Abdominal angiostrongyliasis: report of two cases with different clinical presentations.

Abdominal angiostrongyliasis is a sporadic infectious disease caused by the nematode Angiostrongylus costaricensis. It usually presents as acute abdomen, secondary to mesenteric ischemia, and pronounced eosinophilia. In some cases its course is insidious and transient, and the diagnosis is suspicious. The disease is confirmed by the detection of A. costaricensis elements in surgical specimen. The treatment is supportive, with avoidance of antihelminthic administration due to a possible erratic migration followed by worsening of the disease. We report two cases, both with intense eosinophilia and serum IgG-ELISA positive to A. costaricensis. The first case presented ileal perforation and was surgically treated. The second one showed hepatic nodules at ultrasound and was only symptomatically treated, evolving to an apparent protracted resolution. These two cases exemplify different clinical forms of the disease, one of them with liver involvement.

Abdominal angiostrongyliasis: report of two cases with different clinical presentations / Angiostrongilíase abdominal: relato de dois casos com diferentes apresentações clínicas

Abdominal angiostrongyliasis is a sporadic infectious disease caused by the nematode Angiostrongylus costaricensis. It usually presents as acute abdomen, secondary to mesenteric ischemia, and pronounced eosinophilia. In some cases its course is insidious and transient, and the diagnosis is suspicious. The disease is confirmed by the detection of A. costaricensis elements in surgical specimen. The treatment is supportive, with avoidance of antihelminthic administration due to a possible erratic migration followed by worsening of the disease. We report two cases, both with intense eosinophilia and serum IgG-ELISA positive to A. costaricensis. The first case presented ileal perforation and was surgically treated. The second one showed hepatic nodules at ultrasound and was only symptomatically treated, evolving to an apparent protracted resolution. These two cases exemplify different clinical forms of the disease, one of them with liver involvement.

A angiostrongilíase abdominal é doença esporádica decorrente da infecção pelo nematódeo Angiostrongylus costaricensis. Costuma manifestar-se como abdome agudo secundário a isquemia mesentérica, além de marcada eosinofilia. Pode também apresentar-se de forma insidiosa e transitória, exigindo alta suspeita clínica para o diagnóstico. A doença é confirmada pela identificação de elementos do A. costaricensis em peças cirúrgicas. O tratamento é apenas de suporte, devendo-se evitar o uso de anti-helmínticos pela possibilidade de migração errática do verme com piora do quadro. Aqui foram apresentados dois casos, ambos com acentuada eosinofilia e ELISA-IgG sérico positivo para A. costaricencis. O primeiro caso cursou com perfuração ileal e foi tratado cirurgicamente. O segundo caso apresentou nódulos hepáticos ao ultrassom e foi tratado sintomaticamente, evoluindo para lenta resolução. Estes dois casos exemplificam diferentes formas de apresentação clínica da doença, uma delas com envolvimento hepático.

Tratamento cirurgico da hipertensao portal na esquistossomose: estado atual da questao / Surgery treatment of the portal hypertension in mansonic schistosomiasis

A esquistossomose hepatesplenica e uma das principais causas de hipertensao portal no Brasil, estimando-se a existencia de cerca de 1 milhao de pessoas com esta forma de doenca em nosso pais. A hemorragia por varizes gastresofagianas e a principal manifestacao da doenca e a indicacao do tratamento. A preservacao da funcao hepatica e a ineficacia do tratamento endoscopico justificam a opcao pelo tratamento cirurgico. Estudo prospectivo randomizado realizado em nosso Grupo levou a escolha da desconexao azigo-portal associada a esplenectomia como a opcao preferencial no tratamento da hipertensao portal na esquistossomose mansonica

Hepatosplenic schistosomiasis. Pathophysiology and treatment.

HSS represents a special model of intrahepatic portal hypertension characterized by a presinusoidal portal block and a well-preserved liver parenchyma. Symmers' fibrosis appears in a small but significant proportion of patients with a high worm load. Its pathogenesis is not well established, although experimental and clinical studies point to egg granulomata as the main pathogenetic factor. The eggs carried continuously through the portal circulation produce inflammation and gross amputation of the intrahepatic veins, portal and periportal granulomas, and, eventually, a coarse perilobular fibrosis ("pipe-stem"). Portal hypertension, esophageal varices, and hepatosplenomegaly are the main consequences of these morphologic changes. Gastrointestinal bleeding is the most frequent cause of death. Unlike in cirrhosis, advanced liver failure is not seen except when HSS is associated with liver lesions from other causes such as virus and alcoholism. Helminthiasis treatment is based on chemotherapy with praziquantel or oxamniquine. Bleeding esophageal varices are managed by sclerotherapy or surgical procedures. Splenectomy with gastroesophageal devascularization seems to be the best choice.

Specific treatment of hepatosplenic schistosomiasis can increase T-lymphocyte reactivity

Tendo sido observado que infecçäo por Schistosoma mansoni pode causar imunodepressäo celular. Neste trabalho foi avaliado se a imunodepressäo associada à esquistossomose pode ser revertida pelo tratamento específico. A resposta imune celular foi determinada através de testes cutâneos de hipersensibilidade retardada em 22 pacientes com a forma hepatoesplênica da esquistossomose um ano após tratamento com oxamniquine e comparado com aquela observada em um grupo de pacientes hepatoesplênicos näo tratados. Somente 27 por cento destes pacientes apresentaram alergia a todos os antígenos testados, em contraste com 80 por cento de indivíduos anérgicos observados entre aqueles näo tratados. Embora a maioria dos indivíduos tratados tenha mostrado algum grau de resposta aos antígenos testados, alguns indivíduos permaneceram anérgicos após o tratamento específico. Anergia a todos os antigenos aplicados näo foi observada em nenhum dos indivíduos normais. Nossos dados indicam que pacientes esquistossomóticos podem recuperar sua reatividade imune após a eliminaçäo do verme pelo tratamento específico

Specific treatment of hepatosplenic schistosomiasis can increase T-lymphocyte reactivity.

It has been recognized that Schistosoma mansoni infection causes depression of T-cell responsiveness. In this study we have evaluated whether immunodepression associated to schistosomiasis could be reverted by specific treatment. T-cell immune response was assessed by means of intradermal tests using recall antigens in a group of 22 patients with hepatosplenic schistosomiasis, one year after treatment with oxamniquine and compared with a group of untreated hepatosplenic patients. Only 27% of treated patients presented complete anergy to all tested antigens, in marked contrast to 80% unresponsiveness showed by hepatosplenic patients without treatment. Although most of the treated individuals showed some response to the tested antigens, in some individuals this unresponsiveness still persisted after treatment. Anergy was not found in any normal individual of the control group. It was concluded that Schistosoma mansoni infected patients may recover their normal immune responsiveness after the elimination of the worm by treatment.