Schistosomiasis of liver graft as a differential diagnosis of abnormal liver tests after transplantation: report of two cases

Schistosomiasis is a major health problem that affects over 200 million people worldwide. There are few reports of Schistosoma mansoni found in liver transplants as well as scarce information about the course of the disease and the long-term effects on the graft. Herein, we report two cases of schistosomiasis in liver transplant recipients who presented abnormal serum liver enzymes, with evidence of gradual improvement after antiparasitic treatment. Furthermore, we discuss the possible role of screening the parasite infection in potential liver transplant recipients from endemic areas

A real-life study on the impact of direct-acting antivirals in the treatment of chronic hepatitis C in liver transplant recipients at two university centers in Northeastern Brazil

The efficacy of direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C (CHC) in liver transplant recipients is poorly understood, and several factors, including immunosuppression, drug interactions, elevated viraemia, and intolerance to ribavirin (RBV), can reduce cure rates. We conducted a real-life study on liver transplant recipients with CHC treated with a combination of sofosbuvir (SOF) and daclatasvir (DCV) or simeprevir (SIM), with or without RBV, followed-up for 12 to 24 weeks. The treatment effectiveness was assessed by determining the sustained virological response (SVR) rates at 12 or 24 weeks after the treatment cessation. Eighty-four patients were evaluated, with a mean age of 63.4 ± 7.4 years, HCV genotype 1 being the most prevalent (63.1%). Nineteen patients (22.7%) had mild fibrosis (METAVIR < F2) and 41 (48.8%) significant fibrosis (METAVIR ≥ F2). The average time between liver transplantation and the start of treatment was 4 years (2.1-6.6 years). The SOF + DCV regimen was used in 58 patients (69%). RBV in combination with DAAs was used in seven patients (8.3%). SVR was achieved in 82 patients (97.6%), and few relevant adverse events could be attributed to DAA therapy, including a patient who stopped treatment due to a headache. There was a significant reduction in ALT, AST, GGT and FA levels, or the APRI index after 4 weeks of treatment, which remained until 12/24 weeks post-treatment. DAA treatment of CHC in liver-transplanted patients achieved a high SVR rate and resulted in the normalization of serum levels of liver enzymes

Diagnosis of coinfection by schistosomiasis and viral hepatitis B or C using 1H NMR-based metabonomics.

Diagnosis of liver involvement due to schistosomiasis in asymptomatic patients from endemic areas previously diagnosed with chronic hepatitis B (HBV) or C (HCV) and periportal fibrosis is challenging. H-1 Nuclear Magnetic Resonance (NMR)-based metabonomics strategy is a powerful tool for providing a profile of endogenous metabolites of low molecular weight in biofluids in a non-invasive way. The aim of this study was to diagnose periportal fibrosis due to schistosomiasis mansoni in patients with chronic HBV or HCV infection through NMR-based metabonomics models.The study included 40 patients divided into two groups: (i) 18 coinfected patients with schistosomiasis mansoni and HBV or HCV; and (ii) 22 HBV or HCV monoinfected patients. The serum samples were analyzed through H-1 NMR spectroscopy and the models were based on Principal Component Analysis (PCA) and Partial Least Squares-Discriminant Analysis (PLS-DA). Ultrasonography examination was used to ascertain the diagnosis of periportal fibrosis. Exploratory analysis showed a clear separation between coinfected and monoinfected samples. The supervised model built from PLS-DA showed accuracy, R2 and Q2 values equal to 100%, 98.1% and 97.5%, respectively. According to the variable importance in the projection plot, lactate serum levels were higher in the coinfected group, while the signals attributed to HDL serum cholesterol were more intense in the monoinfected group.The metabonomics models constructed in this study are promising as an alternative tool for diagnosis of periportal fibrosis by schistosomiasis in patients with chronic HBV or HCV infection from endemic areas for Schistosoma mansoni

Results from PLS-DA modeling.

