12 research outputs found
Abscessos piogĂȘnicos e doenças parasitĂĄrias
Parasitic diseases which during their course in the host switch the immune system from a T helper 1 to a T helper 2 response may be detrimental to the host, contributing to granuloma formation, eosinophilia, hyper-IgE, and increased susceptibility to bacterial and fungal infections. Patients and animals with acute schistosomiasis and hyper-IgE in their serum develop pyogenic liver abscess in the presence of bacteremia caused by Staphylococcus aureus. The Salmonella-S. mansoni association has also been well documented. The association of tropical pyomyositis (pyogenic muscle abscess) and pyogenic liver abscess with Toxocara infection has recently been described in the same context. In tropical countries that may be an interesting explanation for the great morbidity of bacterial diseases. If the association of parasitic infections and pyogenic abscesses and/or fungal diseases are confirmed, there will be a strong case in favor of universal treatment for parasitic diseases to prevent or decrease the morbidity of superinfection with bacteria and fungi.As doenças parasitĂĄrias que durante a sua evolução no hospedeiro provocam mudança de uma resposta imune Th1 para uma resposta Th2 podem tornar-se prejudiciais ao hospedeiro, contribuindo para a formação de granulomas, eosinofilia, hiper-IgE, e suscetibilidade aumentada a infecçÔes bacterianas e fĂșngicas. Demonstrou-se recentemente que animais e pacientes com esquistossomose aguda desenvolvem abscessos hepĂĄticos piogĂȘnicos na presença de bacteriemia por Staphylococcus aureus. A associação da esquistossomose com bactĂ©rias do gĂȘnero Salmonella tambĂ©m encontra-se bem documentada. A infecção por Toxocara tambĂ©m parece predispor o hospedeiro a piomiosite tropical (abscesso muscular piogĂȘnico) e abscesso piogĂȘnico do fĂgado. Nos paĂses tropicais essa poderia ser uma explicação para a maior morbidade das doenças bacterianas. Se a associação de doenças parasitĂĄrias e infecçÔes bacterianas e fĂșngicas for confirmada sobrarĂŁo argumentos favorĂĄveis ao tratamento universal das doenças parasitĂĄrias com o objetivo de prevenir ou diminuir a morbidade dessas infecçÔes
Splenic palpation for the evaluation of morbidity due to Schistosomiasis mansoni
This study was undertaken to determine the accuracy of splenic
palpation for the diagnosis of splenomegaly, and to determine whether
the frequency of individuals with a palpable spleen in an endemic area
can be considered as an index of morbidity of schistosomiasis. For the
clinical diagnosis of splenomegaly, two criteria have been tested: (A)
presence of a palpable spleen and (B) presence of a palpable spleen
whose border could be felt more than 4 cm below the costal margin. In
an area of high prevalence of the disease (66.3%) 285 individuals aged
18 years or more have been submitted to abdominal ultrasonography and
physical examination. Splenomegaly was defined as a splenic length
greater than 120 mm by ultrasound and the sensitivity, specificity,
positive and negative predictive values of criterion A were 72.2%,
90.5%, 35.1% and 97.8%. The values for criterion B were 27.8%, 98%, 50%
and 95%, respectively. In an non endemic area, 517 individuals were
submitted to the same protocol and 22 individuals had a palpable
spleen, but no patient fulfilled criterion B for splenomegaly, and only
one met the ultrasonographic criterion for splenomegaly. The authors
concluded that abdominal palpation is a poor method for the diagnosis
of splenomegaly
Splenic palpation for the evaluation of morbidity due to Schistosomiasis mansoni
This study was undertaken to determine the accuracy of splenic
palpation for the diagnosis of splenomegaly, and to determine whether
the frequency of individuals with a palpable spleen in an endemic area
can be considered as an index of morbidity of schistosomiasis. For the
clinical diagnosis of splenomegaly, two criteria have been tested: (A)
presence of a palpable spleen and (B) presence of a palpable spleen
whose border could be felt more than 4 cm below the costal margin. In
an area of high prevalence of the disease (66.3%) 285 individuals aged
18 years or more have been submitted to abdominal ultrasonography and
