen-III-peptide, a cleavage product of collagen synthesis, was elevated in patients with hepatomegaly (P less than 0.001) but normal in uncomplicated cases. Immunomodulation was assessed by in vivo delayed hypersensitivity to recall antigens and by serum beta 2-microglobulin and neopterin, substances released in the context of lymphocyte activation. Neopterin, predominantly a macrophage product, was elevated most strikingly in hepatomegalic cases (P less than 0.001). The possible interrelation between altered immune responses and excess fibrogenesis is discussed.

Biochemistry of schistosomiasis mansoni. IV. Changes in the hepatic lysosome compartment in relation to the time of infection

O Schistosoma mansoni e/ou seus ovos causam uma hepatopatia muito importante e com aspectos anátomo-clínicos bem característicos. Uma vez carregados pela corrente circulatória, os vermes podem ocluir ramos dicotômicos de maior calibre do sistema portal e, quando mortos produzem lesões às vezes extensas, primeiro necróticas, depois inflamatórias e, posteriormente cicatriciais, sempre circunscritas e não sistematizadas. Os ovos, além de penetrarem no's ramúsculos não dicotômicos da rede periductal, alcançam os ramos de distribuição ou até mesmo as vênulas aferentes, ocluin- do muitas delas e, como conseqüência, formam os granulomas intravasculares que podem levar a uma interrupção da corrente sangüínea portal a esse nível e alterações da circulação intralobular. A diminuição da taxa de oxigênio disponível e conseqüentemente o decréscimo do pH intra e extracelular são potentes labilizadores das membranas dos diversos componentes do compartimento lisossômico. A saída de hidrolases ácidas, proteínas catiônicas e hidrolases neutras, a partir desses orgãnulos, acarreta agressões tissulares muito importantes, com o desencadeamento e/ou manutenção dos processos inflamatórios típicos desta parasitose. Neste trabalho estudou-se as atividades lisossômicas ligadas às diversas fases da esquistossomose mansônica hepática. Os resultados indicaram que a integridade funcional dos complexos membranosos do compartimento lisossômico foi significativamente alterada, já a partir do segundo mês da infecção e que parece haver um estreito relacionamento entre o agravamento das lesões inflamatórias hepáticas com uma maior labilidade lisossômica.

Hepatic schistosomiasis japonica identified by CT.

We reviewed the CT examinations of 17 patients who had hepatic schistosomiasis japonica and noted peculiar hepatic calcifications in 15 cases and a notch on the hepatic surface in six. A hepatocellular carcinoma was found in six patients. The calcifications and notch appeared to indicate the degree of hepatic fibrosis but did not correlate with cirrhotic deformation.

Serum and liver enzymes of collagen synthesis in hepatic murine schistosomiasis mansoni

Serum galactosylhydroxylysyl glucosyltransferase (S-GGT), liver galactosylhydroxylysyl glucosyltransferase (L-GGT), liver hydroxylysyl galactosyltransferase (L-GGal-T) and liver prolyl hydroxylase (L-PH) activities were measured in CF1 female mice each week for 10 weeks after infection with Schistosoma mansoni (50 cercariae per mouse). None of the enzyme activities measured were significantly increased in the first six weeks following the infection. However, the activities increased thereafter reaching a maximum of seven-fold for S-GGT, five-fold for L-GGT, three-fold for L-GGal-T and ten-fold for L-PH compared with control animals. The increase in S-GGT activity was positively correlated with L-GGT (r = 0·788), L-GGal-T (r = 0·774) and L-PH (r = 0·800). The present data suggest that during the first six weeks of the development of murine hepatic schistosomiasis mansoni infection, few eggs bombard the liver. The biochemical changes during this period are mild. During weeks 7 to 10, which is the active fibrotic stage, the liver biochemical markers of collagen synthesis increase rapidly and lead to fibrotic morphological features that are the chronic irreversible hepatic changes characteristic of this infection. The data reported here indicate that the aggressive fibrotic changes in liver during weeks 7 to 10 of murine schistosomiasis infection are predicted by S-GGT activity.

Clinical recognition of mild hepatic schistosomiasis in an endemic area

From this comparison of 37 black children with hepatic schistosomiasis (HS) and 53 with intestinal Schistosoma mansoni (IS) living in an endemic area, we propose easily identifiable clinical features of mild HS. These patients were generally well nourished school-age children who seldom complained of dysentery but who had a firm hepatomegaly with predominant enlargement of the left lobe and a firm splenomegaly. They were also mildly anaemic (9·4 ± 2·2 g/dl) and had low serum albumin (30 ± 7 g/l), raised aspartate transaminase (36 ± 31 u/l) and high globulins (53 ± 15 g/l). The implications of the absence of severe hepatosplenic schistosomiasis in many of these children are discussed.

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.