RESUMEN
BACKGROUND: Acute schistosomiasis is a systemic hypersensitivity reaction against the migrating schistosomula and eggs. In this report, we describe an atypical outbreak of the disease with severe cases. Transmission occurred in a nonendemic area of Brazil, which became a new focus of transmission due to the in-migration of infected workers. METHODS: From December 2009 to March 2010, the 50 patients with acute schistosomiasis (group 1) bathed in a swimming pool supplied by a brook on a country estate in the outskirts of São João del Rei, Brazil. Thirty other subjects (group 2) living in the same area, who denied having contact with the swimming pool, volunteered to participate in the study. All participants were submitted to clinical, laboratory, and ultrasound examinations. RESULTS: Five of 50 (10%) patients were admitted to the hospital: 1 with myeloradiculopathy, 1 with diffuse pulmonary micronodules, and 3 with diarrhea and dehydration. All 5 had hypereosinophilia and prolonged fever. Group 1 patients more frequently had cercarial dermatitis (P = .01), blood in the stool (P = .04), and intra-abdominal lymph nodes (P = .001). All group 1 patients were treated with praziquantel; 1 patient with myeloradiculopathy also received oral prednisone (60 mg/day) for 6 months with complete recovery. CONCLUSIONS: This report describes the first time that patients from an outbreak of acute schistosomiasis have been compared to controls. Five subjects (10%) had severe manifestations of schistosomiasis. Diagnosis of the disease and its severity was delayed because physicians did not consider that an epidemic of schistosomiasis might emerge in a nonendemic area.
Asunto(s)
Brotes de Enfermedades , Schistosoma mansoni/aislamiento & purificación , Esquistosomiasis mansoni/epidemiología , Esquistosomiasis mansoni/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Antihelmínticos/uso terapéutico , Brasil/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Praziquantel/uso terapéutico , Esquistosomiasis mansoni/transmisión , Resultado del Tratamiento , Adulto JovenRESUMEN
We report the findings of abdominal ultrasound and magnetic resonance imaging observed in a patient with advanced schistosomiasis mansoni. A 25-year-old man with hepatosplenic schistosomiasis and variceal bleeding confirmed by upper endoscopy was submitted to abdominal ultrasound and magnetic resonance imaging. During surgery for portal hypertension, a liver biopsy was taken and the diagnosis of Symmers' fibrosis was confirmed. magnetic resonance imaging scans gave more precise information about the gallbladder, periportal thickening and abdominal venous system than did the ultrasound.
Asunto(s)
Várices Esofágicas y Gástricas/diagnóstico , Parasitosis Hepáticas/diagnóstico , Esquistosomiasis mansoni/diagnóstico , Enfermedades del Bazo/diagnóstico , Adulto , Animales , Várices Esofágicas y Gástricas/parasitología , Várices Esofágicas y Gástricas/cirugía , Humanos , Parasitosis Hepáticas/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Esquistosomiasis mansoni/complicaciones , Esquistosomiasis mansoni/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Enfermedades del Bazo/diagnóstico por imagen , Enfermedades del Bazo/parasitología , UltrasonografíaAsunto(s)
Enfermedades Pulmonares Parasitarias/parasitología , Derrame Pleural/parasitología , Esquistosomiasis mansoni/complicaciones , Enfermedad Aguda , Adulto , Animales , Antihelmínticos/uso terapéutico , Femenino , Humanos , Enfermedades Pulmonares Parasitarias/diagnóstico , Enfermedades Pulmonares Parasitarias/tratamiento farmacológico , Derrame Pleural/diagnóstico , Derrame Pleural/tratamiento farmacológico , Praziquantel/uso terapéutico , Prednisona/uso terapéutico , Schistosoma mansoni/aislamiento & purificación , Esquistosomiasis mansoni/diagnóstico , Esquistosomiasis mansoni/tratamiento farmacológicoRESUMEN
INTRODUCTION: There is no study relating magnetic resonance imaging (MRI) to ultrasound (US) findings in patients with Schistosomiasis mansoni. Our aim was to describe MRI findings inpatients with schistosomal liver disease identified by US. METHODS: Fifty-four patients (mean age 41.6±13.5years) from an area endemic for Schistosomiasis mansoni were selected for this study.All had US indicating liver schistosomal fibrosis and were evaluated with MRI performed witha 1.5-T superconducting magnet unit (Sigma). RESULTS: Forty-seven (87%) of the 54 patientsshowing signs of periportal fibrosis identified through US investigation had confirmed diagnosesby MRI. In the seven discordant cases (13%), MRI revealed fat tissue filling in the hilar periportalspace where US indicated isolated thickening around the main portal vein at its point of entryto the liver. We named this the fatty hilum sign. One of the 47 patients with MRI evidence ofperiportal fibrosis had had his gallbladder removed previously. Thirty-five (76.1%) of the other46 patients had an expanded gallbladder fossa filled with fat tissue, whereas MRI of the remainingeleven showed pericholecystic signs of fibrosis. CONCLUSIONS: Echogenic thickening of thegallbladder wall and of the main portal vein wall heretofore attributed to fibrosis were frequentlyidentified as fat tissue in MRI. However, the gallbladder wall thickening shown in US (expandedgallbladder fossa in MRI) is probably secondary to combined hepatic morphologic changes inschistosomiasis, representing severe liver involvement.
Asunto(s)
Parasitosis Hepáticas/diagnóstico por imagen , Parasitosis Hepáticas/patología , Esquistosomiasis mansoni/diagnóstico por imagen , Esquistosomiasis mansoni/patología , Adulto , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Ultrasonografía , Adulto JovenAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Toxoplasmosis Cerebral/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Toxoplasmosis Cerebral/tratamiento farmacológicoAsunto(s)
Cryptococcus neoformans/aislamiento & purificación , Meningitis Criptocócica , Meningoencefalitis , Nódulo Pulmonar Solitario , Adulto , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Seronegatividad para VIH , Humanos , Huésped Inmunocomprometido , Masculino , Meningitis Criptocócica/complicaciones , Meningitis Criptocócica/tratamiento farmacológico , Meningoencefalitis/complicaciones , Meningoencefalitis/tratamiento farmacológico , Recurrencia , Nódulo Pulmonar Solitario/complicaciones , Nódulo Pulmonar Solitario/tratamiento farmacológicoRESUMEN
Over the last 20 years a great advance has been observed in many aspects of medicine, and the advent of novel imaging techniques is certainly amongst the most important. In schistosomiasis these new methods caused a revolution in the definition of the clinical forms of the disease and in the evaluation of its complications, such as, liver fibrosis, pulmonary hypertension and neuroschistosomiasis, as never before. Herein we present an overview of the image methods used to diagnose schistosomiasis mansoni nowadays.