Hepatosplenic Schistosomiasis Mansoni Research Articles

Sarcopenia, body composition and factors associated with variceal gastrointestinal bleeding and splenectomy in hepatosplenic schistosomiasis mansoni.

Sarcopenia is a common complication of cirrhosis and an important predictor of morbimortality. We aimed to determine the prevalence of sarcopenia and its associated factors in hepatosplenic schistosomiasis (HSS) as well as to evaluate whether muscle mass and function are associated with variceal upper gastrointestinal bleeding (VUGIB) and previous splenectomy in subjects without other liver diseases. We conducted a cross-sectional study including adults with HSS who underwent clinical, biochemical, anthropometric, muscle strength and physical performance evaluations and were submitted to bioelectrical impedance analysis and abdominal ultrasound. Sarcopenia was diagnosed according to the 2019 European consensus criteria. A total of 66 patients with HSS (62.1% male; mean age 48.8±8.6y) were included. Overall, six subjects (9.1%) were diagnosed with probable sarcopenia and none had confirmed sarcopenia. Fat-free body mass index (BMI) was independently associated with VUGIB (odds ratio 0.701 [95% confidence interval 0.51 to 0.96]; p=0.025). Compared with patients who did not undergo surgery, individuals who underwent esophagogastric devascularization combined with splenectomy (EGDS) had higher serum lipid levels, fat percentage and frequency of metabolic syndrome, with lower skeletal muscle mass index and hand grip strength. HSS mansoni seems not to cause sarcopenia. However, a lower fat-free BMI was associated with previous VUGIB and the subgroup of patients who underwent EGDS presented higher lipid levels, fat percentage and frequency of metabolic syndrome and lower muscle mass and function.

P-35 NONINVASIVE PREDICTORS OF ESOPHAGEAL VARICES IN PATIENTS WITH HEPATOSPLENIC SCHISTOSOMIASIS MANSONI: MULTICENTER STUDY

No previous study have evaluated transient elastography (TE) for predicting esophageal varices (EV) in hepatosplenic schistosomiasis (HSS). To investigate noninvasive methods of predicting EV in patients with HSS mansoni. Cross-sectional multicentric study included 51 patients with HSS. Patients underwent ultrasonography-dopplerfluxometry, upper endoscopy, complete blood cell count and TE (Fibroscan®) for liver and spleen stiffness measurement (LSM and SSM). Noninvasive scores previously established for cirrhotic population were studied: platelet count to spleen diameter ratio (PSR), LSM-spleen diameter to platelet ratio score (LSPS) and varices risk score (VRS). We proposed a version of LSPS and VRS by replacing LSM with SSM and named them SSPS and modified-VRS, respectively. EV was detected in 42 (82.4%) subjects. Individuals with EV presented higher SSM (73.5 vs 36.3 Kpa, p=0.001), splenic vein diameter (10.8 vs 8.0 mm, p=0.017), SSPS (18.7 vs 6.7, p=0.003) and modified-VRS (4.0 vs 1.4, p=0.013), besides lower PSR (332 vs 542, p=0.038), than those without EV. SSPS was independently associated with EV presence (OR=1.19, 95%CI 1.03-1.37, p=0.020) after multivariate analysis. In a model excluding noninvasive scores, SSM was independently associated with EV diagnosis (OR=1.09, 95%CI 1.03-1.16, p=0.004). AUROC was 0.856 (95%CI 0.752-0.961, p=0.001) for SSM and 0.816 (95%CI 0.699-0.932, p=0.003) for SSPS (p=0.551). Spleen-related variables were predictors of EV: SSM, splenic vein diameter, SSPS, modified-VRS and PSR. Multivariate models indicated that SSM and SSPS are useful tools for predicting EV in non-cirrhotic portal hypertension by HSS and may be used in clinical practice.

Liver stiffness is able to differentiate hepatosplenic Schistosomiasis mansoni from liver cirrhosis and spleen stiffness may be a predictor of variceal bleeding in hepatosplenic schistosomiasis.

