ABSTRACT
A combined clinical and sonographic classification of hepatosplenic schistosomiasis mansoni to be used in field-based studies is proposed herein. Seven hundred forty one individuals out of 892 (83 percent), living in an area endemic for schistosomiasis in Brazil, have been ubmitted to clinical and ultrasound examinations. Based on two stool examinations the overall prevalence for schistosomiasis in this area was 73 percent. Abdominal palpation was performed with patients in dorsal decubit, during deep breath, by two experienced physicians and a portable ultrasound was used for the evaluation of liver fibrosis, portal collaterals and spleen size. Four groups of individuals were identified using data obtained by abdominal palpation and ultrasound examination: (1) palpable spleen and intense periportal thickening in 9 individuals (1.2 percent); (2) spleen not palpable and intense periportal thickening in 15 (2 percent); (3) palpable spleen with light to moderate periportal thickening in 32 (4.3 percent), and (4) palpable spleen with a normal liver on ultrasound in 30 (4 percent). The definition of hepatosplenic schistosomiasis in field-based studies as the finding of Schistosoma mansoni eggs in the stools in an individual with splenomegaly is not acceptable anymore. Abdominal ultrasound should be combined with clinical examination to accurately identify hepatosplenics in endemic areas for schistosomiasis
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Liver Diseases, Parasitic/diagnosis , Schistosomiasis mansoni/diagnosis , Splenic Diseases/diagnosis , Aged, 80 and over , Brazil/epidemiology , Liver Diseases, Parasitic , Liver Diseases, Parasitic/epidemiology , Prevalence , Schistosomiasis mansoni , Schistosomiasis mansoni/epidemiology , Splenic Diseases , Splenic Diseases/epidemiologyABSTRACT
Os autores relatam o caso de um jovem com piomiosite tropical grave, eosinofilia e hiperimunoglobulinemia E. O paciente relatou historia de contato com um cao e o teste de ELISA para Toxocara canis revelou-se positivo. O Staphylococcus aureus foi a unica bacteria isolada da secrecao purulenta obtida dos abscessos musculares. Sugere-se que a piomiosite tropical possa ser iniciada pela presenca das larvas desse ou de outros parasitos com tropismo para os musculos. As alteracoes imunologicas e estruturais nos musculos acometidos pelas larvas e a presenca de bacteriemia podem favorecer a instalacao da bacteria e o desenvolvimento da piomiosite
Subject(s)
Humans , Animals , Adolescent , Dogs , Communicable Diseases/parasitology , Larva Migrans, Visceral/diagnosis , Pyoderma/parasitology , Abscess/etiology , Edema/etiology , Enzyme-Linked Immunosorbent Assay , Erythema/etiology , Fever/etiology , Follow-Up Studies , Larva Migrans, Visceral/blood , Larva Migrans, Visceral/parasitology , Muscles/parasitology , Myositis/parasitology , Pain/etiologyABSTRACT
Apresentam-se os casos de dois jovens com bacteriemia por Salmonella associada a esquistossomose mansoni ativa em pacientes com a sindrome da imunodeficiencia adquirida. A apresentacao clinica incluiu sintomas e sinais inespecificos como fadiga, perda de peso, diarreia, febre prolongada e hepatoesplenomegalia. A biopsia hepatica em um paciente revelou granulomas mal formados em torno de ovos de S. mansoni e hepatite de intensidade moderada. O tratamento da esquistossomose com a oxamniquine induziu melhora clinica progressiva culminando com a cura da salmonelose e da esquistossomose. O reconhecimento da associacao Salmonella-S. mansoni em pacientes com AIDS mostra-se importante nesses casos pois o tratamento da esquistossomose melhora o prognostico da bacteriemia por Salmonella que pode tornar-se recorrente e fatal nos pacientes com AIDS
Subject(s)
Humans , Male , Adult , Diarrhea/etiology , AIDS-Related Opportunistic Infections/parasitology , Salmonella/isolation & purification , Acquired Immunodeficiency Syndrome/parasitology , Biopsy , Enzyme-Linked Immunosorbent Assay , Hepatitis , Salmonella Infections/diagnosis , Salmonella Infections/therapy , Oxamniquine/therapeutic use , Risk Factors , Schistosomiasis/diagnosis , Schistosomiasis/therapy , Signs and SymptomsABSTRACT
In an endemic area for schistosomiasis in the northeast of the state of Minas Gerais in Brazil 516 individuals have been submitted to clinical and laboratory examination, ultrasonography of the abdomen and dopplerecocardiography in order to define the morbidity of schistosomiasis before and after treatment. A high prevalence of schistosomiasis (66.3 per cent) and of severe disease (9.5per cent with palpable spleens) were recorded. Ultrasonography classified liver periportal fibrosis as light (19.4 per cent), moderate (27.6 per cent) and intense (6.8 per cent), and 46.0 per cent presented no periportal fibrosis. Twenty one out of the 53 individuals (39.6 per cent) with palpable spleens did not present liver fibrosis on ultrasound. Periportal lymph nodes were described in 33.8 per cent of the population and anti-KLH antibodies were found in the serum of 40.7 per cent. Urinary alterations compatible with the glomerulopathy of schistosomiasis were observed in 4.5 per cent of the population, and 11.7 per cent of the individuals examined by dopplerecocardiography had pulmonary hypertension. Twelve months after treatment for schistosomiasis the prevalence of the disease dropped from 66.3 per cent to 25.0 per cent. In Queixadinha, a profile of the morbidity of schistosomiasis has just been established.