Criteres echographiques predictifs d'hypertension portale due a Schistosoma mansoni dans une zone d'endemie recente

Les premiers cas de bilharziose a Schistosoma mansoni ont ete depistes dans la vallee du fleuve Senegal il y a dix ans. Aujourd'hui; le niveau d'endemie est tel que certains villages presentent des prevalences superieures a 90 p. 100. Le diagnostic de schistosomose n'est parfois porte qu'au stade d'hypertension portale (rupture de varices oesophagiennes). L'endoscopie est l'examen de reference pour detecter la presence de varices oesophagiennes; mais son application sur le terrain est delicate. C'est pourquoi leur recherche par echographie; acte non invasif; est d'un grand interet. Cette etude a recherche chez 101 sujets de la region de Richard-Toll l'existence de signes d'hypertension portale; simultanement par fibroscopie digestive et par echographie. Elle a montre que moins de 10 ans apres la description du premier cas de bilharziose; il existait deja des formes compliquees d'hypertension portale dans la region. Cette etude a egalement cherche a etablir un score echographique permettant de predire l'existence d'une hypertension portale. Les items retenus ont ete l'epaississement de la paroi des vaisseaux portes; le diametre de la veine porte et de la veine splenique et l'aspect collabe ou non de la veine splenique pendant l'inspiration. Au cours de l'etude; l'echelle de score ainsi etablie a semble etre un bon temoin predictif du developpement de varices oesophagiennes. L'echographie represente un examen utile pour le depistage des formes compliquees de schistosomoses susceptibles de representer un moyen simple de surveillance des populations residant en zone d'endemie recente et intense de schistosomose

[Multivisceral tuberculosis with aortic complication in an immunocompetent patient]. / Tuberculose multiviscérale avec complication aortique chez un sujet immunocompétent.

The medical and imaging data of a 59 year old male is reported. The patient presented with cough, fever, night sweats and weight loss, for which a final diagnosis of multivisceral tuberculosis (with peritoneal involvement and mycotic aneurysm) was made, by means of CT, MRI and laparoscopic findings. This disease is uncommon in developed countries with subjects lacking the usual risk factors. Because delayed treatment may be lethal, especially with such serious vascular complication, the authors review the value and limitations of CT and MRI along with the suggestive features.

[Predictive ultrasonographic criteria for portal hypertension due to Schistosoma mansoni in a recently established endemiz zone]. / Critères echographiques prédictifs d'hypertension portale due à Schistosoma mansoni dans une zone d'endémie récente.

The first cases of Schistosoma mansoni infection were reported in the Senegal River Basin ten years ago. Today endemicity is so high that prevalence rates exceed 90 p. 100 in some areas. Schistosomiasis sometimes goes undiagnosed until the occurrence of portal hypertension with rupture of esophageal varices. Endoscopy is the gold standard for detection of esophageal varices but it is impractical in remote areas. Ultrasonography has been proposed as a non-invasive alternative. The purpose of this study is to describe the results of simultaneous endoscopic and ultrasonographic assessment in 101 subjects from the Richard-Toll area of the Senegal River Basin. Findings showed that severe forms of schistosomiasis complicated by portal hypertension were already present in the region less 10 years after description of the first case. This study also proposes a diagnostic score for portal hypertension based on ultrasonographic findings. The features included in this score are thickening of portal vessel walls, portal vessel diameter, and collapsed appearance of the splenic vein during inspiration. In our hands this score allowed reliable prediction of the development of esophageal varices. Ultrasonography is a good tool for identifying severe forms of schistosomiasis. It should be useful for routine screening in recently established endemic zones.

Schistosoma mansoni infection in a recently exposed community in Senegal: lack of correlation between liver morphology in ultrasound and connective tissue metabolites in serum.

Four hundred and seventy villagers of Ndombo, a village with recently established intensive transmission of Schistosoma mansoni in the Senegal River Basin, were enrolled in a study with the intention to assess hepatosplenic morbidity. All patients were examined parasitologically and by ultrasound. Hepatic fibrosis serum markers were determined in 153 adult patients (aminoterminal propeptide of procollagen type III, hyaluronan and laminin). By ultrasound, about 60% of the patients showed early stages of hepatic involvement, 3% of the patients unequivocally showed severe hepatosplenic pathology (grade 3 according to the Managil classification), whereas in another study performed in the same village 3 years earlier, no patients with severe hepatosplenic pathology had been found. No correlation between the aminoterminal propeptide of procollagen type III, hyaluronan or laminin and the ultrasound findings could be established. These hepatic fibrosis serum markers do not seem to be a sensitive method to detect early hepatic fibrosis in schistosomiasis.

[Value of hepatosplenic ultrasonography in the surveillance of Schistosoma mansoni endemics (a study conducted in the Richard Toll region of Senegal)]. / Intérêt de l'échographie Hépato-splénique dans la surveillance de l'endémie á Schistosoma mansoni (á propos d'une étude realisée dans la region de Richard Toll au Senegal).

Abdominal ultrasound is a reliable and reproducible technique for monitoring the progression of hepatosplenic schistomiasis. It was used in the framework of the @Hope" program against endemic Schistosoma mansoni in the Senegal River region. A total of 166 patients presenting Schistosoma mansoni eggs in stools were divided into age groups with a sex ratio of 1. All patients underwent the same ultrasound examination including measurement of the liver and assessment of the branches of the portal vein system. Our findings indicated that highly sensitive hypertrophy of the left lobe of the liver occurs early since this feature was observed in all patients over the age of 15 years. Alterations of the portal system were observed in 73% of patients but were moderate, stage 1, in the zone where incidence of positive stools is over 90%. Grade III lesions were only found in patients over 23 years of age. Although these lesions accounted for 4% of the cases, this finding underscores the need for surveillance in a region where infestation became endemic less then ten years ago raising fears that severe schistosomal portal hypertension would become widespread. A mobile ultrasonographic surveillance unit would be useful in the region.