Ultrasonography is limited for differentiating portal hypertension due to liver cirrhosis from that secondary to hepatosplenic schistosomiasis (HSS). We aimed to investigate the role of transient elastography (TE) in differentiating HSS mansoni from cirrhosis and the factors associated with liver and spleen stiffness (LS and SS) in HSS. A cross-sectional study was conducted including patients with HSS mansoni (n=29) and liver cirrhosis due to non-alcoholic steatohepatitis (n=23). All patients underwent TE and those with HSS were assessed by the Niamey protocol. HSS subjects presented lower median LS (9.6 vs 21.3 Kpa, p<0.001) and liver controlled attenuation parameter (229 vs 274 dB/m, p=0.010) than cirrhosis subjects, in addition to higher SS (73.5 vs 42.2 Kpa, p=0.002). The area under the receiver operating characteristic curve for detecting cirrhosis by LS was 0.947 (95% CI 0.89 to 1.00, p<0.001), with an optimal cut-off of 11.75 Kpa. In HSS subjects, higher SS was associated with the presence of the following: diabetes mellitus (p=0.036), metabolic syndrome (p=0.043), esophageal varices (p=0.001), portal vein thrombosis (p=0.047) and previous variceal bleeding (p=0.011). In HSS patients without portal vein thrombosis, variceal bleeding was associated with higher SS (p=0.018). Niamey categories were not associated with LS (p=0.676) or SS (p=0.504). TE can play a role in differentiating HSS from cirrhosis, especially by LS. SS may be further investigated for predicting complications in HSS.

EDTA-dependent pseudothrombocytopenia in patients with hepatosplenic schistosomiasis mansoni: a clinical management alert.

Hepatosplenic schistosomiasis mansoni (HS) is associated with thrombocytopenia. Accurate platelet counts are required for identification and management of HS patients. EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) is an in vitro phenomenon of anticoagulant-activated platelet agglutination resulting in low platelet counts by automated methods. The prevalence of EDTA-PCTP in schistosomiasis is unknown and only one case has been described. Our aims were to determine the prevalence of EDTA-PTCP in HS and evaluate alternative methods to overcome this analytical error. Blood samples from 56 HS patients and 56 healthy volunteers were collected, and platelet counts were obtained using standard microscopy and automated (electric impedance) methods. Automated platelet counts and the presence of platelet clumps in blood smears were evaluated in samples collected in EDTA or sodium citrate tubes 20 and 180 min after blood collection. EDTA-PTCP was more frequent in HS patients than healthy volunteers (8.92% vs 0.00%, p<0.0285). Platelet clumps and PTCP were also observed in samples collected in sodium citrate tubes, refuting its use as an alternative method. Automated platelet counts in blood samples from HS patients should be performed right after blood collection in EDTA tubes and verified by manual counts in blood smears.

Haemostatic changes in urogenital schistosomiasis haematobium: a case-control study in Gabonese schoolchildren.

In many tropical areas schistosomiasis is a major health problem causing hepatosplenic, intestinal or urogenital complaints. Hepatosplenic schistosomiasis mansoni is also characterized by blood coagulation abnormalities. Liver pathology plays a role in the development of haemostatic changes and the parasitic infection may directly affect coagulation. However, these contributing factors cannot be studied separately in hepatosplenic schistosomiasis infections. This pilot study provides insight in haemostatic changes in urinary schistosomiasis by studying coagulation parameters in schistosomiasis haematobium-infected Gabonese schoolchildren. Selection on urinary schistosomiasis patients without hepatosplenic complaints allows for the investigation of the direct effects of the parasite on haemostasis. Levels of von Willebrand Factor (VWF) antigen, active VWF and osteoprotegerin were elevated, indicating inflammation-mediated endothelial activation. In contrast to hepatosplenic schistosomiasis, thrombin-antithrombin complex and D-dimer levels were not affected. Despite its small sample size, this study clearly indicates that Schistosoma haematobium directly alters the activation status of the endothelium, without initiation of coagulation.

