Agreement between magnetic resonance imaging and ultrasonography in the classification of schistosomal periportal fibrosis, according to Niamey's criteria

OBJECTIVE: To evaluate the reproducibility of magnetic resonance imaging and the agreement between ultrasound and magnetic resonance imaging in the classification of periportal fibrosis in patients with schistosomiasis based on Niamey's qualitative criteria. MATERIALS AND METHODS: A prospective, double-blinded study was conducted between February 2005 and June 2006 with 20 patients (10 men and 10 women, with ages ranging between 24 and 60 years, mean age 42.7 years) diagnosed with schistosomiasis mansoni. Both ultrasound and magnetic resonance images were independently evaluated by two experienced observers. Interobserver agreement was evaluated for findings of periportal fibrosis on magnetic resonance images and in a comparison between magnetic resonance and ultrasound images. RESULTS: The analysis of magnetic resonance images showed total interobserver agreement in 14 patients (70%). The comparison between ultrasound and magnetic resonance imaging showed agreement between images in only six cases (30%) by observer 1, and in eight cases (40%) by observer 2. CONCLUSION: Magnetic resonance imaging presents a good reproducibility in the evaluation of periportal fibrosis in later stages of schistosomiasis, however, the correlation between magnetic resonance imaging and ultrasound is poor.OBJETIVO: Avaliar a reprodutibilidade da ressonância magnética e a concordância entre a ultra-sonografia e a ressonância magnética na classificação da fibrose periportal em pacientes esquistossomóticos, segundo os critérios qualitativos de Niamey. MATERIAIS E MÉTODOS: Foi realizado estudo prospectivo e duplo-cego, entre fevereiro de 2005 e junho de 2006, em 20 pacientes (10 homens e 10 mulheres, idades entre 24 e 60 anos, média de 42,75 anos) com diagnóstico de esquistossomose mansônica. As imagens de ultra-sonografia e de ressonância magnética foram avaliadas por dois examinadores experientes de forma independente. Foi medida a concordância interobservador para a ressonância magnética e entre a ressonância magnética e a ultra-sonografia. RESULTADOS: A ressonância magnética apresentou resultados concordantes entre os observadores em 14 pacientes (70%). Quando comparamos a ressonância magnética com a ultra-sonografia, obtivemos concordância em apenas seis pacientes pelo observador 1 (30%) e em oito pacientes pelo observador 2 (40%). CONCLUSÃO: A ressonância magnética tem boa reprodutibilidade na avaliação de fibrose periportal em pacientes com esquistossomose avançada, porém sua concordância com a ultra-sonografia é fraca.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por ImagemUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de GastroenterologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de Diagnóstico por ImagemUNIFESP, EPM, Depto. de GastroenterologiaUNIFESP, EPM, Depto. de MedicinaSciEL

The role of point-of-care ultrasound in the assessment of schistosomiasis-induced liver fibrosis: a systematic scoping review

Background Abdominal ultrasound imaging is an important method for hepatic schistosomiasis diagnosis and staging. Several ultrasound staging systems have been proposed, each attempting to standardise schistosomal periportal fibrosis (PPF) diagnosis. This review aims to establish the role of ultrasound in the diagnosis and staging of schistosomal PPF, and to map the evolution of ultrasound staging systems over time, focusing on internal validation and external reproducibility. Methods A systematic search was undertaken on 21st December 2022 considering the following databases: PubMed/MEDLINE (1946-present), Embase (1974-present), Global Health (1973-present), Global Index Medicus (1901-present), and Web of Science Core Collection–Science Citation Index Expanded (1900-present) and the Cochrane Central Register of Controlled Trials (1996-present). Case reports, systematic reviews and meta-analyses, and studies exclusively using transient or shear-wave elastography were excluded. Variables extracted included study design, study population, schistosomal PPF characteristics, and diagnostic methods. The PRISMA-ScR (2018) guidelines were followed to inform the structure of the scoping analysis. Results The initial search yielded 573 unique articles, of which 168 were removed after screening titles and abstracts, 43 were not retrieved due to full texts not being available online or through inter-library loans, and 170 were excluded during full text review. There were 192 remaining studies eligible for extraction. Of the extracted studies, 61.8% (76/123) of studies that reported study year were conducted after the year 2000. Over half of all extracted studies (59.4%; 114/192) were conducted in Brazil (26.0%; 50/192), China (18.8%; 36/192) or Egypt (14.6%; 28/192). For the species of schistosome considered, 77.6% (149/192) of studies considered S. mansoni and 21.4% (41/192) of studies considered S. japonicum. The ultrasound staging systems used took on three forms: measurement-based, feature-based and image pattern-based. The Niamey protocol, a measurement and image pattern-based system, was the most used among the staging systems (32.8%; 63/192), despite being the most recently proposed in 1996. The second most used was the Cairo protocol (20.8%; 40/192). Of the studies using the Niamey protocol, 77.8% (49/63) only used the image patterns element. Where ultrasound technology was specified, studies after 2000 were more likely to use convex transducers (43.4%; 33/76) than studies conducted before 2000 (32.7%; 16/49). Reporting on ultrasound-based hepatic diagnoses and their association with clinical severity was poor. Just over half of studies (56.2%; 108/192) reported the personnel acquiring the ultrasound images. A small number (9.4%; 18/192) of studies detailed their methods of image quality assurance, and 13.0% (25/192) referenced, discussed or quantified the inter- or intra-observer variation of the staging system that was used. Conclusions The exclusive use of the image patterns in many studies despite lack of specific acquisition guidance, the increasing number of studies over time that conduct ultrasound staging of schistosomal PPF, and the advances in ultrasound technology used since 2000 all indicate a need to consider an update to the Niamey protocol. The protocol update should simplify and prioritise what is to be assessed, advise on who is to conduct the ultrasound examination, and procedures for improved standardisation and external reproducibility

A role for peroxisome proliferator-activated receptors in the immunopathology of schistosomiasis?

