Sonographic and hemodynamic findings of schistosomiasis mansoni: doppler sonography assessment in endemic areas

OBJETIVO: Este estudo de campo objetivou identificar as alterações ultrassonográficas e hemodinâmicas indicativas da morbidade da esquistossomose mansônica em áreas endêmicas. MATERIAIS E MÉTODOS: Foram examinados pela ultrassonografia Doppler 554 pacientes esquistossomóticos em três áreas com níveis distintos de endemicidade: baixa endemicidade (n = 109); média endemicidade (n = 255) e alta endemicidade (n = 190). Para o estudo ultrassonográfico foi utilizado o protocolo da Organização Mundial da Saúde (Niamey Working Group, 2000). Pelo Doppler foram avaliados: vasos portais, artérias hepática e esplênica, veias hepáticas e vasos colaterais. RESULTADOS: Houve correlação significativa entre a frequência das alterações ultrassonográficas e o nível de endemicidade das áreas, exceto a hipertrofia do lobo esquerdo. As veias hepáticas apresentaram padrão de fluxo alterado em 23,7% dos casos, alteração esta relacionada à presença e à intensidade de espessamento periportal. A artéria hepática não apresentou alterações nos parâmetros avaliados. Os vasos colaterais foram identificados apenas na área de alta endemicidade. A artéria esplênica apresentou alterações (aumento do calibre, da velocidade e do índice de resistência) mais frequentes na área de alta endemicidade, com diferença significativa entre os grupos. CONCLUSÃO: A ultrassonografia Doppler mostrou-se ferramenta auxiliar importante no estudo da morbidade relacionada à esquistossomose mansônica, contribuindo para definição mais precisa do perfil da doença nas áreas endêmicas.OBJECTIVE: The present field research was aimed at identifying sonographic and hemodynamic findings indicative of the presence of schistosomiasis mansoni in endemic areas. MATERIALS AND METHODS: Doppler sonography was performed in 554 patients with schistosomiasis in three areas with different endemicity levels: low (n = 109), medium (n = 255) and high endemicity (n = 190). The World Health Organization (Niamey Working Group, 2000) protocol was adopted for sonographic evaluation. Doppler study included portal vessels, hepatic and splenic arteries, hepatic veins and collateral vessels. RESULTS: A significant correlation was observed between the frequency of sonographic findings, except for left lobe hypertrophy, and the areas endemicity levels. Altered hepatic veins flow pattern was observed in 23.7% of cases, such abnormality being related to the presence and intensity of periportal thickening. Hepatic arteries did not present any alteration as related to the evaluated parameters. Collateral vessels were identified only in the patients from the high-endemicity area. The splenic artery presented alterations (increase in caliber, flow velocity and resistive index), most frequently in the high-endemicity area, with significant difference between groups. CONCLUSION: Doppler sonography has shown to be a relevant auxiliary tool in the study of the morbidity related to schistosomiasis mansoni, contributing for a more accurate description of the disease profile in endemic areas

Parásitos intestinales ¿Cuáles tratar y cuáles no?

En países en vías de desarrollo, la mala calidad del agua para el consumo, la pobre higiene y poco saneamiento ambiental, facilitan la adquisición de múltiples patógenos entre ellos parásitos intestinales. Las infecciones causadas por helmintos y protozoos intestinales forman parte de las enfermedades tropicales desatendidas y representan un importante problema de salud pública en el mundo. En niños, las parasitosis intestinales pueden causar retraso en el desarrollo cognitivo y del rendimiento escolar, retraso en el crecimiento y malnutrición, e incapacidad crónica en adultos; a largo plazo, las parasitosis intestinales pueden transformarse en un obstáculo para el desarrollo social y económico de la población afectada. En ocasiones las personas con altas cargas parasitarias o con alteraciones en su sistema inmune pueden presentar síntomas graves y hasta fallecer a consecuencia de una infección parasitaria. Por ello la importancia de recordar cuáles parasitosis deben ser tratadas y cuáles no

LA TRANSMISIÓN ORAL EN LA ENFERMEDAD DE CHAGAS

La Enfermedad de Chagas se transmite al hombre por varios mecanismos participando en algunos, el vector de maneradirecta ó indirecta. En otras ocasiones, la transmisión de hombre a hombre ocurre a través de transfusiones, trasplantesde órganos y transplacentaria, y menos frecuente por la manipulación de tejidos, líquidos de animales infectados ó accidentesde laboratorio. La transmisión oral por contaminación de alimentos con el contenido intestinal de triatominos infectadoscon Trypanosoma cruzi ha sido un mecanismo demostrado experimentalmente en animales. Esta particular vía, probablementela más común entre los animales silvestres, asociado a la constitución bioquímica de los aislados, ha sidoresponsable de numerosos brotes en Brasil. En Venezuela se han descrito cuatro episodios desde 2007 con 228 casos y 6fallecimientos. Las medidas de vigilancia epidemiológica y control sanitario deben basarse en el estudio del comportamiento de los vectores, identificación de factores de riesgo y la concientización del personal de salud y autoridades sanitarias de que es una modalidad de transmisión de T cruzi por alimentos, definitivamente demostrada en VenezuelaABSTRACT: Chagas Disease is transmitted to humans through various mechanisms in which the vector directly or indirectly can participate.In other circumstances, infection from man to man occurs through blood transfusions, organ transplants and transplacentalthrough food contamination with the intestinal content of triatomines infected with Trypanosoma cruzi has been demonstratedexperimentally in animals. This particular way, probably the most common among wild animals, will depend on the biochemicalconstitution of the isolates and it has been responsible for numerous outbreaks in Brazil. In Venezuela, four episodeshave been reported since 2007 with 228 cases and 6 deaths. The measures of surveillance and disease control by the health authoritiesshould by based on the study of the behaivor of the vectors, identification of the main risk factors for the human population and awereness of the health staff and health authorities, that this way of transmission is definitely establishedin Venezuela

Comparison between clinical and ultrasonographic findings in cases of periportal fibrosis in an endemic area for schistosomiasis mansoni in Brazil

INTRODUCTION: Abdominal palpation and ultrasound findings among patients from an endemic area for schistosomiasis in Brazil who had been followed up for 27 years were compared. METHODS: In 2004, 411 patients from Brejo do Espírito Santo, in the State of Bahia, were selected for the present investigation after giving their written informed consent. Based on clinical data, they were divided into three groups: 41 patients with evidence of liver fibrosis in 2004 (Group 1); 102 patients with evidence of liver fibrosis in the past (1976-1989) but not in 2004 (Group 2); and 268 patients without evidence of liver fibrosis at any time during the 27-year follow-up (Group 3). All of the patients underwent abdominal ultrasound in which the examiner did not know the result from the clinical examination. The data were stored in a database. RESULTS: The prevalence of periportal fibrosis on ultrasound was 82.9%, 56.9% and 13.4% in Groups 1, 2 and 3, respectively. In the presence of hard, nodular liver or prominent left lobe and a hard palpable spleen, ultrasound revealed periportal fibrosis in 70.9%. However, periportal fibrosis was diagnosed using ultrasound in 25.4% of the patients in the absence of clinical evidence of liver involvement. Thus, ultrasound diagnosed periportal fibrosis 3.1 times more frequently than clinical examination did. CONCLUSIONS: Although clinical examination is important in evaluating morbidity due to Manson's schistosomiasis in endemic areas, ultrasound is more accurate in diagnosing liver involvement and periportal fibrosis