Retinal nerve fiber layer in hepatosplenic schistosomiasis mansoni patients: analysis using optical coherence tomography

Objetivo: Avaliar a espessura da camada de fibras nervosas da retina em portadores de esquistossomose mansonica na forma hepatoesplenica utilizando a tomografia de coerencia optica. Metodos: Realizou-se estudo observacional, analitico, de corte transversal. O grupo de doentes foi composto por 24 individuos (13 femininos e 11 masculinos), com idades variando entre 27 e 73 anos (55,7±11,6 anos). No grupo controle foram incluidos 22 individuos (12 femininos e 10 masculinos) com idades entre 31 e 77 anos (55,4±16,5 anos). Dos 92 olhos avaliados, tres foram excluidos por apresentarem opacidade de meios que impossibilitaram o exame. Todos os participantes foram submetidos ao exame oftalmologico completo e medida da camada de fibras nervosas da retina pela tomografia de coerencia optica. Resultados: A media das espessuras da camada de fibras nervosas da retina foi de 98,1±15,2μm no grupo de estudo e 114,2±10,0 μm no grupo controle (p<0,001). Conclusao: Observou-se diminuicao significante da espessura da camada de fibras nervosas da retina, em todos os quadrantes, nos pacientes com esquistossomose mansonica na forma hepatoesplenica.

Alterações angiográficas e pressóricas determinadas pela esplenectomia e ligadura da veia gástrica esquerda em portadores de esquistossomose mansônica

In hepatosplenic schistosomiasis occurs diffuse hepatic fibrosis associated with venous congestion of the portal system resulting in hepatosplenomegaly. It can produce digestive hemorrhage caused by rupture of esophageal and stomach varices or peptic gastroduodenal mucosal lesions. To study the effects of splenectomy and ligature of the left gastric vein on portohepatic hemodynamics. Twenty-three patients with hepatosplenic schistosomiasis mansoni were studied before and about two weeks after operation through angiographic diameter of the common and proper hepatic artery, splenic artery, superior mesenteric artery, portal vein, superior mesenteric vein and left gastric vein. The pressures of the inferior vena cava and central venous pressure, free hepatic vein, the hepatic sinusoidal and occluded vein were measured. The splenectomy and ligature of the left gastric vein determined low morbidity and null mortality. It determined significant addition to the following variables: diameters of the common and proper hepatic artery; diameter of the superior mesenteric vein. It determined non significant increase on the following measurements: right atrial pressure and diameter of the superior mesenteric artery. It determined non significant decrease to the following variables: inferior vena cava pressure; free hepatic vein pressure; occluded hepatic vein pressure; sinusoidal pressure, diameter of the portal vein. Splenectomy and ligature of the left gastric vein do not determine portal hemodynamic changes capable of breaking the functional hemodinamic balance that characterizes the hepatosplenic mansoni schistosomiasis.

Hemostatic dysfunction is increased in patients with hepatosplenic schistosomiasis mansoni and advanced periportal fibrosis.

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.

Comment on: Relationship between splenomegaly and hematologic findings in patients with hepatosplenic schistosomiasis

Schistosomiasis remains an important public health problem worldwide. It is a parasitic disease endemic in over 70 countries and is estimated that the infection is responsible for more than 200,000 deaths annually(1,2). For Gryseels et al.(3) inflammatory hepatic schistosomiasis is the main cause of hepatomegaly and severe splenomegaly in children and adolescents. The severity of disease is related to the intensity of the egg infestation. The most severe form of the disease, hepatosplenic schistosomiasis, is an important cause of morbidity and mortality (30% and 10% of those infected, respectively)(4). Dunn & Kamel(1) showed that Schistosomiasis is one of the most common causes of noncirrhotic portal hypertension in the world Schistosomiasis is associated to significant morbidity including anemia, chronic pain, diarrhea, exercise intolerance, malnutrition, bladder cancer, portal hypertension and central nervous system complications(5). Although most infections occur in residents of endemic areas, it has been clearly documented that brief freshwater exposure is sufficient to establish infection; thus, travelers may also be infected. From the standpoint of laboratory exams, these patients have leukopenia and significant thrombocytopenia. Sometimes patients have pancytopenia, iron deficiency anemia, leukopenia and thrombocytopenia secondary to great hepatosplenic schistosomiasis(6-8). We know that both leukopenia and thrombocytopenia are correlated to size of the spleen(9), but there are nostudies that directly or precisely correlate splenomegaly and hematologic findings. It is still controversial whether the thrombocytopenia observed in patients with chronic liver disease is more associated to splenomegaly or to very high portal blood pressure. In the early stages the portal resistance, hypertension is principally presinusoidal. However, due to progressive fibrotic changes in the portal tracts, lobular distortion occurs at the sinusoidal level. This results in increases in resistance to portal venous flow, as evidenced by increased wedged hepatic venous pressure in advanced cases(10). This may explain possible hematological abnormalities in these patients. Martins et al.(11) revisited 141 medical records of patients with hepatosplenic schistosomiasis mansoni submitted to the surgical treatment of portal hypertension. The variations in the serum levels of platelets in both the pre- and postoperative periods of these patients were directly correlated to changes in weight and volume of the spleen. Splenomegaly was directly responsible for the variation in the number of platelets. In this study, patients who underwent surgical treatment showed increased serum levels of platelets in the immediate postoperative compared to the preoperative period. Santos et al.(12) showed that this result refers to the splenic sequestration that occursin schistosomiasis. The results of this study suggest that ultrasound can be reliably usedin the classification of periportal fibrosis using the criteria of Niamey in patients withthe advanced form of schistosomiasis. Ultrasound scans in patients with schistosomiasishave been restricted to study the caliber of the portal and splenic veins, and organometricinvestigations of the portal vein(13). Some studies reported results relevant to the understanding of the importance of the correlation between splenomegaly and thrombocytopenia in hepatosplenic schistosomiasis. Martins et al.(11), analyzing the serum level of platelets in respect to pre and postoperative weight, tried to correlate this with volume of the spleen in patients with hepatosplenic schistosomiasis with indication for the surgical treatment of portal hypertension. He found that the number of platelets in the immediate postoperative period was inversely correlated with the weight of the spleen removed. Splenomegaly was directly responsible for the variation in the number of platelets. Thus, the study of Leite et al. is highly relevant since it suggests that the hematological abnormalities are associated with splenomegaly, hypersplenism and hypertension(14). Further studies are necessary to verify that the platelet count may be a non-invasive tool for portal hypertension.

