Receptor Antagonist of IL-13 Exerts a Potential Negative Regulation During Early Infection of Human Schistosomiasis.

The pathology of schistosomiasis is associated with the formation of granulomas, and this process is associated with liver fibrosis. Studies indicate that Th1 cytokines reduce fibrosis in schistosomiasis, while Th2 cytokines play a part in the progression of fibrosis, and IL-13 has a critical role in this process. The IL-13Rα2 receptor, known as a 'receptor antagonist' binds with high affinity to IL-13, and studies have identified that this plays a part in reducing fibrosis and the size of granulomas. The objective of this study was to evaluate the function of IL-13Rα2 and cellular immune response in hepatic fibrosis. A negative correlation between IL-13Rα2 and IL-13 was found, suggesting an increase in cytokine in early fibrosis. Initially, a negative correlation between IFN-γ and IL-13 was found in patients without fibrosis, and subsequently, this correlation was found to be positive in patients with severe fibrosis, thereby highlighting a new mechanism for regulating the progress of periportal fibrosis. There was a positive correlation between the profiles of Th1 and Th2 cytokines, suggesting the presence of both responses, thus regulating the disease. The results contribute to a better understanding of the immune mechanisms that control the process of hepatic fibrogenesis in schistosomiasis in humans.

Splenosis after splenectomy and spleen tissue autoimplantation: Late followup study.

AIM: In children suffering from severe hepatosplenic schistosomiasis, the surgical protocol includes splenectomy and autoimplantation of spleen morsels in the major omentum, which has the potential of reducing the overwhelming postsplenectomy infection (OPSI). The purpose of the study was to evaluate the remaining splenosis, with the mean postoperative followup of 12.1 ± 5.6 years; to compare the efficacy of the 2 evaluation tools. MATERIALS AND METHODS: Nineteen patients underwent, when they were children, portal decompression and autoimplantation of spleen. After a mean age of 23.4 ± 5.3 years, they were investigated regarding the number of infections and OPSI. They had undergone hepatosplenic scintigraphy with labeled colloidal SnTc(99m) and abdominal ultrasound. It was considered efficient splenosis when the patients presented with 5 or more spleen nodules. The evaluation was performed by 3 observers. RESULTS: None of the patients had increased infection rate or developed OPSI. Sixteen (84.2%) presented efficient splenosis. CONCLUSIONS: The remaining postoperative splenosis was considered efficient in the majority of patients in the long-term followup; and nuclear medicine was considered the gold standard for splenosis evaluation.

Prevalence of pulmonary hypertension in patients with schistosomal liver fibrosis.

Between the April and July of 2007, patients undergoing treatment for schistosomal liver fibrosis, at a university hospital in north-eastern Brazil, were examined by transthoracic Doppler echocardiography (TTE). The main aim was to determine the prevalence of pulmonary hypertension in the patients. The thorax of each patient who had such hypertension, as indicated by an estimated pulmonary arterial systolic pressure (PASP) in excess of 35 mmHg, was then investigated by contrast-enhanced multidetector-row computed tomography (MDCT). The 84 patients (53 women and 31 men) enrolled in the study had a mean (S.D.) age of 50.06 (12.25) years. Nine (10.7%, with a 95% confidence interval of 5.0%-19.4%) of the patients were found to have pulmonary hypertension, with PASP ranging from 40-126 mmHg, and a median (S.D.) PASP of 58.78 (28.01) mmHg. The contrast-enhanced thoracic MDCT indicated that most of the patients with pulmonary hypertension had a pulmonary artery trunk that was unusually wide (67%) and more than 1.1-fold wider than the ascending aorta (56%), dilatation of the main pulmonary arteries (100%), a segmental artery that, in diameter, was more than 1.1-fold larger than the adjacent bronchi (89%), tapering of the peripheral pulmonary arteries (78%), and cardiac enlargement (78%). No patient suffered pulmonary embolism as a result of the investigations. The prevalence of pulmonary hypertension in the patients with schistosomal liver fibrosis (10.7%) justifies the screening of such patients by TTE.

Gastropatia da hipertensão portal na esquistossomse manônica: associação com helicobater pylori / Mansonica esquistosomiasis portal hypertensive gastropathy: association with helicobater pylori

O povo brasileiro, principalmente no nordeste, em razão da pobre condição socio-economico, está exposta a infecção pelo shistosoma mansoni e pelo H. pylori, o que justifica em estabelecer as repercussões desta associação na mucosa gástrica. Foram incluídos na presente investigação 80 pacientes com sintomas dispéticos. Os pacientes foram investigados por meio de ultra-sonografia de abdome, endoscopia do trato digestivo superior com biópsia da mucosa gástrica para o teste da urese e coloração pelo giemsa. No grupo I, ocorreu gastropatia hpipertensiva portal em 84por cento, com padrão mosaico em 72por cento, sendo leve em 71 por cento e grave em 29por cento. A alterações mais graves foram encontradas no segmento gástrico proximal. erosões gástricas antrais foram encontradas em 72 por cento o que sugere a necessidade de adaptar uma classificação própria para a gastropatia hipertensiva na esquistossomose mansônica. Helicobater pylori foi encontrado em 40por cento dos pacientes no grupo I, e em 69por cento no grupo II. Nos pacientes em que ocorreu associação de gastropatia hipertensiva e infecção pelo H. Pylori, foram observadas alterações histopatológicas peculiares como: infiltrado polimorfonuclear em 91por cento e agregado linfocitário em 27por cento,úlcera duodenal em 9por cento e úlcera gástrica em 3por cento. Os resultados da presente investigação sugere que a gastropatia hipertenseiva portal na esquistossomose pode modificar a mucosa gástrica tornando-a menos dusceptível à infecção pela H. pylori. Por outro lado quando ocorre a associação da infecção pele H. pylori e esquistossomose, apesar de não influenciar fundamentalmente na patogênese da gastropatia da hipertensão portal, pode reproduzir as caracteristicas endoscópicas da infecção pelo H. Pylori