Splenic palpation for the evalution of morbidity due to schistosomiasis mansoni

RESUMO

This study was undertaken to determine the accuracy of splenic palpation for the diagnosis of splenomegaly, and to determine whether the frequency of individuals with a palpable spleen in an endemic area can be considered as an index of morbidity of schistosomiasis. For the clinical diagnosis of splenomegaly, two criteria have been tested: (A) presence of a palpable spleen and (B) presence of a palpable spleen whose border could be felt more than 4 cm below the costal margin. In an area of high prevalence of the disease (66.3 per cent) 285 individuals aged 18 years or more have been submitted to abdominal ultrasonography and physical examination. Splenomegaly was defined as a splenic lengh greater than 120 mm by ultrasound and the sensitivity, specificity, positive and negative predictive values of criterion A were 72.2 per cent, 90.5 per cent, 35.1 per cent and 97.8 per cent. The values for criterium B were 27.8 per cent, 98 per cent, 50 per cent and 95 per cent, respectively. In an non endemic area, 517 individuals were submitted to the same protocol and 22 individuals had a palpable spleen, but no patient fulfilled criterium B for splenomegaly, and only one met the ultrasonographic criterium for splenomegaly. The authors concluded that abdominal palpable is a poor method for the diagnosis of splenomegaly.