Brain Magnetic Resonance Imaging Findings in Young Patients with Hepatosplenic Schistosomiasis Mansoni without Overt Symptoms

The purpose of this study was to describe the brain magnetic resonance imaging (MRI) findings in young patients with hepatosplenic schistosomiasis mansoni without overt neurologic manifestations. This study included 34 young persons (age range = 9-25 years) with hepatosplenic schistosomiasis mansoni who had been previously treated. Patients were scanned on a 1.5-T system that included multiplanar pre-contrast and post-contrast sequences, and reports were completed by two radiologists after a consensus review. Twenty (58.8%) patients had MRI signal changes that were believed to be related to schistosomiasis mansoni. Twelve of the 20 patients had small focal hyperintensities on T2WI in the cerebral white matter, and eight patients had symmetric hyperintense basal ganglia on T1WI. There was a high frequency of brain MRI signal abnormalities in this series. Although not specific, these findings may be related to schistosomiasis.

Early Right Cardiac Dysfunction in Patients with Schistosomiasis Mansoni

Pulmonary hypertension (PH) is a complication of schistosomiasis mansoni (SM), mainly in the hepatosplenic form. However, its prevalence is not well established. We evaluated the usefulness of Doppler echocardiographic indexes to detect right heart dysfunction in SM. A total of 83 patients divided into two groups were studied: Group 1: 44 patients with hepatosplenic SM, and Group 2: 39 patients with hepatointestinal SM who served as controls. All patients underwent a Doppler echocardiogram. Right ventricular end-diastolic area (RVEDA), the peak systolic tricuspid annular tissue velocity (S'), right ventricular index of myocardial performance (RVIMP) and right atrial area (RAA) were measured in all patients. Tricuspid regurgitation peak velocity (TR) was measured and the pressure gradient (TG) was obtained. The prevalence of patients with elevated systolic pulmonary artery pressure at echocardiography was 31% in hepatosplenic patients, while no patient with the hepatointestinal form presented PH. Patients with hepatosplenic SM had larger RVEDA (10.0 ± 2.8 vs. 8.5 ± 1.8 cm(2) /m, P = 0.006) and RAA (9.39 [8.3-11.0] vs. 7.7 [6.9-8.4 cm(2) /m], P < 0.001). There was correlation between TG and RVIMP (r = 0.58; P < 0.001) and between TG and RAA (r = 0.36; P = 0.03) in Group 1. Larger RAA and RVEDA were found in patients with hepatosplenic SM, when compared to patients with the hepatointestinal form, which may suggest early impairment of RV function in patients with hepatosplenic SM.

