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Pulmonary shunts in severe hepatosplenic schistosomiasis: Diagnosis by contrast echocardiography and their relationship with abdominal ultrasound findings.
- Source :
-
PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2017 Apr 03; Vol. 11 (4), pp. e0005417. Date of Electronic Publication: 2017 Apr 03 (Print Publication: 2017). - Publication Year :
- 2017
-
Abstract
- Background: Schistosomiasis is endemic to several parts of the world. Among the species that affect humans, Schistosoma mansoni is one of the most common causes of illness. In regions where schistosomiasis mansoni is endemic, reinfection is responsible for the emergence of hepatosplenic schistosomiasis (HSS) with portal hypertension in about 10% of infected individuals. Regardless of its etiology, portal hypertension may bring about the formation of arteriovenous fistulas and pulmonary vascular dilation, thus constituting a pulmonary shunt and its presence has been associated with the occurrence of neurological complications. The objective of this study was to identify pulmonary shunt using TTCE in patients with HSS and esophageal varices, and to compare the abdominal ultrasound and endoscopy findings among patients with and without pulmonary shunt.<br />Methodology/principal Findings: In this case series, a total of 461 patients with schistosomiasis mansoni were prospectively evaluated using abdominal ultrasound and endoscopy and 71 presented with HSS with esophageal varices. Fifty seven patients remained in the final analysis. The mean age of the patients was 55 ± 14 years, and 65% were female. Pulmonary shunts were observed in 19 (33.3%) patients. On comparing the groups with and without pulmonary shunt, no significant differences were observed in relation to the abdominal ultrasound and endoscopic findings. When comparing the two subgroups with pulmonary shunts (grade 1 vs grades 2 and 3), it was observed that the subgroup with shunt grades 2 and 3 presented with a significantly higher frequency of an enlarged splenic vein diameter (>0.9 cm), and an advanced pattern of periportal hepatic fibrosis (P = 0.041 and P = 0.005, respectively). None of the patients with pulmonary shunts had severe neurological complications.<br />Conclusions/significance: Our findings suggest that in HSS with esophageal varices the pulmonary shunts may be present in higher grades and that in this condition it was associated with ultrasound findings compatible with advanced HSS.
- Subjects :
- Abdomen diagnostic imaging
Adult
Aged
Animals
Echocardiography methods
Esophageal and Gastric Varices complications
Esophageal and Gastric Varices parasitology
Esophageal and Gastric Varices physiopathology
Female
Humans
Hypertension, Portal complications
Hypertension, Portal parasitology
Hypertension, Portal physiopathology
Liver Diseases, Parasitic complications
Liver Diseases, Parasitic parasitology
Liver Diseases, Parasitic physiopathology
Male
Middle Aged
Prospective Studies
Schistosomiasis mansoni complications
Schistosomiasis mansoni physiopathology
Splenic Diseases complications
Splenic Diseases parasitology
Splenic Diseases physiopathology
Ultrasonography
Esophageal and Gastric Varices diagnostic imaging
Hypertension, Portal diagnostic imaging
Liver Diseases, Parasitic diagnostic imaging
Schistosoma mansoni isolation & purification
Schistosomiasis mansoni diagnostic imaging
Splenic Diseases diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1935-2735
- Volume :
- 11
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- PLoS neglected tropical diseases
- Publication Type :
- Academic Journal
- Accession number :
- 28369056
- Full Text :
- https://doi.org/10.1371/journal.pntd.0005417