Prolonged intrahepatic cholestasis in patients with schistosomal hepatic fibrosis and chronic viral hepatitis: role of associated active schistosomiasis

ABSTRACT

Among 50 patients with schistosomal hepatic fibrosis [SHF] and superimposed chronic viral hepatitis [CVH], prolonged intraheptic cholestasis [IHC] was found in 27 patients. In those patients with IHC, the frequency of active S. mansoni infection and serum levels of tumour necrosis factor-alpha [TNF-alpha] were significantly higher than in patients without jaundice [P<0.05]. After 4 courses of praziquantel [PZQ] therapy, there was a significant improvement in the clinical, biochemical and histopathological evidences of IHC in parallel with cure of active schistosomal infection and a significant decrease in serum TNF alpha levels [P<0.05]. In conclusions active S. mansoni infection with subsequent enhanced immune response is a possible etiological factor for the development of prolonged IHC in patients with SHF and superimposed CVH. Repeated course of PZQ therapy may help in the clearance of jaundice in these patients