Glomerulonephritis in schistosomiasis mansoni: a time to reappraise

The current prevalence of glomerulonephritis in patients with hepatosplenic schistosomiasis mansoni in Brazil was evaluated. Sixty three patients (mean age 45.5 ± 11 years) attending the outpatient infectious disease clinic of a University Hospital in Belo Horizonte, Brazil, from 2007 to 2009, were consecutively examined and enrolled in the present investigation. Diagnosis of hepatosplenic schistosomiasis was based on epidemiological, clinical and parasitological data and imaging techniques. Eight patients, who presented >30 mg/day albuminuria, were submitted to percutaneous ultrasound guided renal biopsy. Kidney tissue fragments were examined under light, direct immunofluorescence and electron microscopy. All patients showed mesangial enlargement. In five, mesangial hypercellularity was observed and four presented duplication of the glomerular basement membrane. Areas of glomerular sclerosis were diagnosed in four. Deposits of immunoglobulin M and C3 were present in six samples; deposits of IgG in four, IgA in three and C1q in two samples. In all patients, immunoglobulin A was reported in the lumen of renal tubules. Deposits of kappa and lambda were observed in six samples. Electron microscopy revealed dense deposits in the glomerular tissue of three patients. Arterial hypertension, small esophageal varices, slight increases in serum creatinine and decreases in serum albumin were associated with glomerular disease. Renal disease associated with hepatosplenic schistosomiasis was verified in 12.7% of patients and type I membranoproliferative glomerulonephritis was observed in 50% of them. Schistosomal glomerulopathy still is an important problem in patients with hepatosplenic schistosomiasis in Brazil.

Avaliação das citocinas IL-10 e IL-13 como mediadores na progressão da fibrose de Symmers em portadores de esquistossomose mansônica na forma hepatoesplênica

To investigate the serum levels of IL-10 and IL-13 in patients with hepatosplenic schistosomiasis mansoni (HSM), evaluating the role of these cytokines in the development of hepatic fibrosis. The study was prospective and analytical, developed at the Department of Surgery, Federal University of Pernambuco, Keizo Asami Laboratory of Immunology. We studied three groups: Group I - 25 patients with hepatosplenic schistosomiasis mansoni who were not submitted to surgery; Group II - 30 individuals who underwent splenectomy and ligature of left gastric vein; Group III - 33 subjects without hepatosplenic schistosomiasis mansoni or any other disease or condition that could compromise the hepatic functional reserve. Serum concentrations of IL-10 and IL-13 were obtained through ELISA. Considering their non-parametric nature, all concentrations were analyzed by Kruskal-Wallis test, with p<0.05 used to reject the null hypothesis. The mean concentrations of IL-10 in ng/mL in serum were GI: 50.0 ± 59.0; GII: 38.0 ± 270; GIII: 38.0 ± 20.0. Concentrations of IL-13 in ng/mL in the serum of patients were respectively: 41.0 ± 93.0 in GI, 16.0 ± 17.0 in GII and 18.0 ± 34.0 in GIII. There was no significant difference between the mean concentrations of IL-10 and IL-13 between the study groups (p> 0.05). The mean serum concentrations of IL-10 and IL-13 were similar in all three groups, indicating that possibly the presence of these cytokines in serum is not associated with different degrees of Symmers fibrosis in patients with hepatosplenic schistosomiasis mansoni.

Imaging techniques and histology in the evaluation of liver fibrosis in hepatosplenic schistosomiasis mansoni in Brazil: a comparative study

Few publications have compared ultrasound (US) to histology in diagnosing schistosomiasis-induced liver fibrosis (LF); none has used magnetic resonance (MR). The aim of this study was to evaluate schistosomal LF using these three methods. Fourteen patients with hepatosplenic schistosomiasis admitted to hospital for surgical treatment of variceal bleeding were investigated. They were submitted to upper digestive endoscopy, US, MR and wedge liver biopsy. The World Health Organization protocol for US in schistosomiasis was used. Hepatic fibrosis was classified as absent, slight, moderate or intense. Histology and MR confirmed Symmers' fibrosis in all cases. US failed to detect it in one patient. Moderate agreement was found comparing US to MR; poor agreement was found when US or MR were compared to histology. Re-classifying LF as only slight or intense created moderate agreement between imaging techniques and histology. Histomorphometry did not separate slight from intense LF. Two patients with advanced hepatosplenic schistosomiasis presented slight LF. Our data suggest that the presence of the characteristic periportal fibrosis, diagnosed by US, MR or histology, associated with a sign of portal hypertension, defines the severity of the disease. We conclude that imaging techniques are reliable to define the presence of LF but fail in grading its intensity.