<p>(A) Permutation test statistic at 2000 permutations with observed statistic of the model prediction accuracy with <i>p</i> < 0.0005. (B) VIP scores from the metabonomics model using two components. The boxes on the right represent the relative integral of the corresponding bin in each group (monoinfection and coinfection).</p

Results from PLS-DA modeling.

<p>(A) Permutation test statistic at 2000 permutations with observed statistic of the model prediction accuracy with <i>p</i> < 0.0005. (B) VIP scores from the metabonomics model using two components. The boxes on the right represent the relative integral of the corresponding bin in each group (monoinfection and coinfection).</p

Results from PLS-DA modeling.

<p>(A) Scores scatter plot discriminating among coinfected and monoinfected patients. (B) The optimal number of PLS-DA components, according to the squared correlation coefficient (R²), the predictive ability (Q²), and the accuracy of the model; the asterisk indicates the best number of components based on accuracy of the model.</p

General aspects of the production and management systems and their relationship with Corynebacterium pseudotuberculosis infection and occurrence of mastitis of white Morada Nova sheep herds in semi-arid region

This study aimed to characterize the production and management systems of white Morada Nova sheep herds and to present data on the occurrence of caseous lymphadenitis (CLA) and clinical mastitis (CM) in a population maintained in a semi-arid region. Blood samples were collected from adult females from herds of the Brazilian northeastern region. The first venous blood sample was used for a complete blood examination. The second blood sample was used to detect the presence of anti-C. pseudotuberculosis specific antibodies. The production and management systems of the herds were characterized using questionnaires, divided into three blocks of indicators: Facilities; Characterization of the production system; Health management. Body weight and hematological results were submitted to an analysis of variance, on which the fixed effect was clinical diagnosis, and the principal component analysis was performed to determine the main variables. For CLA, three herds stood out as having the highest rates of seropositivity (85.71, 79.41 and 60.45%). The same herds also had the highest occurrences of CM (9.30, 8.82 and 5.71%). The main variables that showed differences according the diagnosis of both diseases were blood granulocytes and lymphocytes. The study made it possible to observe the relationship between the best sanitary practices and the lowest occurrence rates of both CLA and CM. The diseases present considerable occurrence in sheep populations

Liver ultrasound elastography for the evaluation of periportal fibrosis in schistosomiasis mansoni: A cross-sectional study.

BackgroundARFI elastrography has been used as a noninvasive method to assess the severity of liver fibrosis in viral hepatitis, although with few studies in schistosomiasis mansoni. We aimed to evaluate the performance of point shear wave elastography (pSWE) for predicting significant periportal fibrosis (PPF) in schistosomotic patients and to determine its best cutoff point.Methodology/principal findingsThis cross-sectional study included 358 adult schistosomotic patients subjected to US and pSWE on the right lobe. Two hundred two patients (62.0%) were women, with a median age of 54 (ranging 18-92) years. The pSWE measurements were compared to the US patterns of PPF, as gold standard, according to the Niamey classification. The performance of pSWE was calculated as the area under the ROC curve (AUC). Patients were further classified into two groups: 86 patients with mild PPF and 272 patients with significant PPF. The median pSWE of the significant fibrosis group was higher (1.40 m/s) than that of mild fibrosis group (1.14 m/s, p1.39 m/s, with specificity of 86.1% and positive predictive value of 92.0%.Conclusions/significancepSWE was able to differentiate significant from mild PPF, with better performance to predict significant PPF

Clinical and laboratory characteristics of the coinfected (n = 18) and monoinfected groups (n = 22).

<p>Clinical and laboratory characteristics of the coinfected (n = 18) and monoinfected groups (n = 22).</p

Results from PCA modeling.

<p>(A) PCA scores of coinfected patients and monoinfected patients. (B) Loading scatter plot of PC1 versus PC2, explaining 80.7% of variance.</p