Peroxisome proliferator-activated receptors (PPARs) have been demonstrated to have a role in immune regulation. In general, they are anti-inflammatory and promote Th2 type responses, and they are associated with the alternative activation of macrophages. Interestingly, helminth infections, such as the schistosome blood flukes that cause schistosomiasis, are characterised by a Th2 response and the accumulation of alternative activated macrophages. This would suggest that at some level, PPARs could have a role in the modulation of the immune response in schistosomiasis. This paper discusses possible areas where PPARs could have a role in this disease

Granulomatous-like immune reaction and hepatic fibrosis induced by Schistosoma haematobium immature worms

Golden hamsters were inoculated with Schistosoma haematobium cercariae to examine histological lesions at different time points over an 18 month period of infection. Hamsters were sacrificed 26 weeks and 82 weeks after inoculation. The parasite was found in the blood and in the liver of infected animals as was expected, but we found exclusively male worms, no female worms nor eggs. Interestingly we observed unexpected hepatic lesions induced by S. haematobium immature male worms alone in the golden hamster, characteristic of schistosome eggs. Samples from liver, kidneys, lungs, bladder and gastrointestinal tract were collected during necropsy to evaluate injuries induced by S. haematobium. Notably we observed hepatitis in the liver of infected hamsters, no lesions were found in other organs. We also found liver fibrosis in infected hamsters. This study provides further experimental evidence for the role that schistosome worms, and their derived antigens, may play in the pathology of the infection and modulation of liver chronic inflammation in the murine model of schistosomiasis

Chemokine responses in schistosomal antigen-elicited granuloma formation *

Host immune systems have evolved specialized responses to multicellular parasites. This is well represented by the type 2 granulomatous response to Schistosoma mansoni egg antigens, which is an eosinophil-rich inflammatory response mediated by Th2-associated cytokines. Using Ag-bead models of pulmonary granuloma formation in mice, we defined characteristic chemokine (CK) profiles in the granulomatous lungs. Our findings point to a role for C-C chemokine receptor-2 (CCR2) and CCR3 agonists such as monocyte chemotactic proteins (MCPs) 1/CCL2, 3/CCL7 and 5/CCL12 as important participants that are subject to regulation by Th2 cytokines interleukin (IL)-4 and IL-13. CCR4 and CCR8 agonists are also likely contributors. Analysis of CK receptor knockout mice revealed that CCR2 ligands (e.g. MCP-1 and 5) promoted early phase granuloma macrophage accumulation, whereas anti-MCP-3 (CCL7) antibody treatment abrogated eosinophil recruitment. CCR8 knockout mice also demonstrated impaired eosinophil recruitment but this appeared to be related to impaired Th2 cell function. Transcript analysis of CD4 + T cells generated during schistosome granuloma formation failed to show biased CCR8 expression but, having a more limited receptor repertoire, these cells were likely more dependent on CCR8 ligands. Together, these studies indicate an intricate involvement of chemokines in various stages and aspects of schistosomal egg Ag-elicited granuloma formation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74858/1/j.1365-3024.2002.00466.x.pd

Interleukin 6 (IL6) as a predictor outcome in patients with compensated cirrhosis and symptomatic gall stones after cholecystectomy

Compensated cirrhosis means that the liver is heavily scarred but can still perform many important functions; many peoples with compensated cirrhosis have gall bladder stones. The advantages of laparoscopic cholecystectomy (LC) for most patients have been extensively published. However its benefits and successful use in patients with cirrhosis are less documented. The study compromised 50 patients with symptomatic gallstone in compensated liver disease and undergone either open cholecystectomy (OC) or laparoscopic cholecystectomy. These patients were randomized into two groups: Group I included 24 patients who underwent OC, and group II included 26 patients who underwent LC. Patient’s age, sex, clinical presentation and Child-Turcotte-Pugh (CTP) class were documented. No patients in this study had CTP class c cirrhosis. IL-6 was measured by ELISA, postoperative pain (measured by Visual analog scale), hospital stay, blood loss, recovery time (return to work), and liver function tests were documented. IL-6 was significantly lowered at 6th hour and 12th hour post operative in LC group. Mean surgical time was significantly longer in OC than LC group, (mean ±SD, 96.6 ±32 vs 58.7 ± 23.8 min, P = 0.037). No patients in group II required any blood replacement in contrast to 9 patients (37.5%) in group I. Intraoperative bleeding remained significantly higher in group I (P = 0.043). No patients in group II had wound complications compared with 5 patients (29.14%) in group I. Group I had significantly longer hospital stay than group II, mean 9.0+ 1.3 days (median 7) vs 2.3 days + 1.9 (median 2.5); P = 0.001. Our results were demonstrated that laparoscopic cholecystectomy can be performed safely in patients with CTP class A and B cirrhosis. IL-6 was more significantly, increased post operatively in open cholecystectomy than laparoscopic one and it correlated well with intensity of operative trauma. Keywords: Interleukin 6; Liver cirrhosis; Cholecystectom