Índices de resistência nas artérias ovariana e uterina na fase lútea média em portadoras de esquistossomose mansônica na sua forma hepatoesplênica

to evaluate the repercussion of portal hypertension in the indexes of the ovarian, uterine and luteus body periphery arterial resistance, at the medium luteal phase of the menstrual cycle. in an observational study with transversal cohort, 28 patients with hepatosplenic schistosomiasis mansoni, submitted to splenectomy and ligation of the left gastric vein (HESO), a similar group of 28 patients who had not had the surgery (HESNO) and 29 healthy volunteers (HV) were submitted to Doppler fluxmetry in the medium luteal phase of the menstrual cycle. Pourcelot's resistance index has been used as RI=[(S-D)/S], in which S means the highest systolic speed, and D, the end of diastole. The best record in the ascendant branch of the uterine artery, in the ovarian artery, when accessible, or in the intraovarian artery, was chosen. When the luteus body was present, the RI was measured in its periphery. The data obtained were analyzed by Kruskal-Wallis and Mann-Whitney tests. there was no significant difference among the groups, concerning the mean RI of the ovarian arteries (Kruskal-Wallis, p=0.50). There was a tendency for higher right uterine artery RI in the HESNO group (Kruskal-Wallis, p<0.07), but it was similar in the left uterine artery (Kruskal-Wallis, p=0.14). Arterial RIs significantly lower have been observed in the luteus body periphery, when compared to the contralateral ovarian arteries in all the groups (Mann-Whitney, p<0.0001). there was no difference among the groups, regarding the ovarian and uterine RIs. The portal hypertension in patients with hepatosplenic schistosomiasis does not affect the natural phenomenon of arterial RI decrease in the ovary where ovulation occurs.

Platelet function and the von Willebrand factor antigen in the hepatosplenic form of schistosomiasis mansoni

Forty-five individuals with hepatosplenic schistosomiasis mansoni were studied with the aim of measuring levels of von Willebrand factor antigen (vWF:Ag), detecting abnormalities in platelet morphology and aggregation, and identifying changes to surface antigens. Haemograms, platelet aggregation tests, flow cytometry investigations of CD41/CD42b antibody and vWF:Ag assays were performed. Mean platelet counts were low (77,522/mm3) and 82.2% of patients presented thrombocytopenia. An inverse relationship between spleen size and platelet count was seen. Macroplatelets were found in 57.1% of patients, indicating good bone-marrow response, but were insufficient to compensate for the decrease in platelets due to splenomegaly. Decreased or absent platelet aggregation was seen in 50% of patients, probably due to low platelet counts. Markers for GPIIb/IIIa were normal in more than 90% of patients, not supporting the increased capture and destruction of platelets in the spleen that is hypothesized to occur with cirrhosis. Similar to cirrhosis, vWF:Ag levels were high or very high in 70.5% of patients. High levels of vWF:Ag were associated with platelet counts <100,000/mm3, larger spleen diameter and oesophageal varices. In conclusion, hepatosplenic schistosomiasis leads to a lower platelet count due to pooling in the spleen and, consequently, impaired aggregation, but not to increased capture and destruction of platelets in the spleen. High vWF:Ag levels probably promote stabilization of platelet microaggregates and prevent minor manifestations of thrombocytopenia such as petechiae, ecchymosis and gingival bleeding.

Níveis de superóxido dismutase produzidos por monócitos em portadores de esquistossomose hepatoesplênica submetidos a esplenectomia, ligadura da veia gástrica esquerda e auto-implante de tecido esplênico no omento maior