physical examination. Splenomegaly was defined as a splenic length
greater than 120 mm by ultrasound and the sensitivity, specificity,
positive and negative predictive values of criterion A were 72.2%,
90.5%, 35.1% and 97.8%. The values for criterion B were 27.8%, 98%, 50%
and 95%, respectively. In an non endemic area, 517 individuals were
submitted to the same protocol and 22 individuals had a palpable
spleen, but no patient fulfilled criterion B for splenomegaly, and only
one met the ultrasonographic criterion for splenomegaly. The authors
concluded that abdominal palpation is a poor method for the diagnosis
of splenomegaly
Schistosomal myeloradiculopathy due to Schistosoma mansoni: report on 23 cases
Schistosoma mansoni  infection is likely to be responsible for
a significant proportion of cases of myelopathy occurring in areas
where schistosomiasis is endemic. The aim of this study is to describe
the clinical, laboratory and therapeutic data of 23 patients with
schistosomal myeloradiculopathy. The medical records of 23 patients
with schistosomal myelopathy admitted to two general hospitals of Belo
Horizonte (MG), in Brazil, from 1995 to 1999, were reviewed
retrospectively. Seventeen patients were male (74%). The mean age for
the whole group was 27 years. Lower limb weakness and associated lumbar
and/or lower limb pain were reported by 20 patients (87%), and 16 (70%)
were unable to walk. All individuals presented urinary retention and 19
(83%) complained of intestinal dysfunction. The treatment was based on
the association of antischistosomal drugs and corticosteroids. Five
patients (22%) presented a full response to treatment, 13 (57%) partial
response without functional limitations and 4 (17%) partial improvement
with limitations or no response. Three out of the 4 patients who
stopped steroids before 45 days of treatment developed recurrence of
the symptoms and signs of myelopathy. Our cases demonstrate the severe
presentation of the disease and the data disclosed here suggest that
treatment with steroids should be kept for months after clinical
improvement
Hepatosplenic Schistosomiasis in Field-based Studies: a Combined Clinical and Sonographic Definition
A combined clinical and sonographic classification of hepatosplenic
schistosomiasis mansoni to be used in field-based studies is proposed
herein. Seven hundred forty one individuals out of 892 (83%), living in
an area endemic for schistosomiasis in Brazil, have been ubmitted to
clinical and ultrasound examinations. Based on two stool examinations
the overall prevalence for schistosomiasis in this area was 73%.
Abdominal palpation was performed with patients in dorsal decubit,
during deep breath, by two experienced physicians and a portable
ultrasound was used for the evaluation of liver fibrosis, portal
collaterals and spleen size. Four groups of individuals were identified
using data obtained by abdominal palpation and ultrasound examination:
(1) palpable spleen and intense periportal thickening in 9 individuals
(1.2%); (2) spleen not palpable and intense periportal thickening in 15
(2%); (3) palpable spleen with light to moderate periportal thickening
in 32 (4.3%), and (4) palpable spleen with a normal liver on ultrasound
in 30 (4%). The definition of hepatosplenic schistosomiasis in
field-based studies as the finding of Schistosoma mansoni eggs in the
stools in an individual with splenomegaly is not acceptable anymore.
Abdominal ultrasound should be combined with clinical examination to
accurately identify hepatosplenics in endemic areas for schistosomiasi
Schistosomiasis and Associated Infections
In hospital-based series viral hepatitis B has been frequently
described in association with schistosomiasis whilst in field-based
studies the association has not been confirmed. The association between
schistosomiasis and Salmonella bacteraemia has been well documented.
More recently, acute schistosomiasis has been shown to be a
facilitating factor in the genesis of pyogenic liver abscesses caused
by Staphylococcus aureus. New evidences indicate an interaction between
the acquired immunodeficiency syndrome (AIDS) and schistosomiasis. In
this paper, data on the association of schistosomiasis with other
infections are updated