OBJETIVO: Investigar os níveis de produção de SOD por monócitos periféricos em pacientes jovens portadores de esquistossomose hepatoesplênica submetidos à esplenectomia, ligadura da veia gástrica esquerda e auto-implante de tecido esplênico. MÉTODO: Quatro grupos foram envolvidos na investigação: G1 - 12 portadores de esquistossomose hepatoesplênica (EHE) sem tratamento; G2 - 13 portadores de EHE que receberam tratamento clínico e se submeteram à operação para descompressão do sistema porta: esplenectomia e ligadura da veia gástrica esquerda (EHE/ELGE); G3 - 19 pacientes jovens similares a G2, mas que receberam também auto-implante de tecido esplênico no omento maior (EHE/ELGE/AI); e G4 - 15 indivíduos sem infecção pelo S. mansoni advindos da mesma área geográfica, apresentando as mesmas condições sócio-econômicas (GC). RESULTADOS: Os indivíduos normais (GC - sem esquistossomose) apresentam níveis de SOD significantemente menores que os portadores de EHE sem tratamento (p&lt;0,01); e aqueles do grupo EHE/ELGE (p&lt;0,05). Os níveis de SOD do grupo EHE/ELGE/AI são estatisticamente similares ao grupo GC (p&gt;0,05). CONCLUSÃO: Os resultados corroboram a hipótese de que o tratamento clínico associado à esplenectomia, ligadura da veia gástrica esquerda e auto-implante de tecido esplênico, em portadores jovens de esquistossomose hepatoesplênica, tendem a manter a resposta imune desses indivíduos.

Segmental splenectomy in schistosomiasis.

Segmental splenectomy was performed in 5 patients with hepatosplenic schistosomiasis mansoni and symptomatic splenomegaly. The aim was to preserve a functional remnant comprising 20-30 per cent of the bulk of a greatly enlarged spleen. The operative technique involved devascularization of anatomic segments and suture of an omental patch to the residual spleen. This procedure was simple, well tolerated and effective in relieving abdominal discomfort and cytopenias. The residual spleens showed normal uptake of 99Tc-sulphur colloid. If long term observation confirms the value of segmental splenectomy in hepatosplenic schistosomiasis, it may become appropriate therapy for those patients with symptomatic splenomegaly who do not require portal decompression.

Effect of splenectomy and ligature of the left gastric vein on portal hypertensive colopathy in carriers of surgical hepatosplenic schistosomiasis mansoni

Esophageal variceal sclerotherapy and band ligation seem not to affect the endoscopic findings of Portal Hypertensive Colopathy (PHC) of cirrhotic patients. The aim was to assess the effect of splenectomy and ligature of the left gastric vein on the PHC in carriers of hepatosplenic schistosomiasis mansoni who underwent this surgery when they were between 9 and 18 year-old. Fourteen patients, mean age of 19.1 +/- 3.1 years, were included in the postoperative group (GI). The follow-up was from 1 to 9 years. The preoperative group (GII) consisted of nine patients, mean age of 14.0 +/- 3.1 years. Full-length colonoscopy was carried out in all patients. Search was made for PHC lesions. Telangiectasy (GI 100% vs GII 100%), increased vascularisation (GI 57.1% vs GII 100%), focal and diffuse hyperemia (GI 14.3% vs GII 66.7%), angiodysplasia (GI 7.1% vs GII 33.3%), and rectal varix (GI 0% vs GII 55.6%) were the most frequent findings. It was observed that the patients of this series tended to exhibit fewer hemodynamic manifestations of the PHC after treatment (postoperative versus preoperative - chi2 = 8.155 - p = 0.004). Splenectomy and ligature of the left gastric vein tend to reduce the abnormal vascular findings of PHC in carriers of hepatosplenic schistosomiasis mansoni.

Avaliação do efeito da esplenectomia e auto-implante esplênico sobre algumas funções de monócitos em crianças com esquistossomose mansônica

Adherence index, superoxide and TNF-alpha production in monocytes, with or without tuftsin treatment, were investigated in hepatosplenic schistosomiasis mansoni bearers with splenectomy with or without autologous implantation of spleen tissue. Three groups were evaluated: Healthy volunteers control group (CG) (n=12); Splenectomy with seft auto-transplant AG (n=18) and Splenectomy without auto-transplant WAG (n=9). Adherence index and TNF-alpha did not differ among the groups. Superoxide production was similar in CG and AG, in the 1st hour after cell stimulation. SP was larger in each hour time in CG and AG groups as compared WAS group. TT recovered normal pattern of SP in AG comparable with levels found in CG, with increase from the 1st to 2nd hour. However, TT did not alter SP in WAG, which remained reduced in all time points. Autologous implantation of spleen tissue seems to contribute for recovery and maintenance of the evaluated immunological reactions, which might be important in response to infections.